Summary: Pursuant to a congressional request, GAO reviewed the Veterans Administration's (VA) monitoring of its Cardiac Surgery Program and Kidney Transplant Program, focusing on whether VA: (1) developed adequate performance standards; (2) centers met these standards; and (3) adequately monitored centers' performance.
GAO found that VA: (1) required its cardiac surgery centers to perform at least 100 procedures a year; (2) set a 5-percent maximum mortality rate for coronary artery bypass grafts and an overall maximum mortality rate for all procedures of not more than twice its national average; (3) raised its standard for the minimum annual number of cardiac surgical procedures to 150 starting in 1988; (4) relied on semiannual reviews of patients' medical records to monitor cardiac surgery centers, although such reviews failed to address nonsurgical problems such as staff recruitment and retention, patient selection, infection control, and outdated equipment and facilities; and (5) did not require site visits even if centers were not meeting performance standards, and made only five site visits during fiscal years 1986 and 1987. GAO also found that VA: (1) reduced its performance standard for kidney transplants from 15 to 12 a year; (2) did not establish standards for patient and transplanted kidney survival rates, although a Department of Health and Human Services (HHS) task force proposed such standards; and (3) conducted very limited monitoring of centers' kidney transplant programs. In addition, GAO found that, in fiscal year 1987: (1) 28 of 43 cardiac surgery centers met VA utilization and mortality standards; and (2) four of nine kidney transplant programs met the VA standards.
