October 18, 2021

News

News Network

Defense Health Care: Efforts to Ensure Beneficiaries Access Specialty Care and Receive Timely and Effective Care

18 min read
<div>The Department of Defense (DOD) has a general expectation that its health care beneficiaries, upon receiving an urgent referral to see a specialist, will access that specialty care in 3 days or less. GAO's analysis of 16,754 urgent referrals at military treatment facilities (MTF) shows that DOD beneficiaries accessed specialty care services in 3 days or less for more than half of the urgent referrals. About 9 percent of the urgent referrals involved beneficiaries waiting 3 weeks or longer to be seen. According to DOD officials, some beneficiaries may have waited longer than 3 days due to factors such as patient preference, appointment availability, or waiting for lab results. Time to access care varied by specialty, with beneficiaries urgently referred to ophthalmology generally seeing a specialist the fastest, and those urgently referred to mental health and oncology generally waiting the longest. According to DOD officials, MTFs are responsible for monitoring beneficiaries' access to specialty care through urgent referrals. GAO found that the monitoring processes used varied by MTF and specialty care clinic at the five selected MTFs that GAO reviewed. For example, officials from one MTF told GAO they centrally manage all urgent referrals using a daily report to address any delays, while officials from another MTF told GAO that individual specialty care clinics are responsible for managing their own urgent referrals. DOD officials acknowledged such variation and MTFs have been directed to centralize their referral management and monitoring processes—an effort that is currently underway. GAO found that DOD monitors the rates at which beneficiaries receive timely and effective care, in part, through 10 outpatient health care quality measures. These measures allow DOD to make comparisons to civilian health care systems, and they are reviewed by various DOD groups at least quarterly. However, DOD officials told GAO that since October 2017, they have been unable to monitor nine of the 10 measures for MTFs using Military Health System (MHS) Genesis, DOD's new electronic health record system. According to the officials, DOD's current data warehouse—a system that stores some MHS Genesis data and can be used by MTFs to create reports on quality measures—is not capable of producing accurate reports for those measures. DOD officials told GAO they expect to implement a new data warehouse by the end of 2020. DOD officials also said they are importing data related to quality measures into another system used for quality monitoring; however, DOD does not have a targeted date for completing these data imports. Until these actions are fully implemented, groups responsible for monitoring quality care will continue to lack the data needed to offer assurance that the growing number of MTFs using MHS Genesis are providing beneficiaries with timely and effective care that will lead to better health outcomes. A draft of this report recommended that DOD establish a timeline to complete importing the quality measure-related data from MHS Genesis into DOD's system used for quality monitoring. In its review of the draft, DOD concurred with the recommendation and established a timeline for importing the data, to be available in DOD's system no later than May 2021. After reviewing the information DOD provided, GAO removed the recommendation from the final report. DOD is responsible for ensuring that beneficiaries have access to specialty care for conditions that, while not life-threatening, require immediate attention, as well as for ensuring that beneficiaries receive timely and effective care for certain routine or other services. A report accompanying the National Defense Authorization Act for Fiscal Year 2020 included a provision for GAO to review the quality of health care in the MHS. This report examines (1) the timeliness with which beneficiaries access specialty care at MTFs through urgent referrals and DOD's efforts to monitor access, and (2) DOD's use of quality measures to monitor and improve the rates of timely and effective care received by beneficiaries at MTFs. GAO examined relevant policies, national DOD referral data (a total of 16,754 urgent referrals) for a 1-year period ending August 2019, and the most recent available quality measure data (April 2020). GAO interviewed officials from five MTFs, selected for variation in military services, geography, provision of select specialty services, and use of the electronic health record system. For more information, contact Debra A. Draper at (202) 512-7114 or draperd@gao.gov.</div>

What GAO Found

The Department of Defense (DOD) has a general expectation that its health care beneficiaries, upon receiving an urgent referral to see a specialist, will access that specialty care in 3 days or less. GAO’s analysis of 16,754 urgent referrals at military treatment facilities (MTF) shows that DOD beneficiaries accessed specialty care services in 3 days or less for more than half of the urgent referrals. About 9 percent of the urgent referrals involved beneficiaries waiting 3 weeks or longer to be seen. According to DOD officials, some beneficiaries may have waited longer than 3 days due to factors such as patient preference, appointment availability, or waiting for lab results. Time to access care varied by specialty, with beneficiaries urgently referred to ophthalmology generally seeing a specialist the fastest, and those urgently referred to mental health and oncology generally waiting the longest.

According to DOD officials, MTFs are responsible for monitoring beneficiaries’ access to specialty care through urgent referrals. GAO found that the monitoring processes used varied by MTF and specialty care clinic at the five selected MTFs that GAO reviewed. For example, officials from one MTF told GAO they centrally manage all urgent referrals using a daily report to address any delays, while officials from another MTF told GAO that individual specialty care clinics are responsible for managing their own urgent referrals. DOD officials acknowledged such variation and MTFs have been directed to centralize their referral management and monitoring processes—an effort that is currently underway.

GAO found that DOD monitors the rates at which beneficiaries receive timely and effective care, in part, through 10 outpatient health care quality measures. These measures allow DOD to make comparisons to civilian health care systems, and they are reviewed by various DOD groups at least quarterly. However, DOD officials told GAO that since October 2017, they have been unable to monitor nine of the 10 measures for MTFs using Military Health System (MHS) Genesis, DOD’s new electronic health record system. According to the officials, DOD’s current data warehouse—a system that stores some MHS Genesis data and can be used by MTFs to create reports on quality measures—is not capable of producing accurate reports for those measures. DOD officials told GAO they expect to implement a new data warehouse by the end of 2020. DOD officials also said they are importing data related to quality measures into another system used for quality monitoring; however, DOD does not have a targeted date for completing these data imports.

Until these actions are fully implemented, groups responsible for monitoring quality care will continue to lack the data needed to offer assurance that the growing number of MTFs using MHS Genesis are providing beneficiaries with timely and effective care that will lead to better health outcomes. A draft of this report recommended that DOD establish a timeline to complete importing the quality measure-related data from MHS Genesis into DOD’s system used for quality monitoring. In its review of the draft, DOD concurred with the recommendation and established a timeline for importing the data, to be available in DOD’s system no later than May 2021. After reviewing the information DOD provided, GAO removed the recommendation from the final report.

Why GAO Did This Study

DOD is responsible for ensuring that beneficiaries have access to specialty care for conditions that, while not life-threatening, require immediate attention, as well as for ensuring that beneficiaries receive timely and effective care for certain routine or other services.

A report accompanying the National Defense Authorization Act for Fiscal Year 2020 included a provision for GAO to review the quality of health care in the MHS. This report examines (1) the timeliness with which beneficiaries access specialty care at MTFs through urgent referrals and DOD’s efforts to monitor access, and (2) DOD’s use of quality measures to monitor and improve the rates of timely and effective care received by beneficiaries at MTFs.

GAO examined relevant policies, national DOD referral data (a total of 16,754 urgent referrals) for a 1-year period ending August 2019, and the most recent available quality measure data (April 2020). GAO interviewed officials from five MTFs, selected for variation in military services, geography, provision of select specialty services, and use of the electronic health record system.

For more information, contact Debra A. Draper at (202) 512-7114 or draperd@gao.gov.

More from:

News Network

  • Vermont Man Pleads Guilty to Hiring A Person to Kidnap and Kill an Individual in a Foreign Country and Child Pornography Charges
    In Crime News
    A Vermont man pleaded guilty today to hiring a woman in Venezuela to kidnap an adult male and make a video of the man being beaten, tortured, and suffocated to death, and to conspiracy to produce child pornography and possession of child pornography.
    [Read More…]
  • Information Technology and Cybersecurity: Significant Attention Is Needed to Address High-Risk Areas
    In U.S GAO News
    What GAO Found In its March 2021 high-risk series update, GAO reported that significant attention was needed to improve the federal government's management of information technology (IT) acquisitions and operations, and ensure the nation's cybersecurity. Regarding management of IT, overall progress in addressing this area has remained unchanged. Since 2019, GAO has emphasized that the Office of Management and Budget (OMB) and covered federal agencies need to continue to fully implement critical requirements of federal IT acquisition reform legislation, known as the Federal Information Technology Acquisition Reform Act (FITARA), to better manage tens of billions of dollars in IT investments. For example: OMB continued to demonstrate leadership commitment by issuing guidance to implement FITARA statutory provisions, but sustained leadership and expanded capacity were needed to improve agencies' management of IT. Agencies continued to make progress with reporting FITARA milestones and plans to modernize or replace obsolete IT investments, but significant work remained to complete these efforts. Agencies improved the involvement of their agency Chief Information Officers in the acquisition process, but greater cost savings could be achieved if IT acquisition shortcomings, such as reducing duplicative IT contracts, were addressed. In March 2021, GAO reiterated the need for agencies to address four major cybersecurity challenges facing the nation: (1) establishing a comprehensive cybersecurity strategy and performing effective oversight, (2) securing federal systems and information, (3) protecting cyber critical infrastructure, and (4) protecting privacy and sensitive data. GAO identified 10 actions for agencies to take to address these challenges. However, since 2019, progress in this area has regressed—GAO's 2021 rating of leadership commitment declined from met to partially met. To help address the leadership vacuum, in January 2021, Congress enacted a statute establishing the Office of the National Cyber Director. Although the director position has not yet been filled, on April 12 the President announced his intended nominee. Overall, the federal government needs to move with a greater sense of urgency to fully address cybersecurity challenges. In particular: Develop and execute a more comprehensive federal strategy for national cybersecurity and global cyberspace. In September 2020, GAO reported that the cyber strategy and implementation plan addressed some, but not all, of the desirable characteristics of national strategies, such as goals and resources needed. Mitigate global supply chain risks. In December 2020, GAO reported that few of the 23 civilian federal agencies it reviewed implemented foundational practices for managing information and communication technology supply chain risks. Enhance the federal response to cyber incidents. In July 2019, GAO reported that most of 16 selected federal agencies had deficiencies in at least one of the activities associated with incident response processes. Why GAO Did This Study The effective management and protection of IT has been a longstanding challenge in the federal government. Each year, the federal government spends more than $100 billion on IT and cyber-related investments; however, many of these investments have failed or performed poorly and often have suffered from ineffective management. Accordingly, GAO added improving the management of IT acquisitions and operations as a high-risk area in February 2015. Information security has been on the high-risk area since 1997. In its March 2021 high-risk update, GAO reported that significant actions were required to address IT acquisitions and operations. Further, GAO noted the urgent need for agencies to take 10 specific actions on four major cybersecurity challenges. GAO was asked to testify on federal agencies' efforts to address the management of IT and cybersecurity. For this testimony, GAO relied primarily on its March 2021 high-risk update and selected prior work across IT and cybersecurity topics.
    [Read More…]
  • Secretary Blinken’s Call with Tajikistan Foreign Minister Muhriddin
    In Crime Control and Security News
    Office of the [Read More…]
  • Spitzer Telescope Reveals the Precise Timing of a Black Hole Dance
    In Space
    The recently retired [Read More…]
  • 5 Hidden Gems Are Riding Aboard NASA’s Perseverance Rover
    In Space
    The symbols, mottos, and [Read More…]
  • Secretary Antony J. Blinken at the International Women of Courage (IWOC) Awards Ceremony
    In Crime Control and Security News
    Antony J. Blinken, [Read More…]
  • Armenian Independence Day
    In Crime Control and Security News
    Antony J. Blinken, [Read More…]
  • Nuclear Weapons: NNSA Plans to Modernize Critical Depleted Uranium Capabilities and Improve Program Management
    In U.S GAO News
    The Department of Energy's (DOE) National Nuclear Security Administration (NNSA) is taking steps to establish a new supply of high-purity depleted uranium (DU) to modernize the nuclear weapons stockpile. DU for fabrication of weapons components must be in high-purity metal form. Producing DU metal generally involves first converting a byproduct of uranium enrichment, known as “tails,” into a salt “feedstock,” which is then converted into metal. (See figure.) To reestablish a supply of feedstock, NNSA plans to install conversion equipment in an existing facility at DOE's Portsmouth site in Ohio. DOE initially estimated costs of $12 million to $18 million to design and install the equipment, with operations beginning in fiscal year 2022. However, in March 2020, NNSA requested an increase in conversion capacity, and an updated proposal in July 2020 estimated costs of $38 million to $48 million and a slight delay to the start of operations. NNSA plans to convert the feedstock into DU metal using a commercial vendor at a cost of about $27 million annually. Conversion of a Byproduct of Uranium Enrichment into Metal NNSA is also taking steps to reestablish and modernize DU component manufacturing capabilities, but it risks delays that could affect the timelines of nuclear stockpile modernization programs, according to officials. NNSA has reestablished processes for manufacturing some DU components but not for components made with a DU-niobium alloy, a material for which NNSA has no alternative. Thus, restarting the alloying process—a complicated, resource-intensive process that has not been done in over a decade—is NNSA's top priority for DU and presents a very high risk to timely supply of components for certain nuclear stockpile modernization programs, according to NNSA documents and officials. NNSA is also developing more efficient manufacturing technologies, in part because the current alloyed component process wastes a very high percentage of the materials and NNSA cannot recycle the waste. For its DU activities, NNSA has requested an increase in funding from about $61 million in fiscal year 2020 to about $131 million in fiscal year 2021. Until recently, NNSA had not managed DU activities as a coherent program in a manner fully consistent with NNSA program management policies. Since October 2019, however, NNSA has taken actions to improve program management. For example, NNSA has consolidated management and funding sources for DU activities under a new office and DU Modernization program with the goal of better coordinating across the nuclear security enterprise. Further, NNSA appointed two dedicated Federal Program Managers to gather and organize information for required program management and planning documents. High-purity DU is an important strategic material for ongoing and planned modernizations of the nation's nuclear weapons stockpile. However, according to NNSA estimates, NNSA has a very limited supply of DU feedstock, and its current supply of DU metal will be exhausted in the late 2020s. NNSA also does not have the full range of capabilities needed to manufacture DU into weapon components needed for modernizing the stockpile. GAO has previously reported that NNSA has experienced challenges in restarting some technical manufacturing processes. A Senate committee report accompanying a bill for the National Defense Authorization Act for Fiscal Year 2017 included a provision for GAO to examine NNSA's management of DU for nuclear stockpile modernization. GAO's report examines (1) the status of NNSA's efforts to obtain the necessary quantities of DU to meet stockpile modernization requirements; (2) the status of NNSA efforts to develop DU component manufacturing capabilities to meet stockpile modernization requirements; and (3) the extent to which NNSA is managing DU activities as a program, consistent with agency policy. GAO reviewed relevant agency documents; interviewed NNSA officials and contractor representatives; and conducted site visits at headquarters and at research, development, and production locations. For more information, contact Allison Bawden at (202) 512-3841 or bawdena@gao.gov.
    [Read More…]
  • Stabilization and Reconstruction: Actions Needed to Improve Governmentwide Planning and Capabilities for Future Operations
    In U.S GAO News
    The United States has become increasingly involved in stabilization and reconstruction operations as evidenced in the Balkans, Haiti, Somalia, Iraq, and Afghanistan. In December 2005, the President issued National Security Presidential Directive 44, establishing governmentwide policy for coordinating, planning, and implementing U.S. stabilization and reconstruction assistance to affected foreign entities. This testimony addresses stabilization and reconstruction issues related to (1) State Department (State) efforts to improve interagency planning and coordination, (2) Department of Defense (DOD) efforts to enhance its capabilities and planning, and (3) State efforts to develop civilian capabilities. GAO's statement is based on its May 2007 report on DOD stability operations and preliminary observations related to State's interagency planning framework and civilian response capabilities.State and DOD have begun to take steps to better coordinate stabilization and reconstruction activities, but several significant challenges may hinder their ability to integrate planning for potential operations and strengthen military and civilian capabilities to conduct them. State's Office of the Coordinator for Reconstruction and Stabilization is developing a framework for U.S. agencies to use when planning stabilization and reconstruction operations, but the framework has yet to be fully applied to any operation. The National Security Council has not approved the entire framework, guidance related to the framework is unclear, and some interagency partners have not accepted it. For example, some interagency partners stated that the framework's planning process is cumbersome and too time consuming for the results it produces. While steps have been taken to address concerns and strengthen the framework's effectiveness, differences in planning capacities and procedures among U.S. government agencies may pose obstacles to effective coordination. DOD has taken several positive steps to improve its ability to conduct stability operations but faces challenges in developing capabilities and measures of effectiveness, integrating the contributions of non-DOD agencies into military contingency plans, and incorporating lessons learned from past operations into future plans. These challenges, if not addressed, may hinder DOD's ability to fully coordinate and integrate stabilization and reconstruction activities with other agencies or to develop the full range of capabilities those operations may require. Among its many efforts, DOD has developed a new policy, planning construct and joint operating concept with a greater focus on stability operations, and each service is pursuing efforts to improve capabilities. However, inadequate guidance, practices that inhibit sharing of planning information with non-DOD organizations, and differences in the planning capabilities and capacities of DOD and non-DOD organizations hinder the effectiveness of these improvement efforts. Since 2005, State has been developing three civilian corps to deploy rapidly to international crises, but significant challenges must be addressed before they will be fully capable. State and other agencies face challenges in establishing two of these units--the Active Response Corps and Standby Response Corps--because of staffing and resource constraints and concerns that stabilization and reconstruction operations are not core missions for each parent organization. Congress has not yet enacted legislation necessary for State to obligate funds for the third unit, the Civilian Reserve Corps, staffed solely with non-federal volunteers. Further, State has not fully defined the types of missions these personnel would be deployed to support.
    [Read More…]
  • Patient Recruiter Convicted in $2.8 Million Telemedicine Scheme Against Medicare
    In Crime News
    The owner of an Orlando-area telemarketing call center was convicted for his role in a kickback scheme involving expensive genetic tests and fraudulent telemedicine services that resulted in the payment of approximately $2.8 million in false and fraudulent claims to Medicare.
    [Read More…]
  • Secretary Blinken’s Call with Ghanaian Foreign Minister Botchwey
    In Crime Control and Security News
    Office of the [Read More…]
  • Removal Order Upheld Against Tennessee Man Who Served as Nazi Concentration Camp Guard During WWII
    In Crime News
    The Board of Immigration Appeals (BIA) has dismissed the appeal of Tennessee resident Friedrich Karl Berger, a German citizen who was ordered removed from the United States earlier this year on the basis of his service in Nazi Germany in 1945 as an armed guard of concentration camp prisoners in the Neuengamme Concentration Camp system (Neuengamme).
    [Read More…]
  • On the Occasion of World Humanitarian Day
    In Crime Control and Security News
    Antony J. Blinken, [Read More…]
  • Tax Cuts and Jobs Act: Future Rulemaking Should Provide Greater Detail on Paperwork Burden and Economic Effects of International Business Provisions
    In U.S GAO News
    What GAO Found GAO's interviews with officials representing eight selected U.S.-based companies revealed considerable uncertainty in how the international business provisions of Public Law 115-97—commonly known as the Tax Cuts and Jobs Act of 2017 (TCJA)—may be affecting business planning decisions. Some companies reported making specific changes, such as moving intellectual property back to the U.S. in response to a new deduction for income earned from certain foreign-derived sales of property or services attributed to assets located in the U.S. Preliminary studies on another provision taxing net income earned by foreign subsidiaries exceeding a specified threshold of certain assets hypothesized that this provision could encourage moving tangible property outside the U.S. Other business representatives emphasized the importance of nontax factors in business planning decisions, such as entering foreign markets where executives believe potential customers may be located. The Department of the Treasury (Treasury) and the Internal Revenue Service (IRS) proposed eight regulations and finalized six of them to implement four international provisions of TCJA between December 2017 and October 2020 (the most current information available at the time of GAO's review) and used guidance to supplement the regulations. The agency generally complied with legal requirements for issuing regulations and offered public comment opportunities for some guidance. However, Treasury and IRS did not fully address expectations set in government-wide guidance related to Paperwork Reduction Act (PRA) burden estimates, economic analysis requirements for regulations, and public comment on significant guidance: IRS generally did not provide specific estimates of the incremental paperwork burden of TCJA's international regulations and instead estimated the total burden for all business tax forms. The Office of Information and Regulatory Affairs' PRA guide says agencies should estimate the time and money required for an information collection. GAO's interviews with representatives of selected companies show why it is important for IRS to consider burden because representatives reported challenges, such as gathering required information from foreign subsidiaries. Anticipated economic benefits and costs of Treasury's and IRS's regulations were generally not quantified. An executive order requires agencies to provide such information to the extent feasible for regulations with the largest anticipated economic effects. As a result, Treasury and IRS made important decisions about regulations, such as whether to allow foreign military sales to be eligible for a U.S. deduction, without more specific information about the potential economic effects. IRS did not provide an opportunity for public comment before issuing revenue procedures related to TCJA's international provisions. The Office of Management and Budget identified ensuring public comment opportunities for significant guidance when appropriate as a leading practice that agencies should follow. The President recently directed a government-wide review of agency guidance processes. Why GAO Did This Study TCJA made sweeping changes to taxing U.S. corporations' international activities: (1) a transition tax on untaxed overseas earnings of foreign subsidiaries that accrued prior to 2017; (2) a tax on the net income earned by foreign subsidiaries exceeding a specified threshold of certain assets; (3) a deduction for income from certain foreign-derived sales of property or services exceeding a specified threshold of certain assets; and (4) a tax on certain payments made to a related foreign party referred to as base erosion payments. GAO was asked to review IRS's implementation of TCJA and early effects of the law. This report: (1) describes how TCJA's international provisions may be affecting U.S.-based corporations' international business activities; and (2) assesses IRS's and Treasury's development of relevant regulations and guidance to implement the provisions. GAO interviewed representatives from eight companies' tax departments randomly selected from among the 100 largest U.S.-based companies and compared relevant regulations and guidance against procedural requirements.
    [Read More…]
  • Secretary Antony J. Blinken At the 2021 Trafficking in Persons Report Launch Ceremony
    In Crime Control and Security News
    Antony J. Blinken, [Read More…]
  • Floridians Charged and Convicted in Connection with International Enterprise that Operated Sexually Exploitive ‘Child Modeling’ Websites
    In Crime News
    A series of charges and convictions were announced today in connection with an international enterprise based in Florida that operated subscription-based sexually exploitive “child modeling” websites.
    [Read More…]
  • Former Chattanooga Police Officer Sentenced to 20 Years in Prison for Sexual Assault
    In Crime News
    Desmond Logan, 35, a former officer with the Chattanooga Police Department (CPD), was sentenced by the Honorable Curtis L. Collier, U.S. District Court Judge in the Eastern District of Tennessee at Chattanooga.
    [Read More…]
  • Malta Travel Advisory
    In Travel
    Reconsider travel to [Read More…]
  • Las Vegas Resident Sentenced to Prison for Elder Fraud Scheme
    In Crime News
    A Las Vegas resident who participated in a fraudulent prize-notification scheme that bilked victims out of more than $9 million was sentenced today to federal prison, the Department of Justice announced.
    [Read More…]
  • Department Press Briefing – February 19, 2021
    In Crime Control and Security News
    Ned Price, Department [Read More…]
Network News © 2005 Area.Control.Network™ All rights reserved.