The Veterans Affairs Department doesn't know whether it has enough staff at its medical facilities to give veterans the quality care they need, failing to comply with a decade-old law despite several prior warnings, the agency's internal watchdog has concluded.
A January 2002 law "mandated that VA establish a nationwide policy to ensure medical facilities have adequate staff to provide appropriate, high-quality care and services" but the agency "did not have an effective staffing methodology to ensure appropriate staffing levels for specialty care services," the VA inspector general reported Thursday.
Specifically, inspectors found that the Veterans Health Administration (VHA) hadn't developed staffing guidelines for 31 of its specialty care services.
"As a result, VHA’s lack of productivity standards and staffing plans limit the ability of medical facility officials to make informed business decisions on the appropriate number of specialty physicians to meet patient care needs, such as access and quality of care," the report said.
The critical review comes at a time when many veterans are facing growing delays to receive their medical treatment. The Washington Guardian previously reported that wait times at some medical centers are reaching 10 hours.
The VA's Under Secretary for Health agreed with the report's recommendations and promised the department would work to implement staffing guidelines.
"Even though this will be a complicated task, VHA understands the importance of measuring our effectiveness and productivity in achieving all of these missions," Undersecretary Robert Petzel said. "Medical facility officials need reliable and accurate data to improve their ability to make informed business decisions on the appropriate number of specialty physicians to meet patient care needs, such as access and quality of care."
The agency's internal watchdog dismissed some of the excuses VA has offered for its failure to comply with the law, pointedly noting warnings about inadequate staffing measures dated back to Ronald Reagan's first year in office.
"The need for VHA to develop a staffing methodology is not a recent issue," the inspector general said. "In 1981, the Government Accountability Office (GAO) recommended that VHA develop a methodology to measure physician productivity. Since then, six VA OIG and GAO reports have made similar recommendations."
Staffing levels have led to many problems with treatment, investigators said. At one medical facility, the work equivalent of one full-time employee provided infectious disease care to 316 patients.
The IG report is the latest in a long line to highlight problems and create contrasts with the rosier assessments that VA Secretary Eric K. Shinseki has given the public and Congress about his agency's efforts.
"We hold ourselves to the same high standards of performance that the Nation and its Veterans do," Shinseki wrote Congress less than two months ago in forwarding his annual evaluation report to lawmakers. "Every VA employee is charged to be an advocate for Veterans. We are all committed to providing Veterans and their families with the very best healthcare and services."
The IG report, however, found disputes were getting in the way of solutiions.
The VHA wants to develop guidelines, but according to the IG, disagreements over how to evaluate staffing levels and the effectiveness of current staff are preventing any definitive guidelines from being drawn up.
The IG acknowledged the difficulties, but said standards have been delayed too much already.
"We recognize the challenge in establishing standards for all specialties," investigators said. "But VHA needs to initiate a plan by the end of FY 2013 that ensures all specialty care services have productivity standards within 3 years."