What GAO Found
There is no complete information on the health care costs of firearm injuries. National data allow for estimates of the costs of initial hospital treatment and some first-year costs, but less is known about costs the more time passes from the injury. Examining available data and information, GAO found the following:
- Initial hospital costs: Using hospital data from 2016 and 2017—the most recent that were available—GAO estimated that the initial hospital costs of firearm injuries were just over $1 billion annually. However, physician costs not captured in the data could add around 20 percent to that total. GAO also found that each year there were about 30,000 inpatient stays and about 50,000 emergency department visits to initially treat firearm injuries, and that patients with Medicaid and other public coverage accounted for over 60 percent of the costs of this care.
- First-year costs: Findings from studies on health care costs within the first year of hospital discharge after a firearm injury suggest that those costs can be significant. For example, studies estimating first-year hospital readmissions costs found that up to 16 percent of firearm injury survivors with an initial inpatient stay were readmitted at least once for their injury, with average costs of $8,000 to $11,000 per patient.
- Long-term costs: Less is known about the costs of health care for firearm injuries beyond the first year after hospital discharge. GAO identified studies that estimated lifetime costs of these injuries, but the estimates relied on data from over 20 years ago, making them no longer a reliable indicator of costs.
Clinical experts GAO met with described a wide range in both physical and behavioral health care needs for firearm injury survivors after hospital discharge, with some survivors needing lifelong care. These experts also told GAO that survivors often face barriers to receiving needed care, such as being denied care when it is not covered by their insurance. While not receiving needed services may minimize costs initially, the consequences of unmet health needs for firearm injury survivors may ultimately result in greater costs.
Range of Physical Health Care Needs for Firearm Injuries after Hospital Discharge
Why GAO Did This Study
In 2019, close to 40,000 people died from a firearm injury in the U.S., and around twice that number sustained non-fatal injuries. Over 100 organizations representing health care providers consider the number of firearm injuries that occur each day to be a public health epidemic. Health care costs associated with firearm injuries—both those for services provided during initial hospital treatment and those for services provided long-term—are paid for, at least in part, by public payers, such as Medicaid and Medicare.
GAO was asked to review the health care costs of firearm injuries. This report describes the initial hospital costs of firearm injuries in the U.S. and what is known about the costs of subsequent care, as well as the post-discharge services that may be needed to treat these injuries.
GAO analyzed hospital data for 2016 and 2017 collected by the Agency for Healthcare Research and Quality related to the initial costs of treating firearm injuries, and conducted a literature review on the health care costs of these injuries following discharge. In addition, GAO moderated meetings with 12 experts, representing clinicians, economists, and others—selected with assistance from the National Academies of Sciences, Engineering, and Medicine—to discuss the post-discharge health care service needs and costs of firearm injuries.
The Department of Health and Human Services provided technical comments on a draft of this report, which GAO incorporated as appropriate.
For more information, contact Carolyn L. Yocom at (202) 512-7114 or firstname.lastname@example.org.
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Money Spent by States and Reimbursed by CMS from 2008–2018 for Medicaid Management Information Systems (MMIS) and Eligibility and Enrollment (E&E) Systems For fiscal years 2016 through 2018, CMS approved 93 percent and disapproved 0.4 percent of MMIS funding requests, while for E&E it approved 81 percent and disapproved 1 percent of the requests. The remaining 6.6 percent of MMIS requests and 18 percent of E&E requests were either withdrawn by states or were pending. GAO estimates that CMS had some level of supporting evidence of its review for about 74 percent of MMIS requests and about 99 percent of E&E requests. However, GAO estimates that about 100 percent of E&E requests and 68 percent of MMIS requests lacked pertinent information that would be essential for indicating that a complete review had been performed. Among CMS requirements for system implementation funding is that states submit an alternatives analysis, feasibility study, and cost benefit analysis. However, GAO found that about 45 percent of such requests it sampled for fiscal years 2016 through 2018 did not include these required documents. The above weaknesses were due, in part, to a lack of formal, documented procedures for reviewing state funding requests. CMS also lacked a risk-based process for overseeing systems after federal funds were provided. CMS provided helpful comments and recommendations to states in selected cases, but in other instances it did not. In two states that had contractors struggling to deliver successful projects, state officials said they had not received recommendations or technical assistance from CMS. The states eventually terminated the projects after spending a combined $38.5 million in federal funds. According to CMS officials, they rely largely on states to oversee systems projects. This perspective is consistent with a 2018 Office of Management and Budget (OMB) decision that federal information technology (IT) grants totaling about $9 billion annually would no longer be tracked on OMB's public web site on IT investment performance. Accordingly, the CMS and Health and Human Services chief information officers (CIO) are not involved in overseeing MMIS or E&E projects. Similarly, 21 of 47 states responding to GAO's survey reported that their state CIO had little or no involvement in overseeing their MMISs. Such non-involvement of officials with duties that should be heavily focused on successful acquisition and operation of IT projects could be hindering states' ability to effectively implement systems. To improve oversight, CMS has begun a new outcome-based initiative that focuses the agency's review of state funding requests on the successful achievement of business outcomes. However, as of February 2020, CMS had not yet established a timeline for including MMIS and E&E systems in the new outcome-based process. CMS had various initiatives aimed at reducing duplication of Medicaid systems (see table). Description and Status of Centers for Medicare and Medicaid Services Initiatives Aimed at Reducing Duplication by Sharing, Leveraging, and Reusing Medicaid Information Technology Initiative Description Implementation status Number of surveyed states reporting use of the initiative Reuse Repository Used by states to collect and share reusable artifacts. Made available in August 2017. As of January 2020, CMS was no longer supporting this initiative. 25 of the 50 reporting states Poplin Project Was to provide free, open-source application program interfaces for states to use in developing their modular Medicaid systems. Initiative never fully implemented. As of January 2020, CMS was no longer supporting this initiative. Three of the 50 reporting states Open Source Provider Screening Module Open-source module for states to use at no charge. Made available in August 2018. As of January 2020, CMS was no longer supporting this initiative. One of the 50 states reported attempting to use the module. Medicaid Enterprise Cohort Meetings A forum where states can discuss sharing, leveraging, and/or reuse of Medicaid technologies. As of January 2020, Cohort meetings were being held on a monthly basis. 47 of the 50 states reported participating in the meetings. Source: GAO analysis of agency data. | GAO-20-179 However, as of January 2020, the agency was no longer supporting most of these initiatives because they failed to produce the desired results. CMS regulations and GAO's prior work have highlighted the importance of reducing duplication by sharing and reusing Medicaid IT. 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- Marine Corps Civilian Employee Pleads Guilty to Assaulting His SpouseBy Sam NewsJanuary 21, 2021A civilian employee working for the U.S. Marine Corps Community Association pleaded guilty today to assaulting his spouse while working in Iwakuni, Japan.[Read More…]
- Attorney General Merrick B. Garland Delivers Remarks Announcing Lawsuit Against the State of Georgia to Stop Racially Discriminatory Provisions of New Voting LawBy Sam NewsJune 25, 2021Good morning, I’m pleased to be joined by Deputy Attorney General Lisa Monaco, Associate Attorney General Vanita Gupta, and Assistant Attorney General for Civil Rights Kristen Clarke.[Read More…]
- Veterans Affairs: Use of Additional Funding for COVID-19 ReliefBy Sam NewsMay 6, 2021What GAO Found The Department of Veterans Affairs (VA) received $19.6 billion in supplemental funding—additional funding above the annual appropriation—in March 2020 to respond to the COVID-19 pandemic. GAO's analysis of VA data shows that through March 2021, VA had obligated $9.9 billion and expended $8.1 billion of the supplemental funding. Department of Veterans Affairs (VA) Reported Obligations and Expenditures of CARES Act and Families First Coronavirus Response Act Funding through March 2021 Note: An obligation is a definite commitment that creates a legal liability to pay, and an expenditure is the actual spending of money. The majority of the obligated supplemental funding ($8.3 billion) was obligated by VA's Veterans Health Administration (VHA) for care provided to veterans by non-VA providers, the additional costs of salaries (such as for overtime) and related expenses of VHA staff, supplies and materials, and support for homeless veterans, due to COVID-19 response. The remaining obligations included costs of VA's transition to telehealth and telework during the COVID-19 pandemic, primarily through the Office of Information Technology (OIT). According to spend plan documents and department officials, VA plans to obligate its remaining $9.7 billion in funding on activities including COVID-19 testing, purchasing supplies and equipment, and distributing COVID-19 vaccines. VA mainly relies on its standard financial management processes to oversee the use of supplemental funds, including establishing new versions of standard financial codes to account for and report on use of funds through VA's financial system. VA also collected details about the use of supplemental funding, such as descriptions of the activities for which funds were obligated, that were not available in its financial system. In addition, the VA components that received the majority of the supplemental funding—VHA and OIT—set up additional processes and issued guidance specific to the use of supplemental funding, such as establishing councils to review funding requests. Why GAO Did This Study As of April 14, 2021, VA reported 224,538 cumulative veteran cases of COVID-19, and 11,366 deaths. The CARES Act and Families First Coronavirus Response Act included supplemental funding for COVID-19 relief, and the Consolidated Appropriations Act, 2021, permitted VA additional flexibility to transfer these funds across the department. The CARES Act also included a provision for GAO to report on its ongoing monitoring and oversight efforts related to the COVID-19 pandemic. This report examines 1) VA's obligations and expenditures of COVID-19 supplemental funding, as well as its plans to obligate remaining funds, and 2) how VA oversees the use of COVID-19 supplemental funds. GAO reviewed VA data on obligations, expenditures, and spend plans for COVID-19 supplemental funding, as well as contracting documentation and documentation on the processes and guidance VA developed to oversee the use of funds. GAO interviewed VA officials responsible for oversight of the supplemental funding, including officials from five regional networks, selected based on funding levels and geography, to gather information about their roles in overseeing the use of and accounting for supplemental funding. VA reviewed a draft of this report and provided a technical comment, which was incorporated as appropriate. For more information, contact Sharon M. Silas at (202) 512-7114 or firstname.lastname@example.org.[Read More…]
- Justice Department Invests $2.6 Million to Mitigate Violent Crime and Support Public Safety in Disruption EffortsBy Sam NewsNovember 10, 2020The Department of Justice announced awards from the Office of Justice Programs (OJP) totaling $2.6 million to four jurisdictions to disrupt and mitigate threats of violence. The funds support state and local prosecutors and investigators who seek expertise from mental health and threat assessment experts to identify these individuals and prevent violent acts.[Read More…]
- Law Clerk Hiring Plan ExtendedBy Sam NewsIn U.S CourtsNovember 12, 2020The Judiciary’s Federal Law Clerk Hiring Pilot Plan, which makes the judicial clerkship hiring process more transparent and uniform, has been extended for two years after getting good reviews from both law school deans and judges.[Read More…]
- Assistant Secretary of State for Political-Military Affairs R. Clarke Cooper Travels to the United Arab Emirates, Saudi Arabia, Bahrain, and IsraelBy Sam NewsNovember 12, 2020
- Liechtenstein Travel AdvisoryBy Sam NewsSeptember 26, 2020
- Executions Scheduled for Inmates Convicted of Brutal Murders Many Years AgoBy Sam NewsNovember 21, 2020Attorney General William P. Barr today directed the Federal Bureau of Prisons to schedule the execution of three federal-death row inmates sentenced to death for staggeringly brutal murders, including the murder of a child and, with respect to two inmates, the murder of multiple victims.[Read More…]
- 16-Year-Old Cosmic Mystery Solved, Revealing Stellar Missing LinkBy Sam NewsIn SpaceDecember 9, 2020The Blue Ring Nebula, [Read More…]
- Former Managers at Major Property Management Firm Plead Guilty to Defrauding U.S. Air ForceBy Sam NewsJune 9, 2021An Arizona man and a Texas woman have pleaded guilty to major fraud against the United States, and conspiracy to commit wire fraud, respectively, for their roles in a scheme to defraud the U.S. Air Force in connection with privatized military housing contracts between approximately 2013 and 2016.[Read More…]
- Former NGO Procurement Official Sentenced to Prison for BriberyBy Sam NewsMay 24, 2021A former non-governmental organization (NGO) official was sentenced today to 40 months in prison for paying bribes to NGO officers in exchange for sensitive procurement information related to NGO contracts funded in part by the U.S. Agency for International Development (USAID).[Read More…]
- Missile Defense: Observations on Ground-based Midcourse Defense Acquisition Challenges and Potential Contract Strategy ChangesBy Sam NewsOctober 21, 2020The Missile Defense Agency (MDA) is developing a system to defend the U.S. from long-range missile attacks. As MDA continues to develop this system, called Ground-based Midcourse Defense (GMD), it has opportunities to incorporate into its approach lessons learned from over 2 decades of system development. MDA has made progress in developing and fielding elements of the GMD system. For example, MDA is constructing a new missile field to expand the fleet of interceptors. However, MDA has also experienced significant setbacks. Most recently, the Department of Defense canceled development of a key GMD element, the Redesigned Kill Vehicle, in 2019 because of fundamental problems with the system's design. Ongoing Construction of a New Ground-based Midcourse Defense Interceptor Field (July 16, 2019) Over the years, GAO has identified practices that MDA could apply to the GMD program to improve acquisition outcomes, such as: Using knowledge-based acquisition practices Involving stakeholders early and often Providing effective oversight Promoting competition Performing robust testing GAO has also made numerous recommendations to improve MDA's acquisition outcomes and reduce risk. As of July 2020, the department has concurred with most of the recommendations GAO made since MDA's inception in 2002. Although the department has implemented many of the recommendations, it has further opportunities to implement the remaining open recommendations and apply lessons learned on a major, new effort to develop a next-generation GMD interceptor. Since the late 1990s, DOD has executed the GMD program through a prime contractor responsible for developing and integrating the entire weapon system. MDA is considering taking over these responsibilities for GMD for the next phase of the program. GAO found that this approach offers potential benefits to the agency, such as more direct control over and greater insight into GMD's cost, schedule, and performance. However, the approach has some challenges that, if not addressed, could outweigh the benefits. For example, MDA may encounter challenges obtaining the technical data and staffing levels necessary to manage this complex weapon system, which could ultimately affect its availability or readiness. As of October 2020, MDA has not yet determined an acquisition strategy for the next phase of the GMD program. The GMD system aims to defend the U.S. against ballistic missile attacks from rogue states like North Korea or Iran. DOD has been developing this system since the 1990s and has spent $53 billion on the system so far. GMD is a complex system that includes interceptors and a ground system, and MDA has largely relied on a contractor, Boeing, to manage development and system integration. MDA is considering moving away from this approach as the program embarks on developing a key element of the GMD, a new interceptor. The House Armed Services Committee included a provision in a report for GAO to assess the GMD contract structure and identify potential opportunities to improve government management and contractor accountability. This report addresses (1) the lessons learned from challenges MDA encountered acquiring the GMD system and (2) the potential benefits and risks of MDA taking over system integration responsibilities for GMD. To conduct this work, GAO reviewed GMD program documentation, prior GAO reports on missile defense, GAO interviews with other DOD components, and expert panel reviews of GMD. GAO also spoke with officials from MDA and other DOD components. GAO has 17 open recommendations aimed at improving missile defense acquisition outcomes and reducing risk. Recently, DOD has taken steps to address some of these open recommendations, but further action is needed to fully implement the remaining recommendations. For more information, contact W. William Russell at (202) 512-4841 or email@example.com.[Read More…]
- Arrest of Eight Pan-Democratic Politicians in Hong KongBy Sam NewsNovember 2, 2020
- Joint Statement of the C5+1 on the International Conference “Central and South Asia: Regional Connectivity. Challenges and Opportunities”By Sam NewsJuly 16, 2021
- RGV attorney admits to detainee list bribery schemeBy Sam NewsMay 2, 2021A 40-year-old Weslaco [Read More…]
- Federal prisoner convicted of possessing a weaponBy Sam NewsJuly 24, 2021A 38-year-old Mexican [Read More…]
- Championing America’s First FreedomBy Sam NewsJanuary 16, 2021
- International Day in Support of Victims of Torture By Sam NewsJune 26, 2021