Social Security Administration: Better Planning Needed to Improve Service Delivery

GAO Testimony by Barbara D. Bovbjerg, managing director, education, workforce, and income security, before the Subcommittee on Social Security, House Committee on Ways and Means

While SSA is managing increasing workloads resulting from growing retirement and disability claims, it still faces the challenge of providing quality service. SSA’s management of increased workloads came at a cost—the accuracy rate for SSI overpayments fell to the lowest level in 30 years, and some customer service continues to decline. These problems may become more severe as workloads continue to grow from the nation’s baby boom generation, waves of SSA’s most experienced staff retire, and the current level of field office staffing stays flat. Such challenges make it essential for SSA to develop a plan to manage its increasing workload. Whether SSA will need more resources or an altered field office infrastructure, or both, is unclear. We still believe that a detailed service delivery plan should make this clear, and if additional resources are needed to achieve agencywide goals, SSA should identify the resources required to meet long-term service delivery needs.
Read More

Preliminary Findings on VA’s Provision of Health Care Services to Women Veterans

GAO Testimony Before the Senate Committee on Veterans Affairs The extent to which the VA medical facilities GAO visited were following VA policies that apply to the delivery of health care services for women veterans varied, but none of the facilities had fully implemented these policies. None of the VAMCs and CBOCs GAO visited were fully compliant with VA policy requirements related to privacy for women veterans in all clinical settings where those requirements applied. For example, many of the medical facilities GAO visited did not have adequate visual and auditory privacy in their check-in areas. Further, the facilities GAO visited were in various stages of implementing VA’s new initiative to provide comprehensive primary care for women veterans, but officials at some VAMCs and CBOCs reported that they were unclear about the specific steps they would need to take to meet the goals of the new policy. Officials at facilities that GAO visited identified a number of challenges they face in providing health care services to the increasing numbers of women veterans seeking VA health care. One challenge was that space constraints have raised issues affecting the provision of health care services. For example, the number, size, or configuration of exam rooms or bathrooms sometimes made it difficult for facilities to comply with VA requirements related to privacy for women veterans. Officials also reported challenges hiring providers with specific training and experience in women’s health care and in mental health care, such as treatment for women veterans with post-traumatic stress disorder or who had experienced military sexual trauma. Full Testimony

Testimony -- Moving to a Higher Level: How Collaboration and Cooperation Can Improve Nursing Home Quality

M. J. Koren, Moving to a Higher Level: How Collaboration and Cooperation Can Improve Nursing Home Quality, Invited Testimony, U.S. House of Representatives Committee on Energy and Commerce, Subcommittee on Oversight and Investigations, "In the Hands of Strangers: Are Nursing Homes Safeguards Working?," Thank you, Mr. Chairman, for this invitation to testify today. I am Dr. Mary Jane Koren, a geriatrician by training, and I've been involved with nursing homes for over 25 years. I've taken care of nursing home residents, taught medical students and geriatric fellows in nursing homes, and done research on nursing home quality. In addition, I was the director of New York State's Bureau of Long-Term Care, which oversaw the survey and certification process for New York's over 600 nursing homes, pilot-tested a new federal survey process for HCFA [now the Centers for Medicare and Medicaid Services], and implemented the Nursing Home Reform Law, OBRA'87, in New York. More recently—only last year—I sat by my father's beside in a nursing home during his final months.

Testimony--Achieving Person-Centered Primary Care: The Patient-Centered Medical Home

Thank you, Mr. Chairman, for this invitation to testify on person-centered care for older adults in ambulatory care settings. I am Melinda Abrams, assistant vice president at The Commonwealth Fund, where I direct the Patient-Centered Primary Care Initiative. The patient-centered medical home is an approach to providing person-centered care in primary care settings. This model organizes care around the relationship between the patient and the personal clinician. In February 2007, four primary care specialty societies representing more than 300,000 physicians released joint principles outlining and defining key characteristics of a medical home.