In addition to health care, VA provides disability benefits to those veterans  with service-connected conditions. Many Veterans Travel Too Far for Hospital Admissions and Specialty Consultations

The substantial increase in VA health care delivery locations has enhanced  access for enrolled veterans in need of primary care, although many still  travel long distances for primary care. Shifting the delivery of health care closer to where  veterans live may have significant ramifications for other stakeholders,  such as medical schools. Specifically, VA’s current projections of  acute health care workload indicate a surge in demand for acute health  care services over the next 10 years. VA intended to address veterans’ access to nursing home care as part of its  larger CARES initiative to project future health care needs and determine  how to ensure equitable access. Capital Assets Not Well- Aligned to Meet Veterans’ Needs

VA has a large and aged infrastructure, which is not well aligned to  efficiently meet veterans’ needs. VA faces difficult challenges when attempting to improve service delivery  efficiencies. VA also faces difficult decisions concerning the need for and sizing of  capital investments, especially in locations where future workload may  increase over the short term before steadily declining. In fact, we identified federal real property management as a high-risk  area in January 2003. Patient Support Services Could Be Provided More Efficiently

As VA continues to transform itself from an inpatient- to an outpatient- based health care system, it must find more efficient, systemwide ways of  providing patient care support services, such as consolidation of services  and the use of competitive sourcing. Until VA  completes these assessments and takes action to reduce costs, it may be  paying more for inpatient food services than required and as a result have  fewer resources available for the provision of health care to veterans. Fundamental Changes Could Improve Effectiveness of VA’s Disability Programs

Significant program design and management challenges hinder VA’s ability  to provide meaningful and timely support to disabled veterans and their  families. Moreover, advances in medicine and technology have reduced the severity  of some medical conditions and allowed individuals to live with greater  independence and function more effectively in work settings. VA’s disability program challenges are not unique. VA Is Trying to Improve the Quality and Timeliness of Claims Processing

Even if VA brought its disability criteria up to date, it would continue to  face challenges in ensuring quality and timely decisions, including  ensuring that veterans get consistent decisions—that is, comparable  decisions on benefit entitlement and rating percentage—regardless of the  regional office making the decisions. VA is not alone in facing these challenges; SSA is also challenged  to improve its ability to provide accurate, consistent, and timely disability  decisions to program applicants. VA  proposed such a consolidation in 1995 and in that proposal enumerated  several potential benefits, such as allowing VA to assign the most  experienced and productive adjudication officers and directors to the  consolidated offices; facilitating increased specialization and as-needed  expert consultation in deciding complex cases; improving the  completeness of claims development, the accuracy and consistency of  rating decisions, and the clarity of decision explanations; improving  overall adjudication quality by increasing the pool of experience and  expertise in critical technical areas; and facilitating consistency in  decisionmaking through fewer consolidated claims-processing centers. Major Management Challenges and Program Risks: Department of  Veterans Affairs. VA Health Care: VA Is Struggling to Address Asset Realignment  Challenges. VA Disability Compensation: Disability Ratings May Not Reflect  Veterans’ Economic Losses.
Why GAO Did This Study

In previous GAO reports and testimonies on the Department of Veterans Affairs (VA), and in its ongoing reviews, GAO identified major management challenges related to enhancing access to health care, improving the efficiency of health care delivery, and improving the effectiveness of disability programs. This testimony underscores the importance of continuing to make progress in addressing these challenges and ultimately overcoming them.

What GAO Found

VA has taken actions to address key challenges in its health care and disability programs. However, growing demand for health care and a potentially larger and more complex disability workload may make VA's challenges in these areas more complex. Enhancing access to health care: VA is challenged to deliver timely, convenient health care to its enrolled veteran population. Too many veterans continue to travel too far and wait too long for care. However, shifting care closer to where veterans live is complicated by stakeholder interests. In addition, VA's efforts to reduce waiting times may be complicated by an anticipated short-term surge in demand for specialty outpatient care. VA also faces difficult challenges in providing equitable access to nursing home care services to a growing elderly veteran population. Improving the efficiency of health care delivery: VA is challenged to find more efficient ways to meet veterans' demand for health care. VA operates a large portfolio of aged buildings that is not well aligned to efficiently meet veterans' needs. As a result, VA faces difficult realignment decisions involving capital investments, consolidations, closures, and contracting with local providers. VA also faces challenges in implementing management changes to improve the efficiency of patient support services, such as food and laundry services. Improving the effectiveness of disability programs: VA is challenged to find more effective ways to compensate veterans with disabilities. VA's outdated disability determination process does not reflect a current view of the relationship between impairments and work capacity. Advances in medicine and technology have allowed some individuals with disabilities to live more independently and work more effectively. VA also faces continuing challenges to improve the timeliness, quality and consistency of claims processing. Major improvements may require fundamental program changes. GAO designated federal real property, including VA health care infrastructure, and federal disability programs, including VA disability benefits, as high-risk areas in January 2003. GAO did this to draw attention to the need for broad-based transformation in these areas, which is critical to improving the government's performance and ensuring accountability within expected resource limits.