August 31, 1999

Thompson Letter on GPRA - VA

Thompson Letter on GPRA - VA

August 17, 1999

The Honorable Togo D. West, Jr.

Secretary

Department of Veterans Affairs

810 Vermont Avenue, NW

Washington, D.C. 20420

Dear Secretary West:

As you know, the Congress is focused on ensuring that the federal government delivers better results to its citizens and taxpayers. The Congress has enacted a statutory framework to achieve these results. This statutory framework includes the Government Performance and Results Act (GPRA); financial management statutes, such as the Chief Financial Officers Act; and information resources management statutes, such as the Clinger-Cohen Act. Each of these reforms aims at achieving more efficient and effective performance throughout the federal government.

As part of our oversight agenda, the Committee has developed information on how effectively the Department of Veterans Affairs (VA) is using the above statutory tools to improve its performance in several key areas such as becoming more results-oriented and resolving long-standing problems of fraud, waste, and mismanagement. The purpose of this letter is to share with you the information we have developed and obtain your response to certain questions pertaining to it. With this dialog as a start, we hope to work with you on a continuing basis to ensure that VA delivers the best possible results for the American people.

Performance Plan Assessment

The Congress continues to look closely at how well departments and agencies are implementing GPRA. At the request of this Committee and others, GAO recently completed an assessment of the VA annual performance plan for fiscal year (FY) 2000. According to GAO, VA’s FY 2000 plan has made "moderate improvement" in addressing weaknesses GAO identified in its FY 1999 plan. For instance, where the 1999 plan included no results-oriented goals or measures for certain business lines, the 2000 plan includes interim outcome goals and measures.

The FY 2000 plan’s major strengths are that it contains quantified goals and measures for all of VA’s major business lines; explicitly links strategies, crosscutting activities, mission-critical management problems and lack of data sources to each of VA’s key performance goals; provides an in-depth discussion of performance data reliability problems and VA’s initiatives for addressing these problems.

GAO found that the FY 2000 plan had two key weaknesses. One was that the plan does not contain results-oriented performance goals for FY 2000 for the Veterans Benefits Administration compensation, pension, and insurance programs. The other key weakness was that the plan discusses data verification and validation procedures for only some of the key performance goals and measures. For instance, the plan discusses how 11 of 36 key data elements will be examined for susceptibility to manipulation or erroneous reporting but does not say how the remaining 25 will be verified.

Need to implement audit recommendations on major management problems

One area where there have been too few results is solving major management challenges that seem to persist year after year at most agencies, including VA. An area of particular concern at VA is resolving serious information security weaknesses.

Specifically, VA has yet to fully implement GAO recommendations addressed to this high-risk problem area, including three recommendations detailed in the enclosures. One example is a GAO recommendation from September 1998 that VA limit access authority to only those computer programs and data needed to perform job responsibilities. In addition, VA’s FY 2000 plan identifies computer security as a mission-critical problem and lists the GAO and Inspector General (IG) recommendations but does not include action plans or a time line to address this critical issue.

According to information provided to the Committee by your IG and GAO, there are a number of open audit recommendations addressing other major management problems at VA as well. The enclosures describe these unresolved recommendations. Several of the IG recommendations propose ways to stop inappropriate payments to veterans who are incarcerated and to veterans who are serving on active duty. As you know, I wrote to you on March 15, 1999 regarding my concerns over VA’s improper payments to prisoners and to ask that you take actions to stop this unnecessary drain on taxpayers’ dollars.

Need for specific performance goals to address major management problems

It is essential that agency heads and other managers commit themselves to tangible steps that will lead to solutions and that agency heads accept accountability for following through on these commitments. One obvious way to do this is to establish specific and measurable goals in your annual GPRA performance plans. OMB guidance for agencies to prepare their performance plans states that:

performance goals for management problems should be included particularly for problems whose resolution is mission-critical or which could potentially impede achievement of program goals...

GAO recently evaluated the extent to which VA’s fiscal year 2000 GPRA performance plan contains specific and measurable performance goals to address the two high risk and other most serious management problems confronting VA that GAO and your IG have identified. According to the GAO evaluation, which is detailed in the enclosures, VA’s plan has no specific goals for 25 of these problem areas.

I am quite concerned over the absence of such goals for most of your major problem areas. Without specific and measurable performance goals, it is difficult, if not impossible, to assess progress in addressing major management problems and to hold agencies accountable.

Congressional follow-up

With so many tax dollars being wasted, this Committee expects agencies to take every opportunity to use the many tools available to them, such as GPRA plans, to resolve major management problems. Furthermore, the GAO and your own IG exist to work in partnership with you to solve longstanding issues of waste, fraud, and abuse.

I hope that the information provided with this letter will stimulate you to make greater use of these tools and resources. In this regard, I ask that you review the enclosed information and respond to the following questions:

• Do you disagree with any of the GAO or IG recommendations described in the enclosures? If so, what is the basis for your disagreement?

• Where you agree with the recommendations, what specific actions are you taking to implement each one and how long will it take to complete?

• Do you disagree with any of the GAO or IG designations of management problems facing VA? If so, which ones and why?

• Where you agree with the problem designations, are you prepared to establish specific and measurable commitments to address each one of them in your next performance plan?

• If so, could you outline what approach you plan to take for each problem?

• If you believe that any of these problems do not lend themselves to specific and measurable performance plan goals, please explain why. Please also explain what alternative steps you are taking to solve the problem.

I would appreciate your early attention to this letter. After receiving your response, I will ask Committee staff to arrange a meeting with your representatives to discuss it. My Governmental Affairs Committee staff contact is Robert Shea.

Sincerely,

Fred Thompson

Chairman

FT/rs

Enclosures

 

OPEN GAO RECOMMENDATIONS ON "HIGH RISK" AREAS: INFORMATION SECURITY

Date	GAO Report	Recommendation
2/ 98	AIMD-98-175	Direct the VA CIO to work in conjunction with VBA and VHA CIOs and the facility directors, as appropriate, to limit access authority to only those computer programs and data needed to perform job responsibilities and review access authority periodically to identify and correct inappropriate access.
2/98	AIMD-98-175	Direct the VA CIO to work in conjunction with VBA and VHA CIOs and the facility directors, as appropriate, to implement identification and password management controls across all computer platforms to maintain individual accountability and protect password confidentiality and test these controls periodically to ensure that they are operating effectively.
2/98	AIMD-98-175	Direct the VA CIO to work in conjunction with VBA and VHA CIOs and the facility directors, as appropriate, to require operating system software changes to be documented, authorized, tested, independently reviewed, and implemented by a third party.

 

OPEN GAO RECOMMENDATIONS ON VA’s MAJOR MANAGEMENT CHALLENGES

VA Health Care Infrastructure Does Not Meet Current and Future Needs

Many Department of Veterans Affairs (VA) facilities are deteriorating, unneeded, or inappropriately configured. As VA shifts its emphasis from providing specialized inpatient services to providing primary outpatient care, less of VA’s existing hospital space is needed. Unneeded, vacant buildings and grounds create a financial drain on VA. Maintaining unproductive assets siphons valuable resources away from providing direct medical services. In confronting this challenge, VA needs to decide whether and how to maintain, renovate, liquidate, or redirect the use of these assets. VA needs to decide which services could be consolidated across its facilities as well as those that could be offered more efficiently by other public and private providers who contract with VA. These decisions must be made in the context of a decreasing population of veterans--one that has a rapidly increasing proportion of members aged 85 and older who may require more intensive services, such as nursing home care. Furthermore, these decisions are likely to affect how VA meets its medical education mission to train physicians and other clinical care providers and will require VA to restructure its affiliation agreements with medical schools and other institutions. All these decisions will be of critical importance in shaping how VA fulfills its health care role well into the next century.

There are six open recommendations related to this major management challenge. They address the need for (1) VA to improve its planning and budgeting for capital assets, (2) VA to more accurately collect information on nursing home availability costs, and (3) the Great Lakes Veterans Integrated Service Network to develop and implement a detailed plan for meeting veterans’ needs in the Chicago area with three hospitals instead of four.

GAO Product	Recommendation
HEHS-97-27 Dec. 20, 1996	As part of VA’s ongoing efforts to improve nursing home resource management decisions, the Secretary of Veterans Affairs should direct the Under Secretary for Health to more accurately accumulate and report nursing home costs, assess the availability of community nursing home resources, and identify locations where current reimbursement rates are not competitive.
HEHS-98-64 Apr. 16, 1998	The Secretary of Veterans Affairs should direct the Great Lakes network director to develop and implement a detailed plan for meeting veterans’ needs in three hospitals. This plan should explore all options available and select those that maximize veterans’ access to services while minimizing to the extent practical, the impact on employees, medical schools, and others. The plan should also identify which of the four Veterans Health Administration (VHA) hospitals in the Chicago area to close.
T-HEHS-99-83 Mar. 10, 1999	The Secretary of Veterans Affairs should require the Under Secretary for Health to (1) use VA’s centralized budget process for a larger share of its investment decisions, (2) ensure that the fundamental principles underlying that process are rigorously implemented when making decentralized investment decisions, (3) modify written guidelines to describe, in greater detail, minimum quantitative data required for each decision criteria, and (4) exclude, from the prioritization process, all proposals that fail to meet the information requirements.

VA Lacks Adequate Information to Ensure That Veterans Have Access to Needed Health Care Services

Because VA lacks accurate, reliable, and consistent information on how resources are being allocated, it cannot ensure that veterans are receiving equitable access to care across the country, as mandated by the Congress. The Congress was concerned that the dramatic shift in the veteran population from the Northeast and Midwest to the South and West had occurred without a corresponding shift in VA health care resources. In fiscal year 1997, therefore, VA introduced a new resource allocation system to begin to correct historical inequities in allocating resources, with the intent of improving the equity of veterans’ access to care. However, VA does not know if it is making progress in providing similar services to similarly situated veterans. VA has also been unable to ensure that veterans who need costly specialized treatment and rehabilitative services have access to such care. Also, the Congress required VA to ensure that its capacity for specialized treatment and rehabilitative services for certain conditions is not reduced below October 1996 levels and that veterans with these conditions have reasonable access to care. However, as a result of VA’s changing definitions for data, inaccurate data reporting at the local level, and irreconcilable data differences within VA, it is difficult to determine the extent to which VA is maintaining its national capacity to treat special disability groups. Finally, VA has not developed information that will enable it to ensure that it meets the increased demand for care generated by its new enrollment process. VA projects that by the end of fiscal year 1999, it will have enrolled about 4.4 million veterans. If each of these veterans receives medical services from VA in fiscal year 1999, the percentage of veterans receiving VA care will increase about 47 percent compared with the percentage of those served annually in recent years.

Twenty recommendations related to this major management challenge are open. In addition to the 13 recommendations discussed below, 7 recommendations are related to VA’s Medical Care Cost Recovery authority and participation rates in Persian Gulf Spouse and Children Examinations.

GAO Product	Recommendation
HEHS-96-121 July 25, 1996	The Secretary of Veterans Affairs should provide the Congress, through future budget submissions, data on the extent to which VA services were provided to veterans in the mandatory and discretionary care categories for both inpatient and outpatient care.
HEHS-97-7 Oct. 25, 1996	The Secretary of Veterans Affairs should direct the Under Secretary for Health to provide the Congress a report that presents the overall VA plan and time schedule for the system-wide establishment of access points to assist the Congress in determining the affordability of the VA plan.
HEHS-97-178 Sept. 17, 1997	The Secretary of Veterans Affairs should direct the Under Secretary for Health to develop more timely and detailed indicators of changes in key Veterans Equitable Resource Allocation (VERA) workload measures and medical care practices to maintain VERA’s ability to equitably allocate resources in the future and help ensure that veterans receive the most appropriate care.
HEHS-97-178 Sept. 17, 1997	The Secretary of Veterans Affairs should direct the Under Secretary for Health to improve oversight of VISNs’ allocation of resources to their facilities by: (1) developing criteria for use in designing VISN resource allocation methods, (2) reviewing and approving these methods, and (3) monitoring the impact of the methods on veterans’ equitable access to care.
HEHS-98-4 Oct. 17, 1997	The Secretary of Veterans Affairs should, in designing the enrollment process for the veterans’ health care program, develop procedures for gathering and updating detailed information on veterans’ employment, insurance, and service-connected disabilities.
HEHS-98-4 Oct. 17, 1997	The Secretary of Veterans Affairs should develop procedures to ensure that authority to retain health insurance recoveries would not detract from services to veterans who lack private health insurance.
HEHS-98-116 June 15, 1998	The Secretary of Veterans Affairs should direct the Under Secretary for Health to set a national target level of performance that focuses each network on a goal of providing reasonable geographic access to VA primary care for highest percentage of current users practical by 2002.
HEHS-98-116 June 15, 1998	The Secretary of Veterans Affairs should direct the Under Secretary for Health to require networks to include in their business plans the percentage of: (1) current users, by priority status, who have reasonable access, (2) the remaining current users (without reasonable access), by priority status, who are targeted to receive improved access through the establishment of community clinics by 2002, and (3) current users, by priority status, who will not have reasonable access by 2002.
HEHS-98-116 June 15, 1998	The Secretary of Veterans Affairs should direct the Under Secretary for Health to require networks to plan and propose new community-based clinics in a manner that ensures that veterans with highest statutory priorities achieve reasonable access as quickly as possible, consistent with the requirements of the Veteran Health Care Reform Act of 1996.
HEHS-98-116 June 15, 1998	The Secretary of Veterans Affairs should direct the Under Secretary for Health to establish minimum criteria that all networks are to use annually for evaluating new clinics’ performance.
HEHS-98-116 June 15, 1998	The Secretary of Veterans Affairs should direct the Under Secretary for Health to require networks to annually report their evaluation results to the Capital Budgeting and Oversight Service, a unit within VA, and others for their use in reviewing proposals for new clinics and other purposes.
HEHS-98-226 Aug. 28, 1998	The Secretary of Veterans Affairs should direct the Under Secretary for Health to develop uniform definitions and institute timely reporting of changes in access to care, including the number and eligibility priority of patients served, waiting times for care, and patient satisfaction for specific services at the VISN and facility level.
HEHS-98-226 Aug. 28, 1998	The Secretary of Veterans Affairs should direct the Under Secretary for Health to develop criteria for equitably allocating resources to facilities and monitor any improvements in equity of access among and within VISNs.

VA Lacks Outcome Measures and Data to Assess Impact of Managed Care Initiatives

VA does not know how its rapid move toward managed care is affecting the health status of veterans because measures of the effects on patient outcomes of changes in its service delivery have not been established. VA, like many other public and private health care providers, has recognized the necessity for and the difficulty of creating such measures. VA’s challenges in assessing outcomes are further complicated by poor data. GAO and others have reported numerous concerns about VA’s outcome data, including inconsistent, incompatible, and inaccurate databases; changes in data definitions over time; and the lack of timely and useful reporting of information to medical center, VISN, and national program managers.

GAO’s work on health care for Persian Gulf War and homeless veterans has resulted in eight open recommendations related to this management challenge. They involve the development and uniform implementation of a process focusing on the integration of diagnostic services, treatment and evaluation of the effectiveness of that treatment, and periodic reevaluation of veterans with undiagnosed illnesses.

GAO Product	Recommendation
HEHS-98-197 Aug. 19, 1998	The Secretary of Veterans Affairs should direct the Under Secretary for Health to uniformly implement a health care process for Gulf War veterans that provides for the coordination of diagnoses of illnesses.
HEHS-98-197 Aug. 19, 1998	The Secretary of Veterans Affairs should direct the Under Secretary for Health to uniformly implement a health care process for Gulf War veterans that provides for the coordination of treatment of symptoms and illnesses.
HEHS-98-197 Aug. 19, 1998	The Secretary of Veterans Affairs should direct the Under Secretary for Health to uniformly implement a health care process for Gulf War veterans that provides for coordinating evaluations of treatment effectiveness.
HEHS-98-197 Aug. 19, 1998	The Secretary of Veterans Affairs should direct the Under Secretary for Health to uniformly implement a health care process for Gulf War veterans that provides for the coordination of periodic reevaluation of those veterans whose illnesses remain undiagnosed.
HEHS-99-53 Apr. 1, 1999	The Secretary of Veterans Affairs should direct the Under Secretary for Health and the Assistant Secretary for Planning and Analysis to collaborate on conducting a series of program evaluation studies to clarify the effectiveness of VA's core homeless programs and provide information about how to improve those programs. Where appropriate, VA should make decisions about these studies (including the type of data needed and the methods to be used) in coordination with other federal agencies with homeless programs, including the Department of Health and Human Services (HHS), the Department of Housing and Urban Development (HUD), and the Department of Labor (Labor).
NSIAD-97-163 June 23, 1997	Because of the numbers of Gulf War veterans who continue to experience illnesses that may be related to their service during the Gulf War, the Secretary of Defense, in conjunction with the Secretary of Veterans Affairs, should develop and implement a plan to monitor the clinical progress of Gulf War veterans in order to help promote appropriate and effective treatment and provide direction to the research agenda.
NSIAD-97-163 June 23, 1997	Because of the numbers of Gulf War veterans who continue to experience illnesses that may be related to their service during the Gulf War, the Secretary of Defense, in conjunction with the Secretary of Veterans Affairs, should give greater priority to research on treatment for ill veterans and on low-level exposures to chemicals and their interactive effects and less priority to further epidemiological studies.
NSIAD-98-89 Mar. 3, 1998	In order to evaluate more effectively the incidence of tumors and other Gulf War illnesses over time, the Secretaries of Defense and Veterans Affairs should continue to strengthen existing monitoring capabilities. Attention should be directed toward improving the utility of existing data systems and particularly in developing cost-effective ways to make data systems more compatible with one another so that information from different sources can be linked. In addition, steps should be taken to address the data quality concerns identified in this report.

VA Faces Major Challenges in Managing Non-Health-Care Benefits Programs

In managing its nonhealth-care benefits programs, VA needs to overcome a variety of difficulties. Currently, VA cannot ensure that its veterans’ disability compensation benefits are appropriately and equitably distributed because its disability rating schedule does not accurately reflect veterans’ economic losses from their disabilities. Also VA is compensating veterans for diseases that are neither caused nor aggravated by military service. In addition, claims-processing in VA’s compensation and pension program continues to be slow, and the vocational rehabilitation program has yielded limited results. Moreover, the data that VA will use to measure compensation and pension program performance are questionable. Finally, VA has inadequate control and accountability over the direct loan and loan sales activities within its Housing Credit Assistance program.

There are 33 open recommendations related to the management of various VA nonhealth-care benefits, including the administration of disability and pension benefits, vocational rehabilitation benefits, and direct loan and loan sale activities. Some of the most important open recommendations are discussed in the table below.

GAO Product	Recommendation
AIMD-99-24 Mar. 24, 1999	(The following seven recommendations relate to management of loan assets and cash flows associated with VA’s direct loans): The Secretary of Veterans Affairs should direct the Under Secretary for Benefits to: i. Provide a basis for monitoring and controlling loan and property assets and any related cash flows managed by contractors by establishing a database for direct loans, through the development of a complete inventory of all loans originated. The database should be similar to the information systems in place at major owners of housing loan portfolios. ii. Implement processes to allow immediate improvements in VA’s capability to monitor contractor servicing of direct loans and disbursements related to VA-owned properties. These improvements would include periodically obtaining tax bills for VA-owned properties from independent sources and comparing this information to that in its Property Management System (PMS) to validate servicer requests for reimbursement of expenses. iii. Develop a centralized database to immediately record loans in the process of being assumed by VA in order to establish timely and thorough visibility over those assets and to facilitate transferring such information to the contract servicer expeditiously. iv. Reconcile all loan records in the contractor’s database to VA’s general ledger on a monthly basis, by the end of the following month.
AIMD-99-24 Mar. 24, 1999	v. Continue to develop standardized policies and procedures intended to ensure completeness, consistency, and accuracy of data obtained and recorded concerning individual loans and properties. Implement quality assurance steps to ensure the accuracy of these data. vi. Adhere to federal legislation and guidance regarding cash management. Servicers should be instructed to remit all proceeds to VA’s Treasury accounts daily upon receipt. Further, VA should recoup the total interest on Season’s Mortgage Group’s (SMS) account balances from the inception of VA’s contract with Computer Data Systems, Incorporated/SMG. vii. Establish suspense accounts, and a control account in VA’s general ledger, to record all collections that cannot be allocated to specific loan accounts.
AIMD-99-24 Mar. 24, 1999	(The following five recommendations relate to operational and accounting control over loan sales): The Secretary of Veterans Affairs should direct the Under Secretary for Benefits to: iii. Establish adequate separation of duties and supervision over VA staff involved in all loan sale operational and administrative activities. iv. Disclose cash flows related to loan sales and related guarantees in VA's budget records, calculate and report the cost of direct loans and loan guarantees, and budget for the subsidy and administrative cost of the loans and guarantees in accordance with the Federal Credit Reform Act of 1990 and Office of Management and Budget (OMB) Circular A-11. v. Develop and implement procedures to ensure that relevant data from servicers and the trustee/custodian are provided promptly to VA offices responsible for managing or recording trust activities and transactions. vi. Complete the reconstruction of the historical data for the loan sales, the resulting trust, and financing for the required reserve accounts for each trust. vii. Record loan sale transactions and all subsequent activity associated with the trusts consistent with federal accounting standards and any related guidance. This would include: (1) making appropriate accounting adjustments to accurately reflect the results of prior years’ transactions and (2) recording all financial transactions relating to trust activities, including those associated with the original sale, the establishment of the reserves, drawdowns to satisfy the federal guarantee, subsidy reestimates, and replenishments to satisfy trust agreement provisions as well as revenue from trust investments and assets including those associated with the original sale, the establishment of the reserves, drawdowns to satisfy the federal guarantee, subsidy reestimates, and replenishments to satisfy trust agreement provisions as well as revenue from trust investments and assets.
AIMD-99-24 Mar. 24, 1999	The Secretary of Veterans Affairs should direct the Under Secretary for Benefits to establish and implement adequate monitoring activities of out-sourced activities to include both direct loans and VA property servicing as well as activities associated with the loan sales. These efforts should be designed to comply with OMB Circular A-129 and be stringent, given the risks inherent in the existing servicing environment.
HRD-92-100 Sept. 4, 1992	The Secretary of Veterans Affairs should implement the requirements of the 1980 amendments related to finding and maintaining suitable employment for disabled veterans.
HRD-92-100 Sept. 4, 1992	The Secretary of Veterans Affairs should take the lead in developing more effective working arrangements with the Department of Labor (DOL), state rehabilitation agencies, and private contractors for providing job placement services to disabled veterans.
HRD-92-100 Sept. 4, 1992	The Secretary of Veterans Affairs should --determine why so many disabled veterans drop out before successfully completing the vocational rehabilitation program, and --take action aimed at reducing the number of dropouts and increasing the numbers who are successfully rehabilitated.
HRD-92-100 Sept. 4, 1992	The Secretary of Veterans Affairs should review the performance standards established for the vocational rehabilitation program and determine whether services to the veterans can be improved by establishing a realistic performance measurement system, such as benchmarking, that clearly focuses on the program’s objectives and continually measures progress toward achieving them.
HEHS-99-35 Mar. 1, 1999	To further strengthen VA’s ability to identify error-prone cases, ensure the integrity of accuracy rate-related performance data reported under the Government Performance and Results Act (Results Act), and keep the Congress informed about VA’s progress in addressing challenges that must be met in order to improve accuracy, the Secretary of Veterans Affairs should direct the Under Secretary for Benefits to revise Systematic Technical Accuracy Review (STAR) to collect more detailed medical characteristics data, such as the human body systems, the specific impairments, and the specific deficiencies in medical evidence involved in those disability claims which are found to be in error, so that VA can identify and focus corrective actions on specific problems that Regional Office adjudicators have in correctly evaluating certain types of medical conditions or in correctly determining whether medical evidence is adequate to make a decision.
HEHS-99-35 Mar. 1, 1999	To further strengthen VA’s ability to identify error-prone cases, ensure the integrity of accuracy rate-related performance data reported under the Results Act, and keep the Congress informed about VA’s progress in addressing challenges that must be met in order to improve accuracy, the Secretary of Veterans Affairs should direct the Under Secretary for Benefits to implement a claims-processing accuracy review function that meets the government’s internal control standard on separation of duties and the program performance audit standard on organizational independence.
HEHS-99-35 Mar. 1, 1999	To further strengthen VA’s ability to identify error-prone cases, ensure the integrity of accuracy rate-related performance data reported under the Results Act, and keep the Congress informed about VA’s progress in addressing challenges that must be met in order to improve accuracy, the Secretary of Veterans Affairs should direct the Under Secretary for Benefits to inform the Congress on VA’s progress in the annual Results Act reports by (1) establishing stricter employee accountability for the achievement of performance goals and (2) developing more effective training for claims adjudicators.

VA Needs to Manage Its Information Systems More Effectively

GAO has recently reported on several key issues related to VA information systems. First, in July 1998 GAO reported that VA had not yet institutionalized a disciplined process for selecting, controlling, and evaluating information technology investments as required by the Clinger-Cohen Act. Second, GAO reported in September 1998 that VA lacked adequate control and oversight of access to its computer systems. Third, GAO reported in April 1999 that VA has progressed in addressing year 2000 challenges but still has a number of associated issues to address.

Twenty-two recommendations related to this major management challenge are open. GAO discusses below five recommendations on VA’s implementation of Clinger-Cohen Act requirements, two recommendations related to the development of year 2000 contingency plans, and five recommendations on VA’s need to implement comprehensive departmentwide computer security planning and management. Ten other recommendations related to VA’s computer security management are not separately addressed. Finally, VA has acted on six recommendations related to its year 2000 readiness and they are being closed.

GAO Product	Recommendation
AIMD-98-154 July 7, 1998	The Secretary of Veterans Affairs should direct the Assistant Secretary for Policy and Planning to develop a departmentwide strategy that details how VA will reengineer its business processes, including identifying and prioritizing process improvement projects, and delineating their interrelationships.
AIMD-98-154 July 7, 1998	To fulfill the requirements of the Clinger-Cohen Act and other information technology legislative reforms, the Secretary of Veterans Affairs should direct VA’s Chief Information Officer (CIO) to develop a detailed implementation plan with milestones for completing an integrated, departmentwide information technology architecture.
AIMD-98-154 July 7, 1998	To fulfill the requirements of the Clinger-Cohen Act and other information technology legislative reforms, the Secretary of Veterans Affairs should direct VA’s CIO to fully implement a disciplined process for selecting information technology investments in which all decisions are based upon complete and current project information, including estimated project costs, expected mission-related benefits, projected schedule, and risks.
AIMD-98-154 July 7, 1998	To fulfill the requirements of the Clinger-Cohen Act and other information technology legislative reforms, the Secretary of Veterans Affairs should direct VA’s CIO to conduct formal in-process reviews at key milestones in a project’s life cycle, including comparing actual estimated project costs, benefits, schedule, and risks, and provide these results, as well as the results of periodic project status reviews performed by VA components, to decisionmakers who will determine whether to continue, accelerate, or terminate information technology projects.
AIMD-98-154 July 7, 1998	To fulfill the requirements of the Clinger-Cohen Act and other information technology legislative reforms, the Secretary of Veterans Affairs should direct VA’s CIO to initiate postimplementation reviews for information technology projects within 12 months of implementation, to compare completed project cost, schedule, performance, and mission improvement outcomes with original estimates, and provide the results of these reviews to decisionmakers so that improvements can be made to VA’s information technology investment process.
AIMD-98-237 Aug. 21, 1998	To reduce the likelihood of delayed or interrupted benefits, the Secretary of Veterans Affairs, with support from VBA’s CIO, should ensure that VBA establishes a milestone for the contractor-developed business continuity framework and subsequent critical dates for the preparation of business continuity and contingency plans for each core business process or program service so that mission-critical functions affecting benefits delivery can be carried out if software applications and commercial off-the-shelf (COTS) products fail. These plans should provide a description of resources, staff roles, procedures, and timetables needed for implementation.
AIMD-98-237 Aug. 21, 1998	The Secretary of Veterans Affairs, with support from the VHA CIO, should ensure the rapid development of business continuity and contingency plans for each medical facility so that mission-critical functions affecting patient care can be carried out if software applications, COTS products, or facility-related systems and equipment do not function properly. These plans should address issues, such as when to invoke alternative solutions or options if the manufacturer, who VHA depends on for compliance information, does not submit any. The plans also should describe resources, staff roles, procedures, and timetables needed for implementation.
AIMD-98-175 Sept. 23, 1998	The Secretary of Veterans Affairs should develop and implement a comprehensive departmentwide computer security planning and management program. Included in this program should be procedures for ensuring that risks are assessed periodically to ensure that controls are appropriate.
AIMD-98-175 Sept. 23, 1998	The Secretary of Veterans Affairs should develop and implement a comprehensive departmentwide computer security planning and management program. Included in this program should be procedures for ensuring that security policies and procedures comprehensively address all aspects of VA's interconnected environment.
AIMD-98-175 Sept. 23, 1998	The Secretary of Veterans Affairs should direct the VA CIO to work in conjunction with the VBA and VHA CIOs and the facility directors, as appropriate, to establish controls to ensure that disaster recovery plans are comprehensive, current, fully tested, and maintained at the off-site storage facility.
AIMD-98-175 Sept. 23, 1998	The Secretary of Veterans Affairs should direct the VA CIO to review and assess computer control weaknesses that have been identified throughout the department and establish a process to ensure that these weaknesses are being addressed.
AIMD-98-175 Sept. 23, 1998	The Secretary of Veterans Affairs should direct the VA CIO to work in conjunction with the VBA and VHA CIOs and the facility directors, as appropriate, to separate incompatible computer responsibilities, such as system programming and security administration, and ensure that access controls enforce segregation of duties principles.

 

SPECIFIC PERFORMANCE GOALS IN VA’s FY 2000 PERFORMANCE PLAN

ADDRESSING

GAO- AND IG-DESIGNATED MAJOR MANAGEMENT CHALLENGES

Major Management Challenge	Specific Performance Goal(s)
VA’s health care infrastructure does not meet its current and future needs	None
Specifically, VA’s facilities are deteriorating, inappropriately configured, or no longer needed because of their age and VA’s shift from providing specialized inpatient services to providing primary care in an outpatient setting.	None.
Unneeded vacant space creates a financial drain on VA and maintaining unproductive assets siphons valuable resources away from providing direct medical services.	There is no goal or measure regarding eliminating vacant space and unproductive assets. However, the general goal mentioned calls for the "right sizing" of facilities. VA plans to implement that goal by consolidating and realigning services and facilities where there is costly redundancy, opportunities to achieve economies of scale, or when service or workload measures fall below minimum levels to assure cost effectiveness and clinical quality. However, the plan does not describe quantifiable goals or performance measures for these activities.
VA lacks adequate information to ensure that veterans have access to needed health care services. Specifically, VA lacks accurate, reliable, and consistent information for measuring the extent to which:	None.
Veterans are receiving equitable access to care across the country.	None.
All veterans enrolled in VA’s health care system are receiving the care they need.	None.
VA is maintaining its capacity to care for special populations, such as veterans with spinal cord injuries, amputations, traumatic brain injuries or who are blind. (The IG also identified resource allocation in the VA’s health care system as a management challenge. The IG will continue to monitor VHA’s progress in improving the balance of distribution of staffing and other resources.)	None.
VA lacks outcome measures and data to assess the impact of managed care initiatives. Specifically, VA does not know how its rapid move toward managed care is affecting the health status of veterans because measures of the effects of its service delivery changes on patient outcomes have not been established.	None.
VA needs to overcome difficulties in managing its non-health-care benefit programs. Specifically: VA cannot adequately ensure that its veterans disability compensation benefits are appropriately and equitably distributed because its disability rating schedule does not accurately reflect veterans’ economic losses resulting from their disabilities.	None.
Claims processing in the compensation and pension programs continues to be slow.	The plan contains performance goals to reduce processing time for rating-related C&P claims and appeals resolution to an average of 95 days and 545 days, respectively, by fiscal year 2000. Timeliness is listed as mission-critical management problems, and the plan lists several proposed actions including, adding staff to the claims processing operation, better training for staff, and pre-discharge examinations and information exchange between VA and DOD.
The vocational rehabilitation program has yielded limited results in finding jobs for veterans.	The plan contains a performance goal that, by FY 2000, at least 50 percent of veterans who exit the program will be rehabilitated.
VA has inadequate control and accountability over the direct loan and loan sales activities within VA’s Housing Credit Assistance program. (The IG also identified as management challenges: (1) the timeliness of C&P claims processing, and (2) debts from defaults on home loan guaranties and direct home loans. In March 1999, the IG gave VA a qualified opinion on its fiscal year 1998 financial statements due, in part, to material weaknesses in accounting in the loan guaranty program.)	None.
VA needs to manage its information systems more effectively. Specifically, VA has made progress in addressing Year 2000 challenges, but still has some issues to address. VA lacks adequate control and oversight of access to its computer systems. VA has not yet clearly linked its process for selecting, controlling, and evaluating information technology investments to any specific performance measures in its annual performance plan. (The IG also identified the Year 2000 computer problem and computer security as management challenges.)	None. None. None.
Health care quality management is one of the most serious and potentially volatile challenges facing VA. Specifically, the IG is concerned about: The potential for serious errors to increase as VA transitions into the more rapid pace of patient care in the ambulatory care setting. The caliber of leaders who are able to manage a "full service" VA operation and processes for monitoring and tracking quality of care in the 22 networks (VISNs). VHA’s inability to determine the role, staffing, and interactive relationships within VHA of the Office of Medical Inspector.	None. None.
Debt prevention and collection practices are deficient for compensation and pension payments, education payments, and medical care cost recovery (MCCR). The IG recommends that: Delinquent MCCR debts be referred to VBA for collection. VBA and VHA increase collaboration in the Income Verification Match program. VBA improve the quality and uniformity of its debt waiver decisions.	None. The plan states that VA has implemented in FY 1999 the practice of referring medical care debts that are delinquent beyond 90 days to VA’s Debt Management Center which will collect debts by offsetting payments to VA beneficiaries. None. None.
The timeliness and quality of medical examinations conducted for the purposes of deciding C&P claims need to be improved. Untimely or poor quality examinations lead to repeat examinations, resulting in remands of appealed cases and significant processing delays.	None.
VA is not effectively managing its Federal Employees’ Compensation Act (FECA) program. A pilot effort by the IG and VHA found VA employees who were fraudulently receiving workers’ compensation benefits under FECA, and private health providers who aided and abetted them. VA could reduce future workers’ compensation payments by returning current claimants to work if they are no longer disabled.	None. None. None.
VA needs to develop and implement a more effective method to identify inappropriate benefit payments. Specifically: VA needs to offset disability, compensation payments from active military reservists’ training and drill pay, but this has not occurred since at least FY 1993. VA needs to implement a more effective method to identify both deceased and incarcerated beneficiaries and to timely terminate their C&P benefits.	None. None. None.
VA has numerous automated data collection systems that are needed to support GPRA objectives. OIG has found erroneous data in many of these systems, including those involved in the following programs: Medical Care Compensation and Pension Education	None. Among the 11 most critical data elements: VHA’s data on the number of unique patients, prevention index, chronic disease care index, bed days, and addiction severity index. VBA’s data on the average days to complete original compensation claims, original disability pension claims, and reopened compensation claims. No education data were identified among the top 11 most critical data elements.