Government and Regulations

VA Commits to Improving Health Care Provider Efficiency

Carolyn Clancy responds to a GAO report that criticized the VA’s performance metrics.


The VA is working to implement Government Accountability Office (GAO) recommendations on improving efficiency and reporting of health care providers, according to Carolyn Clancy, MD, deputy under secretary for organizational excellence at the VHA. Dr. Clancy told members of the House Committee on Veterans’ Affairs that the “VA concurred with GAO’s recommendations and is already working to complete them.”

In July 2017, the GAO issued the report “Improvements Needed in Data and Monitoring of Clinical Productivity and Efficiency.” The report found that “VA’s productivity metrics and efficiency models may not provide complete and accurate information on provider productivity and VAMC efficiency.” Based on its findings, the GAO recommended that the “VA develop a policy requiring VAMCs to monitor and improve clinical inefficiency through a standard process, such as establishing performance standards based on VA’s efficiency models, and develop remediation plans for addressing clinical inefficiencies.” The GAO also made 4 specific recommendations:

  1. Expand existing productivity metrics to track the productivity of all providers of care to veterans, including contract physicians and some advanced practice providers;
  2. Ensure the accuracy of underlying staffing and workload data by, training all providers on coding clinical procedures;
  3. Create a policy for all VAMCs to monitor and improve clinical efficiency by establishing performance standards based on VA’s efficiency models and developing a remediation plan for addressing clinical inefficiency; and
  4. Establish an ongoing process to systematically review VAMCs and ensure that VAMCs and VISNs are implementing those plans and addressing low clinical productivity and inefficiency.

In her testimony, Dr. Clancy took pains to reassure the House committee that she agreed with the GAO recommendations. “VA appreciates our colleagues at GAO’s efforts and the efforts of others to improve clinical efficiency and productivity,” she told the panel. “Mr. Chairman, I am proud of the health care our employees provide to our nation’s veterans. Together with Congress, I look forward to making sure that VA will be a good steward of taxpayer dollars while providing this care in a productive and efficient manner.”

Dr. Clancy explained to the Committee that the VA will expand the use of some of its measures, such as the Specialty Productivity-Access Report and Quadrant (SPARQ) tool. In addition, Dr. Clancy pledged that the VA would take up training in clinical coding for health care providers as well as an effort to improve the efficiency of specialty providers. “We have also undertaken a comprehensive education and communication plan about the specialty physician productivity and staffing standards,” she told the committee. “Our specialty physicians are committed to demonstrating and improving specialty productivity and access.”

In addition, Dr. Clancy insisted that plans to improve clinical efficiency must be developed at each VAMC and that remediation plans would be tracked at both the facility and VISN. The central office will “review the progress VAMCs are making on the remediation plans for addressing low clinical productivity twice a year with the VISN,” she said. The expected completion date for this will be March 2018.

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