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Despite decades of prodding, VHA still doesn't measure physicians' productivity

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A lack of standards for its physicians' productivity hampers the Veterans Health Administration's ability to determine how many physicians it needs, the Veterans Affairs office of inspector general says.

VHA didn't have such standards for 31 of the 33 specialty services auditors reviewed for a report dated Dec. 27. Ophthalmology and radiology were the exceptions.

The situation stems from VHA's inability to agree on what methodology to use to measure productivity, the report (.pdf) says.

That issue is not new. In 1981, the Government Accountability Office recommended that VHA develop a methodology to measure the productivity of its physicians, and six more GAO or VA OIG reports have made similar recommendations since then, this report says.

The VHA's own office of productivity, efficiency and staffing called for productivity standards back in 2006.

The office has also created a tool to measure a physician's workload, number of encounters and number of unique patients. The tool also lets medical facilities compare their productivity to the average VHA facility, other similar facilities and private sector standards. But in their visits to five VHA facilities, auditors found none using the tool.

Some personnel weren't aware the tool was available, and others didn't monitor productivity because it wasn't required or because their access to the tool was limited, auditors say.

While auditors acknowledge the challenge of measuring productivity and establishing standards for every specialty, they say VHA needs a plan by the end of the fiscal year to ensure all specialties have standards within three years.

At least five specialties should have productivity standards by the end of the fiscal year, the report also recommends.

Robert Petzel, VA's undersecretary for health, agreed with the recommendations "in principle." In June 2012, the undersecretary established a task force to decide on a productivity methodology.

For more:
- download the report, 11-01827-36 (.pdf)

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