Characteristics and Services of the Community-Based Programs

Most veterans receive home health care services from community-based providers through either VA’s fee-based program or Medicare’s home health care benefit. Most veterans in this program receive short-term home health care services to address acute medical conditions, such as hip fractures or surgical wounds. HBHC program costs are based on data developed by the hospitals that support the programs. Since VA reports the costs of its programs differently, VA hospital officials are left to make decisions on whether or not to have an HBHC program based on their perceptions of the relative cost of HBHC and fee-based programs. Quality Assurance Approaches for VA Programs and Medicare

VA monitors the quality of care provided by its home health care programs, but it is more directly involved in monitoring the care its own employees provide, through HBHC, than the care delivered by community-based providers. Licensing and certification assessments of community-based providers conducted by independent organizations provide VA some assurance that veterans in the fee-based program and those covered by Medicare’s home health care benefit receive care from qualified home health care providers. Observations

Because VA’s home health care programs provide different arrays of services to veterans who generally have different home health care needs and because consistent program cost data are not available, it is difficult to compare the relative costs of VA’s methods of meeting veterans’ home health care needs. A recorded menu will provide information on how to obtain these lists.
Why GAO Did This Study

Pursuant to a congressional request, GAO provided information on how the Department of Veterans Affairs (VA) meets veterans' home health care needs, focusing on: (1) the characteristics and services of the home health care programs VA uses; (2) the available data describing program costs; and (3) how VA ensures that veterans receive quality home care services.

What GAO Found

GAO found that: (1) most veterans receive home health care services from community-based providers through either the VA fee-based program or Medicare's home health care benefit; (2) most veterans in these programs receive short-term home health care services for acute medical conditions, while some veterans receive long-term care for chronic conditions; (3) VA provides in-home physician, nursing, social work, and dietician services to veterans with chronic conditions through its Hospital-Based Home Care (HBHC) program; (4) VA makes decisions about using HBHC programs based on its perception of relative costs, since comparable cost data are not available; (5) HBHC program costs are based on data developed by hospitals that support the programs, while VA reported fee-based program costs represent payments made to providers and exclude certain administrative costs; (6) VA monitors the quality of care provided by HBHC programs more directly than it does community-based care; and (7) licensing and certification assessments of community-based providers provide VA assurance that care is provided by qualified sources, but VA is ultimately responsible for ensuring the quality of care in its programs.