What GAO Discovered
The World Commerce Middle Well being Program, administered by the Nationwide Institute for Occupational Security and Well being (NIOSH), gives well being providers to eligible responders and survivors of the September 11, 2001, assaults for free of charge. NIOSH contracts with clinics within the New York Metropolis space and a Nationwide Supplier Community (NPN) to offer well being providers to those people—often called members. Spending on well being providers by this system elevated by about 85 % from fiscal 12 months 2016 by way of 2021. (See determine.) Clinics that serve responders within the New York Metropolis space accounted for almost all of well being providers spending. Clinics that serve survivors within the New York Metropolis space and thru the NPN accounted for a rising share of whole spending over the time interval reviewed.
World Commerce Middle Well being Program Spending on Well being Providers, Fiscal Years 2016 by way of 2021
The World Commerce Middle Well being Program High quality Assurance Committee is comprised of senior program management. It was established to develop high quality assurance aims, formulate plans to realize these aims, and monitor associated actions all through this system. That is to be achieved, for instance, by recommending the event of efficiency metrics. As well as, NIOSH developed strategic priorities for this system. In line with officers, NIOSH additionally applies sources, together with high quality assurance employees, to assist these priorities.
Well timed entry to well being providers is a crucial element of high quality well being care. Nevertheless, NIOSH has not specified making certain well timed entry among the many program’s strategic priorities. As well as, the High quality Assurance Committee has not assessed the extent to which members have well timed entry to well being providers by way of the NPN as a result of there are not any high quality assurance metrics for this. Nevertheless, data beforehand collected by the NPN contractor, which was not offered to the High quality Assurance Committee, signifies there have been potential issues with the timeliness of members’ entry to well being providers. Absent prioritizing well timed entry to well being providers, establishing metrics, and reviewing metric knowledge, there’s elevated danger that reported delays in some members’ entry to NPN-provided well being providers might proceed and negatively have an effect on these members’ morbidity, mortality, and high quality of life.
Why GAO Did This Examine
The World Commerce Middle Well being Program gives well being providers, equivalent to monitoring and therapy for situations associated to the September 11, 2001, assaults, by way of clinics within the New York Metropolis space and the NPN. This system is required to make sure cheap entry to well being providers by way of the NPN. Nevertheless, program stakeholders have reported delays with members’ entry to those providers.
The James Zadroga 9/11 Well being and Compensation Reauthorization Act included a provision for GAO to overview the World Commerce Middle Well being Program. This report examines the extent to which (1) program spending on well being providers elevated, and (2) NIOSH’s high quality assurance efforts included assessing the timeliness of entry to well being providers for members by way of the NPN. GAO analyzed knowledge on claims paid by this system. GAO additionally interviewed NIOSH officers and reviewed program paperwork on its high quality assurance governance construction and strategic priorities.
