VA Health Care: Recruitment and Retention Challenges and Efforts to Make Salaries Competitive for Nurse Anesthetists
Published: 2008-04-09T00:00:00

Fast Facts:

Highlights:
section_title: Why GAO Did This Study
paragraphs: Certified registered nurse anesthetists (CRNA), registered nurses who have completed a master's degree program in nurse anesthesia, provide the majority of anesthesia care in the Department of Veterans Affairs (VA) medical facilities. There are approximately 500 VA-employed CRNAs (VA CRNA) who provide care to veterans in VA medical facilities. While the demand for CRNAs has increased, many employed by VA are nearing retirement eligibility age. Concerns have been raised about the challenges VA may face in making VA CRNA salaries competitive in order to maintain its VA CRNA workforce, particularly in local markets that can be highly competitive. This testimony is based on GAO work reported in VA Health Care: Many Medical Facilities Have Challenges in Recruiting and Retaining Nurse Anesthetists, ( GAO-08-56 , Dec. 13, 2007). This testimony (1) identifies workforce challenges that VA medical facilities experience related to VA CRNAs, and (2) identifies a key mechanism that VA medical facilities have to help make VA CRNA salaries competitive and the extent to which VA facilities use this mechanism. For the December 2007 report, GAO analyzed surveys sent to VA chief anesthesiologists, VA human resources officers, and VA CRNAs. GAO also visited eight VA medical facilities and interviewed facility officials about efforts to recruit and retain VA CRNAs.
section_title: What GAO Found
paragraphs: GAO reported in December 2007 that VA medical facilities had challenges recruiting and retaining VA CRNAs. In GAO's report, most surveyed officials said that they had difficulty recruiting VA CRNAs at their facilities. The challenge of recruiting VA CRNAs affected the ability of VA officials to reduce existing VA CRNA vacancy rates--the number of unfilled VA CRNA positions--at their medical facilities. Vacancy rates varied across VA and, according to GAO's survey, impacted the delivery of services at VA medical facilities. On the basis of its survey results, GAO also found that in addition to their current recruiting challenges, VA medical facilities would likely face a challenge retaining VA CRNAs in the next 5 years due to the number of VA CRNAs projected to either retire from or leave VA. VA medical facility officials reported in GAO's survey that the recruitment and retention challenges were caused primarily by the low level of VA CRNA salaries when compared with CRNA salaries in local market areas. GAO also reported that VA's locality pay system (LPS) is a key mechanism VA medical facilities can use to determine whether to adjust VA CRNA salaries to help the facilities remain competitive with CRNA salaries in local market areas. GAO also reported that the majority of VA medical facilities that employ VA CRNAs used LPS. However, at the eight VA medical facilities it visited, GAO found that although the facilities used VA's LPS, the majority of them did not fully follow VA's LPS policy correctly in either 2005 or 2006. The problems some VA medical facilities had fully following VA's LPS policy, along with the explanations of facility officials, indicated that VA had not provided adequate training on its LPS policy. As a result, VA medical facility officials cannot ensure that VA CRNA salaries have been adjusted as needed to be competitive in local market areas. Training on the LPS is necessary to help ensure that VA medical facilities are competitive as an employer. In December 2007, GAO recommended that VA expedite the development and implementation of a training course for VA medical facility officials responsible for compliance with the policy. VA agreed with GAO's recommendation and in comments on GAO's draft report stated that it had developed a draft action plan for training staff on its LPS policy. VA anticipated that the online training course would be available by the end of fiscal year 2008.

section_title: Letter
paragraphs: I am pleased to be here today as you discuss personnel issues in the  Department of Veterans Affairs (VA). One such issue VA faces is an  increased demand for the services provided by certified registered nurse  anesthetists (CRNA), who provide the majority of anesthesia care veterans  receive in medical facilities operated by VA. CRNAs are registered nurses  who have completed a 2- to 3-year master’s degree program in nurse  anesthesia and who typically provide anesthesia care in health care  settings with anesthesiologists and surgeons. There are approximately 500  VA-employed CRNAs (VA CRNA) who provide anesthesia care to veterans  in VA medical facilities. When hiring VA CRNAs, VA places them in one of  five pay grades, based on the CRNA’s education and experience. The  demand for these practitioners in VA medical facilities has continued to  increase because CRNAs are no longer used only in the operating room,  but are used in other areas of a medical facility, such as administering  anesthesia to patients who are undergoing cardiac catheterization and  providing airway management to patients during cardiac emergencies.
While the demand for CRNAs has continued to increase, many VA CRNAs  are nearing retirement eligibility age. According to VA officials, more than  half of VA CRNAs are over the age of 51, and the average VA CRNA is   7 years closer to retirement eligibility than the average CRNA nationally.  Given the increased demand for CRNAs and the important role they play  in providing anesthesia services in VA medical facilities, concerns have  been raised about the challenges VA may face in making VA CRNA salaries  competitive in order to maintain its VA CRNA workforce, particularly in  some local markets where the labor market for CRNAs can be highly  competitive.
In December 2007 we issued a report that examined the challenges VA  faces recruiting and retaining VA CRNAs. My remarks today are based on  this report. Specifically, I will (1) identify workforce challenges that VA  medical facilities experience related to VA CRNAs, and (2) identify a key  mechanism that VA medical facilities have to help make VA CRNA salaries  competitive for recruitment and retention purposes and the extent to  which VA facilities use this mechanism.
To do the work for our December 2007 report, we analyzed Web-based  surveys we sent to all VA chief anesthesiologists, VA human resources  (HR) officers, and VA CRNAs, with survey response rates of 92, 85, and   76 percent, respectively. We also analyzed data on VA CRNA vacancies— the number of unfilled VA CRNA positions at VA medical facilities— obtained from VA headquarters. These data were from 2005, the most  recent year for which vacancy data were available at the time of our  review. Additionally, we obtained data on VA CRNAs’ salaries for 2005,  2006, and 2007 and compared these to national salary data we obtained  from the American Association of Nurse Anesthetists (AANA), a  professional organization for CRNAs. We visited eight VA medical  facilities and interviewed chief anesthesiologists, VA CRNAs, HR officers,  and other facility officials about their efforts to recruit and retain VA  CRNAs. We also interviewed a representative from Kaiser Permanente, a  large health care plan that primarily uses CRNAs to deliver anesthesia  services, to identify what steps this plan takes to ensure it has a sufficient  number of CRNAs and to determine the indicators this plan uses to  identify a CRNA shortage or potential future CRNA shortage. To ensure  the reliability of the survey and national salary data we used, we  performed a systematic review of the returned questionnaires and  interviewed VA and AANA officials about the quality checks and edits they  performed on their data. We determined that the data we used were  adequate for our purposes. We conducted our work from June 2006  through October 2007 in accordance with generally accepted government  auditing standards. Those standards require that we plan and perform the  audit to obtain sufficient, appropriate evidence to provide a reasonable  basis for our findings based on our audit objectives. We believe that the  evidence obtained provides a reasonable basis for our findings based on  our audit objectives.
In summary, in December 2007 we reported that VA medical facilities had  challenges recruiting and retaining VA CRNAs. Seventy-four percent of the  VA chief anesthesiologists who responded to our survey reported that they  had difficulty recruiting VA CRNAs in fiscal years 2005 and 2006. The  challenge of recruiting VA CRNAs affected the ability of VA officials to  reduce existing VA CRNA vacancy rates at their medical facilities. In our  survey, 54 percent of the VA chief anesthesiologists with VA CRNA  vacancies reported that they temporarily closed operating rooms, and 72  percent reported that they delayed elective surgeries as a result of VA  CRNA vacancies in fiscal year 2006. Based on our survey results, we also  found that in addition to their current recruiting challenges, VA medical  facilities would likely face a challenge retaining VA CRNAs in the next 5  years due to the number of VA CRNAs projected to either retire from or  leave VA. VA medical facility officials reported in our survey that the  recruitment and retention challenges were caused primarily by the low  level of VA CRNA salaries when compared with CRNA salaries in local  market areas. In December 2007 we also reported that VA’s locality pay  system (LPS) is a key mechanism that VA medical facilities can use to  determine whether to adjust VA CRNA salaries to help the facilities remain  competitive with CRNA salaries in local market areas. We reported that  the majority of VA medical facilities that employ VA CRNAs used LPS.  However, at the eight VA medical facilities we visited, we found that  although the facilities used VA’s LPS, five of these facilities did not fully  follow VA’s LPS policy correctly in either 2005 or 2006. The problems  some VA medical facilities had fully following VA’s LPS policy, along with  the explanations of facility officials, indicated that VA had not provided  adequate training on its LPS policy. As a result, VA medical facility officials  cannot ensure that VA CRNA salaries have been adjusted as needed to be  competitive in local market areas. Training on the LPS is necessary to help  ensure that VA medical facilities are competitive as an employer.
To improve VA’s ability to recruit and retain VA CRNAs, we recommended  that the Secretary of Veterans Affairs direct the Assistant Secretary for  Human Resources and Administration to expedite development and  implementation of a training course on VA’s LPS policy for VA medical  facility officials responsible for compliance with the policy. VA generally  agreed with our conclusions and recommendation and stated that it had  developed a draft action plan for training staff on this policy and  anticipated that an online training course would be available by the end of  fiscal year 2008.
subsections: section_title: VA Medical Facilities Have VA CRNA Recruitment and Retention Challenges Primarily Because of Noncompetitive Salaries
paragraphs: We reported in December 2007 that VA medical facilities had challenges  recruiting and retaining VA CRNAs. On the basis of our survey results, we  found that VA medical facilities had challenges in recruiting VA CRNAs at  their facilities and will likely face challenges in retaining VA CRNAs in the  next 5 years due to the number of VA CRNAs projected to either retire  from or leave VA. VA medical facility officials reported in our survey that  the recruitment and retention challenges were caused primarily by the low  level of VA CRNA salaries when compared with CRNA salaries in local  market areas.
subsections: section_title: VA Officials Reported Challenges Recruiting CRNAs, and Projected VA CRNA Attrition Will Likely Create Retention Challenge in the Next 5 Years
paragraphs: In December 2007 we reported our survey results indicating that VA  medical facilities had a challenge recruiting VA CRNAs. Of all VA medical  facility chief anesthesiologists who responded to our survey, 74 percent  reported that they had difficulty recruiting VA CRNAs in fiscal years 2005  and 2006. The recruiting challenges also affected VA medical facility  officials’ ability to reduce existing VA CRNA vacancy rates at their medical  facilities. Additionally, VA medical facility officials responding to our  survey reported that it took VA facilities a long time—on average about   15 months—to fill a VA CRNA vacancy from the time facility management  approval is granted to fill the position until the time the VA CRNA actually  begins providing services at the facility. In particular, VA chief  anesthesiologists at 11 medical facilities reported that their facilities took  2 years or more on average to fill a VA CRNA vacancy. In our survey, the  shortest time taken to fill a vacancy, as reported by the chief  anesthesiologists, was 2 months, and the longest was 60 months.
The challenge of recruiting CRNAs limited the ability of VA officials to  reduce existing vacancy rates at their medical facilities. VA’s fiscal year  2005 vacancy data show that VA had about a 13 percent VA CRNA vacancy  rate systemwide, or 70 unfilled VA CRNA positions at 43 medical facilities.  These rates varied across VA, with 26 medical facilities having vacancy  rates of 25 percent or more and 15 of them having vacancy rates of   40 percent or more in fiscal year 2005. According to the director of Kaiser  Permanente’s school of anesthesia for nurse anesthetists, a vacancy rate of  40 percent or higher is considered indicative of a staffing problem. Like  VA’s vacancy data, our survey also suggested that VA CRNA vacancies  were common across VA medical facilities. Of the chief anesthesiologists  responding to our survey, 54 percent reported that they had VA CRNA  vacancies at their VA medical facilities, with the number of VA CRNA  vacancies ranging from one to six.
According to our survey, VA CRNA vacancies impacted the delivery of  services at VA medical facilities. For example, 54 percent of the VA chief  anesthesiologists with VA CRNA vacancies reported that they temporarily  closed operating rooms, 72 percent delayed elective surgeries, and   68 percent increased the use of overtime for VA CRNAs, as a result of VA  CRNA vacancies in fiscal year 2006. Moreover, 44 percent of chief  anesthesiologists that had VA CRNA vacancies reported that contract  CRNAs supplied by outside companies were used to supplement the VA  facilities’ VA CRNA workforce. In addition, almost one-third of the chief  anesthesiologists whose vacancies were filled by VA CRNAs reported that  they still had a shortage of CRNAs.
In addition to the challenges of recruiting VA CRNAs, we also reported  that VA medical facilities were likely to face another workforce challenge  in the future. Specifically, we found that in the next 5 years VA medical  facilities would likely have difficulty retaining VA CRNAs in their  workforce and this trend could increase the number of VA CRNA  vacancies across VA. On the basis of VA CRNA responses to our survey,  we projected a VA CRNA attrition rate of 26 percent across VA in the next  5 years—that is, 26 percent of VA CRNAs either planned to retire or leave  VA’s health care system within the next 5 years. Overall, 93 VA CRNAs at  53 of VA’s 120 medical facilities that employ VA CRNAs reported that they  plan to retire or leave VA’s health care system. While the overall projected  attrition rate across VA, on the basis of our survey results, will likely be   26 percent, this rate will vary by medical facility. In 27 VA medical  facilities, we projected that the attrition rate would likely be 50 percent or  higher. According to the director of Kaiser Permanente’s school of  anesthesia for nurse anesthetists, an attrition rate of 50 percent or higher  is considered indicative of a future staffing problem.
section_title: According to VA Officials and VA CRNAs, Recruitment and Retention Challenges Are Due to Noncompetitive VA CRNA Salaries
paragraphs: Our surveys of VA medical facility chief anesthesiologists and HR officers  indicated that medical facilities had trouble recruiting and will have  trouble retaining VA CRNAs because salaries for VA CRNAs were low  compared to CRNA salaries in local market areas. Specifically, of the   69 chief anesthesiologists who reported having difficulty recruiting VA  CRNAs during fiscal years 2005 and 2006, about 60 of them attributed this  difficulty primarily to the fact that salaries for VA CRNAs at their medical  facilities were not competitive with CRNA salaries in local market areas.  Additionally, of the 46 chief anesthesiologists who reported having  difficulty retaining VA CRNAs during fiscal years 2005 and 2006, 36 of  them attributed this primarily to the fact that salaries for experienced VA  CRNAs at their medical facilities were not competitive with CRNA  salaries in local market areas. Other reasons most frequently cited by the  chief anesthesiologists were indirectly associated with the level of VA  CRNA salaries.
Of the chief anesthesiologists we surveyed, 72 percent (67) reported that  VA CRNA starting salaries for new graduates at their facility were lower  than local market area salaries in fiscal year 2005, and 69 percent (64)  reported this in fiscal year 2006. In fiscal years 2005 and 2006, 79 percent  (73) of chief anesthesiologists estimated that salaries for experienced VA  CRNAs at their medical facility were lower than local market area CRNA  salaries. Furthermore, about 40 percent of chief anesthesiologists also  reported that salaries for both new graduate and experienced VA CRNAs  at their facility were $10,000 to $30,000 lower than CRNAs salaries in local  market areas during fiscal years 2005 and 2006. (See table 1 for the  differences in VA CRNA salaries and CRNA salaries in local market areas  in fiscal years 2005 and 2006, as reported by VA chief anesthesiologists.)
In December 2007, we reported that to address recruitment challenges  related to VA CRNA salaries, VA CRNAs and the director of VA’s  anesthesia services told us that they were revising VA’s CRNA qualification  standards. These standards establish the five pay grades—grade I being  the lowest—that VA CRNAs are placed into when hired, based on CRNAs’  education and experience. According to the officials, the change to VA’s  qualification standards will have the effect of increasing starting salaries  for new graduate VA CRNAs from grade I to grade II. However, we found  that this revision to VA CRNA qualification standards—increase in grade  and resulting starting salary—would be unlikely to make most VA CRNA  starting salaries competitive with local market area CRNA starting  salaries. We compared VA CRNA 2007 salary schedules to projected AANA  2007 salary data to determine whether VA CRNA salaries would be  competitive with local market area CRNA salaries if salaries for new  graduate VA CRNAs were changed from grade I to grade II. Our analysis  showed that this revision to VA CRNA qualification standards would not  make most VA CRNA starting salaries competitive with local market area  starting CRNA salaries. Specifically, 75 of 120 VA medical facilities that  employ VA CRNAs would have VA CRNA starting salaries below local  market area CRNA salaries by $20,000 or more.
We found similar challenges related to the retention of VA CRNAs. At the  time of our review, more than half of all VA CRNAs earned the maximum  statutory salary cap for a VA CRNA in 2006, which was $133,900.  However, at 107 of VA’s 120 medical facilities that employ VA CRNAs the  2006 maximum statutory salary cap was at least $20,000 lower than 2006  CRNA salaries in local market areas. The 2007 maximum statutory salary  cap increased to $136,200. According to VA officials, VA is developing  proposed legislation to increase this maximum statutory salary cap for VA  CRNAs by $9,200. Our analysis comparing AANA 2007 salary data for  CRNAs to VA’s CRNA 2007 maximum statutory salary cap indicated that  increasing the VA CRNA maximum statutory salary cap by $9,200 would  not, at a majority of VA medical facilities, make VA CRNA salaries  competitive with CRNA salaries in local market areas. Specifically, using  2007 rates, we found that after the proposed change, 70 of the 120 VA  medical facilities’ VA CRNA salaries would still be at least $20,000 or lower  than the local market area CRNA salaries.
section_title: VA Medical Facilities Can Use LPS to Help Make VA CRNA Salaries Competitive, and While Majority of Facilities Have Used LPS, Some Have Not Followed VA’s LPS Policy
paragraphs: In December 2007, we reported that VA’s LPS system is a key mechanism  that VA medical facilities can use to determine whether to adjust VA CRNA  salaries to help the facilities remain competitive with CRNA salaries in  local market areas. We also reported that the majority of VA medical  facilities that employ VA CRNAs used LPS. However, at the eight VA  medical facilities we visited, we found that although the facilities used  VA’s LPS, the majority of them did not fully follow VA’s LPS policy  correctly in either 2005 or 2006.
subsections: section_title: To Recruit and Retain VA CRNAs, Medical Facilities Can Adjust Salaries Using VA’s LPS
paragraphs: In December 2007, we reported that VA CRNA pay grades—and thus  salaries—are initially determined by VA’s qualification standards for VA  CRNAs. Although VA medical facility directors are required to use the LPS  to determine if VA CRNA salaries should be adjusted, they have the option  of adjusting these salaries to recruit and retain VA CRNAs. When  adjusting VA CRNA salaries, VA medical facilities are required to use a  process known as LPS. The system is intended to help VA medical  facilities determine whether to adjust VA CRNA salaries to be regionally  competitive. VA’s LPS supports this goal by providing information on  salaries paid to CRNAs in a facility’s local market area. To collect data for  the LPS, medical facility directors, who are responsible for their facility’s  LPS, can either use a salary survey conducted by another entity or conduct  their own survey in order to determine the CRNA salary levels paid by  health care establishments in the local market area.
VA has an LPS policy, which requires that a medical facility director  initiate an LPS survey if the director determines that a significant pay- related staffing problem exists or is likely to exist for any occupation or  specialty. VA’s LPS policy instructs medical facilities to use a survey  conducted by the Bureau of Labor Statistics (BLS); however, if data from  this survey are not available or not current, facilities are to use a third- party locality pay survey. Third-party surveys include those that are  purchased from a third-party service that collects compensation data on  salaries of health care occupations. These surveys can also include salary  data collected by local hospital associations for their member health care  establishments. When BLS or other third-party surveys are not available or  do not contain sufficient salary data, facilities are to conduct their own  locality pay survey.
Under VA’s LPS policy, a third-party locality pay survey must include data  from at least three non-VA health care establishments, such as hospitals  and outpatient clinics. VA’s LPS policy requires that a third-party survey  cover an appropriate local market area, which is defined by VA as one that  includes the county in which the VA medical facility is located and  includes health care establishments that compete for the same type of  clinical employees, such as CRNAs. The health care establishments that  participate in a third-party survey should provide job descriptions that  include the duties, responsibilities, and education and experience  requirements of CRNAs and should be able to be readily job-matched to  VA’s description of the VA CRNA grade levels.
If a VA medical facility conducts its own LPS survey, VA’s LPS policy  requires that the geographic area surveyed be defined. In order to be valid,  three health care establishments must have job descriptions for CRNAs  that can be job-matched to VA CRNA grade levels. A VA medical facility  may expand the geographic area surveyed when the surveyed area will not  adequately reflect the local market area salaries for CRNAs or there are  less than three job matches.
Once the survey is completed, a facility’s HR officer reports the results to  the medical facility director and on the basis of the survey data,  recommends whether to adjust VA CRNA salaries. The facility director  makes the final decision on whether to adjust the facility’s VA CRNA  salaries and, therefore, may choose not to adjust existing salaries  regardless of what the survey data show, according to VA’s policy. VA  medical facility directors consider the competing demands for funding  across the facility when making decisions about VA CRNA salary  increases.
VA’s LPS policy requires VA medical facilities to report annually to VA  headquarters on VA CRNA staffing, such as the vacancy and turnover rates  for VA CRNAs within the recent fiscal year. VA medical facilities are also  required to report whether the facility had a pay-related staffing problem  as determined by the medical facility director and whether a medical  facility director used a locality pay survey to determine if VA CRNA  salaries should be adjusted. VA reported that in 2005 and 2006 all VA  medical facility directors who determined that a significant pay-related  staffing problem existed or was likely to exist at their facility used a  locality pay survey to determine whether VA CRNA salaries should be  adjusted.
section_title: The Majority of VA Medical Facilities Used LPS, but Instances of Incorrect Use Indicated Inadequate Training on LPS Policy
paragraphs: In December 2007 we reported that according to VA, the majority—86 out  of 120—of the VA medical facilities that employ VA CRNAs used VA’s LPS  to determine whether to adjust salaries of VA CRNAs at their facilities. Of  those facilities that used VA’s LPS, 63 used a third-party survey to obtain  data on local market area salary rates for CRNAs.
We also reported that, while VA facilities that employed VA CRNAs used  LPS, five of the eight facilities we visited did not use the LPS in  accordance with VA’s LPS policy in 2005 or 2006. VA’s LPS policy is  designed to ensure that facility officials have a mechanism to determine  whether their VA CRNA salaries should be adjusted to be competitive in  recruiting and retaining VA CRNAs. By not fully following this policy,  officials at these five facilities made decisions to adjust or not adjust VA  CRNA salaries without sufficient data on the salaries of CRNAs in their  local market areas.
At the five VA medical facilities that did not fully follow VA’s LPS policy  correctly, facility officials with oversight responsibility for the LPS were  not knowledgeable about certain aspects of the LPS policy. One facility  official told us that the third-party salary survey data were determined to  be insufficient, so the facility used salary data from a Hot Jobs Web site to  determine whether to adjust VA CRNA salaries. The official was unaware  that this data source cannot be considered valid survey data for the  purpose of adjusting VA CRNA salaries. At one facility, officials applied an  outdated methodology for adjusting VA CRNA salaries and in doing so did  not fully follow the most current LPS policy. The outdated policy only  permitted VA medical facility officials to adjust salary rates for each VA  CRNA grade at 5 percent above or below the beginning CRNA salary rates  in local market areas. In contrast, VA’s current LPS policy allows facility  officials to adjust these salaries in order to be competitive. The remaining  three facilities did not have sufficient salary data from their own facility- conducted surveys to determine whether VA CRNA salaries should be  adjusted, and officials from these facilities told us they believed they could  not use salary data of CRNAs that work for organizations that contract  CRNA anesthesia services. These officials were unaware that VA’s policy  allows them to expand their data collection to include the use of salary  data of CRNAs that work for organizations that contract anesthesia  services if the data they had previously collected were insufficient.
The problems some VA medical facilities had fully following VA’s LPS  policy, along with the explanations of facility officials, indicated that VA  had not provided adequate training on its LPS policy. VA medical facility  officials can refer to VA’s LPS policy when they have questions, or they  can contact VA headquarters, according to a VA official. VA last changed  its LPS policy in 2001, which resulted in a number of changes, such as the  use of third-party surveys and the use of salary data of CRNAs that work  for organizations that contract anesthesia services. VA, however, had not  conducted nationwide training on its LPS policy since 1995. As a result,  VA medical facility officials had not received LPS training that reflected  VA’s current LPS policy and, accordingly could not ensure that VA CRNA  salaries had been adjusted as needed to be competitive.
In our December 2007 report we noted that VA was in the process of  developing a Web-based training course for the LPS that VA medical  facility officials could complete online. We reported that because VA had  not made the training a priority, it had not established a time frame for  finalizing the development and implementation of the training course. In  our December 2007 report we recommended that VA expedite the  development and implementation of the training course for VA medical  facility officials responsible for compliance with the policy. VA agreed  with our recommendation and in comments on our draft report stated that  it had developed a draft action plan for training staff on its LPS policy. VA  anticipated that the online training course would be available by the end of  fiscal year 2008.
Mr. Chairman, this concludes my prepared remarks. I would be happy to  answer any questions you or other members of the committee may have.
section_title: Contact and Acknowledgments
paragraphs: For more information regarding this testimony, please contact   Marjorie Kanof at (202) 512-7114 or kanofm@gao.gov. Contact points for  our Offices of Congressional Relations and Public Affairs may be found on  the last page of this statement. In addition, Marcia Mann, Assistant  Director; N. Rotimi Adebonojo; Mary Ann Curran; Melanie Egorin; and  Krister Friday made key contributions to this testimony.
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