WASHINGTON, DC — Some of the data VA used to support the recommendations made in its Asset and Infrastructure Report (AIR) is outdated and flawed, VA leaders recently admitted.
One issue was that the COVID-19 pandemic had a profound impact on healthcare services across the country, little of which is acknowledged in VA’s market analysis.
VA’s recommendations, which include drastic changes to VA’s physical footprint in many areas of the country, have predictably caused controversy among veterans and legislators, who are resistant to any perceived removal of resources.
It’s also becoming less and less likely that the AIR Commission, the group of experts the report was meant to assist, will have adequate time to do the job they’re being convened for, which is to help determine the future of VA’s physical infrastructure across the country.
The AIR Commission is a component of the 2018 MISSION Act, which requires Congress to convene a group of experts who will make recommendations to the president on where VA facilities are needed and what type of care those facilities will need to be ready to provide. Over the last few years, VA has been developing a market analysis examining usage trends at VA facilities across the country. Using that analysis, the department put together its AIR Report, released last March, which is to be given to the AIR Commission to help the group make their recommendations.
In it, VA makes its own recommendations on which facilities should be renovated, moved or shuttered and where new facilities will need to be built. The report makes complex and wide-ranging predictions on where veterans will be seeking care in the future and which type of care they will be seeking.
VA compiled the data for its market analysis from December 2018 to November 2020, however, ending its efforts before any long-term effects of the pandemic had taken hold. The acceleration of telemedicine and patients’ growing comfort with technology is only one of the pandemic’s outcome that will impact the number of veterans physically seeking care at facilities.
The analysis also does not fully take into account the changes wrought by VA’s Community Care Program.
According to a recent Government Accountability Office (GAO) report critiquing the market analysis, VA only had data from the first four months of the program when they made their projection on how many veterans would take advantage of community care in the future. GAO expressed doubt that this projection could be entirely accurate.
The report also cast doubt on the reliability of VA’s data in general, noting that the department had no way of verifying its accuracy.
“Documentation on VA’s approach to the market assessments indicated that the department relied mostly on data compiled from its own databases; however, VA’s approach to market assessments did not include steps to determine the reliability of the department’s data for the purposes of the market assessments other than having the Network Directors provide certifications, nor did VA’s approach include plans to report externally on what is known regarding the reliability of these data,” the report stated.
During a House VA Committee budget hearing last month, VA Secretary Denis McDonough acknowledged the flaws in VA’s analysis.
“Since I got this job, I’ve been looking very hard at these questions about whether the data … that forms the foundation for the analytics basis is accurate,” McDonough said. “That’s why I asked a Red Team of well-regarded healthcare experts and former senior officials to take a look at the data. They came back with an answer that I feared, which is that they think the data is not up to speed in light of the pandemic. GAO subsequently came to a similar conclusion.”
Because of the statues built into the MISSION Act, VA was limited in how it could address this lack of good data, because it was facing a tight deadline to get its recommendations published.
“We’ve done the only thing allowed to us under the statute,” McDonough explained. “We’ve set up a process where we will continually update over the life of the commission’s consideration, which is from whenever the Senate confirms those commissioners until roughly next February. We will give the commission updated recommendations.”
When that Senate confirmation will occur is unclear. The commission is to be made up of nine members, submitted by the president and approved by the Senate. Those nine members were supposed to be submitted to the Senate by May 2021. Currently, there are eight members awaiting approval and one member who has yet to be submitted.
“The statute has pretty hard and fast dates in it,” McDonough said. “I don’t think the statue envisions the commission meeting after January 2023 and then the president’s on a tight timeline, then you’re all on a tight timeline. The longer this hangs out there, the less time they have to look at the recommendations. And while I think I did good work, there’s a high probability I screwed something up, so I hope the commission has time to look at it.”
