What, Me Worry?
          No Worries just preparation
      “Give me six hours to chop down a 
      tree and I will spend the first four 
          sharpening the axe.” 
                    Abraham Lincoln
       Adopting the right attitude can 
       convert a negative stress into a 
             positive one.
                       Hans Selye
                    No Small Thing – Your Clinical Trainee Budget
                                                    Education & Training Total
                            Includes Veterans Choice Act Sec. 801 and Veterans Choice 
                                                                Program 
                                                       (dollars in thousands)
                                                                            2018                    2019              2020
                                                        2017         Budget     Approved Advance        Revised     Advance
                             Description               Actual       Estimate     Budget     Approp.     Request     Approp.
                  Obligations [Total]                $2,118,345    $1,920,756  $2,071,918 $1,999,009  $2,028,040  $2,163,137 
                   Education & Training Support      $1,208,609     $935,378    $986,000  $973,188  $994,815  $1,074,681 
                   Education & Training Trainees      $230,857      $229,299    $279,921  $210,623  $232,250       $251,111 
                   Graduate Medical Education         $678,879      $756,079    $805,997  $815,198  $800,975       $837,345 
                   Trainees
          Increased OIG Interest 
       In the end the DEO is Responsible
     “As a result, the Designated 
     Education Officer (DEO) did not 
     establish required local policies and 
     procedures for resident educational 
     activity record keeping, monitoring 
     resident participation in educational 
     activities, and reconciling educational 
     activity records with invoices 
     submitted by the University of XXXX 
     College of Medicine (the medical 
     school).”
             Increased GAO Interest
            Entrance Conference - April 11, 2019 
   103362 - VA Reimbursement of Affiliates for Graduate Medical Education
 Given that disbursement agreement procedures allow for payments to 
 academic affiliates both in advance and in arrears:
    Approximately what percentage of affiliate disbursement agreements are 
    in advance versus in arrears?
    Approximately what percentage of charges does VA typically reimburse in 
    advance ? 
 A recent VA OIG review of the Oklahoma City VA Health Care System 
 found that the system was not following required disbursement 
 agreement procedures, including not establishing a system for resident 
 record keeping and activity monitoring, not reconciling invoices 
 submitted by the medical school, and not conducting periodic audits of 
 the disbursement agreement. 
    Do you think that similar problems may exist at other VA medical centers 
    or were these particularly unique circumstances in Oklahoma City? What 
    do you base this opinion on?