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WASHINGTON,

DC 20510

August 21, 2018
The Honorable Gene L. Dodaro
Comptroller General
U.S. Government Accountability
441 G St., NW
Washington, D.C. 20548

Office

Dear Mr. Dodaro:
The Department of Veterans Affairs (VA) operates one of the largest health care systems
in the United States, encompassing
168 VA medical centers and 1,053 outpatient medical
facilities that provide care to more than 8.9 million veterans each year. Additionally, as the
nation's premier provider of mental health services to veterans, VA delivers services through the
Veterans Health Administration's
Readjustment Counseling Service's (RCS) 300 Vet Centers,
80 Mobile Vet Centers, and hundreds of Community Access Points. We believe Vet Centers are
vital to combat veteran, family member, and servicemember
wellness, and that is why we
supported increasing funding to expand readjustment counselling for Vet Centers to more than
$258 million in the Fiscal Year (FY) 2018 Omnibus Appropriations
law, $15 million above what
the President requested.
Recent reports have drawn attention to RCS's newly implemented productivity
standards. According to media reports, some counselors, including at the Vet Center in
Warwick. Rhode Island, have expressed concern that the productivity metrics have led to
burnout and increased staff turnover rates. As a result, we would like GAO to review RCS's
efforts to operationalize productivity measures and centralize back office functions.
Productivity Standards.
Vet Centers provided nearly 2 million visits and outreach contacts in
FY 2017, a 9% increase over FY 2016. RCS has implemented, for the first time in recent
history, standardized productivity metrics for its counselors, combining outreach events,
individual and group counseling, and family counseling to require 25 encounters per 40 hours
worked. RCS has indicated that it will utilize the same metrics in FY 2019. These metrics were
apparently derived internally from historical self-reported information.
These productivity
measures reflect RCS's unique care delivery model in VA, and are different than that required of
mental health providers in other VHA facilities. To better understand whether RCS's
productivity measures are appropriate, we ask GAO to answer the following questions:
1. Are the changes to the performance metrics having any impact on the quality of services
or the perception of services provided to servicemembers,
veterans. and family members
receiving care at RCS facilities?
2.

Similarly, have RCS facilities seen any increase in turnover or reduction in qualified
applicants for Readjustment Counselor positions since these new standards were
implemented?
If so, what explains these changes?

 3.

Were the performance metrics derived from any objective industry standards and to what
extent is RCS taking action to ensure the standards are not arbitrary and are adjusted
appropriately over time?

Centralization.

In 2018, RCS also centralized

its human resources, finance, and infrastructure
functions. These changes also impact on counselor" s perceptions of the RCS operations because
of disruptions to the hiring process and determinations
ohvhich positions to backfill. While this
centralization provides RCS leadership with greater visibility and accountability of operations,
individual Vet Center leadership may now feel challenged to operate as effectively as they had
previously. Specifically, we would ask you to examine:
1. Whether the centralization of human resources services was implemented seamlessly
if appropriate plans are in place to monitor and alter its operations as needed?
2.

What steps has RCS taken to ensure that staffing levels at Vet Centers are calculated
appropriately and how is local Vet Center and regional District leadership involved in
these decisions?

3.

What processes does RCS have in place to analyze future utilization
footprint will be able to respond to growing demand?

and

and ensure that its

We look forward to working with you and your staff on these important requests. For
additional information on these requests. please contact J Ohl1Nobrega of Senator Reed' s staff at
(202) 224-4642 or Jon Coen on the Senate Veterans Affairs Committee at (202) 224-2074.
Sincerely,

JOI ester
U ted States Senator

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