GAO contends VA’s performance system isn’t boosting quality

A performance measurement system intended to rank the Veterans Health Administration’s medical centers may not be effectively measuring their quality of care.

That’s the assessment of a new audit conducted by the Government Accountability Office and released on Tuesday.

According to the GAO, the VHA primarily uses clinical data from its Strategic Analytics for Improvement and Learning (SAIL) system—which includes 27 quality measures—to calculate and assign each medical center with an annual rating of one star (lowest) to five stars (highest).

“Although the specific medical centers within each star-rating category could change from year to year, GAO found that the Fiscal Year 2018 star ratings for 110 of the 127 medical centers (87 percent) that received star ratings in Fiscal Year 2013 did not differ by more than 1 star from their Fiscal Year 2013 rating,” states the report by auditors.

Making matters worse, the GAO noted that since SAIL was established in 2012 there have been two evaluations of the performance measurement system—in 2014 and 2015—but VHA has not implemented the more than 40 combined recommendations from those evaluations, which found issues related to SAIL’s validity and reliability.

“The findings are similar to concerns expressed by officials GAO interviewed from VHA, networks and medical centers about SAIL's effectiveness and how it is currently being used to assess medical center performance,” states the GAO’s report. “VHA officials told GAO the findings and recommendations of the previous SAIL evaluations were not assessed because the evaluation reports were not widely distributed within VHA due to leadership turnover, as well as attention that was diverted to other concerns, such as extensive wait times for medical appointments.”

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However, auditors warned that “without ensuring that the recommendations resulting from these previous evaluations are assessed and implemented as appropriate, the identified deficiencies may not be adequately resolved.” As a result, they contend that the integrity of SAIL to effectively evaluate the performance of VHA’s medical centers might be diminished, undermining the ability of veterans to accurately compare quality of care at the facilities.

To address these issues, the GAO recommended that the Under Secretary for Health assess recommendations from previous evaluations of SAIL for implementation, as well as putting into practice—as appropriate—recommendations resulting from the assessment.

VA concurred with both of the GAO's recommendations and identified actions the agency is taking to implement them.

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