US Government Accountability Office GAO

Lack of effective procurment strategy - Background

"The Department of Veterans Affairs (VA) has taken some steps in recent years to modernize its processes to acquire hundreds of millions of dollars-worth of medical supplies annually. However, implementation delays for key initiatives, including a new, enterprise-wide inventory management system, limit VA’s ability to have an agile, responsive supply chain. Prior to the Coronavirus Disease 2019 (COVID-19) pandemic, in November 2017 and in GAO’s High-Risk report in March 2019, GAO reported on weaknesses in VA’s acquisition management. For example, GAO reported that VA’s implementation of its Medical-Surgical Prime Vendor-Next Generation (MSPV-NG) program—VA’s primary means for purchasing medical supplies—lacked an effective medical supply procurement strategy, clinician involvement, and reliable data systems. GAO also found that several of VA’s medical supply management practices were not in line with those employed by private sector leading hospital networks. "

Pandemic underlines systemic weaknesses

"GAO’s preliminary observations also show that in response to COVID-19, VA is using various contracting organizations and mechanisms to meet its critical medical supply needs. These include using national and regional contracting offices to obtain supplies from existing contract vehicles, new contracts and agreements, and the Federal Emergency Management Administration’s Strategic National Stockpile to respond to the pandemic. "

"Like most medical institutions nationwide, VA has faced difficulties obtaining personal protective equipment (PPE) for its medical workforce during the Coronavirus Disease 2019 (COVID-19) pandemic, and VA’s antiquated inventory management system hampered its ability to identify the extent to which each of its 170 medical centers faced these shortages. VA officials reported that they had difficulty obtaining sufficient supplies from their existing supply chain and associated contracting vehicles; thus, VA used new contracts and agreements to fill some of this void. "

Addressing shortfalls delayed

"VA is developing another iteration of its MSPV program, called MSPV 2.0, which GAO’s preliminary observations show is intended to address some of the shortfalls GAO has identified in its past and ongoing program reviews. In November 2017, GAO recommended that VA develop, document and communicate an overarching MSPV-NG strategy—to include how the program office will prioritize categories of supplies and increase clinician involvement in this process. Preliminary observations from GAO’s ongoing work indicate that VA has taken some steps, as it implements MSPV 2.0, to address this priority recommendation. However, GAO’s preliminary observations also indicate that the MSPV 2.0 program implementation is delayed and some of these existing program challenges may not be remedied. "

"Based on preliminary observations from GAO’s ongoing work, VA’s implementation of a new supply and inventory management system is delayed. As a result, VA had to rely on an antiquated inventory management system, and initial, manual spreadsheets to oversee the stock of critical medical supplies at its medical centers. This limited the ability of VA management to have real-time information on its pandemic response supplies, ranging from N95 face masks to isolation gowns, to make key decisions. As of April 2020, VA has an automated tool to manage its reporting process, but the information must be gathered and manually reported by each of VA’s 170 medical centers on a daily basis."

Priorities and involvement of experts needed

"Since 2015, we have issued five reports on VA’s acquisition management challenges, with 40 recommendations, and we elevated this issue to GAO’s High-Risk List in 2019, due to longstanding problems such as ineffective purchasing of medical supplies and lack of reliable data systems.1 VA has addressed 22 of our prior recommendations. For example, in November 2017, GAO recommended that VA develop, document, and communicate an overarching Medical-Surgical Prime Vendor-Next Generation (MSPV-NG) strategy—to include how the program office will prioritize categories of supplies and increase clinician involvement in this effort. Our preliminary observations from our ongoing work indicate that although VA has taken some steps to address this priority recommendation, it has yet to fully implement it. Further, VA has also begun efforts to modernize its supply chain, but our ongoing work indicates that several key initiatives are delayed, further limiting VA’s ability to have an agile, responsive acquisition management system. "

Recommendation 01 Further actions are needed to implement the remaining recommendations, such as GAO’s recommendation that VA implement an overarching MSPV strategy, and demonstrate progress toward removing this area from GAO’s High-Risk list.
The items above were selected and named by the e-Government Subgroup of the EUROSAI IT Working Group on the basis of publicly available report of the author Supreme Audit Institutions (SAI). In the same way, the Subgroup prepared the analytical assumptions and headings. All readers are encouraged to consult the original texts by the author SAIs (linked).