VA Health Care:
Access for Chattanooga-Area Veterans Needs Improvement
GAO-04-162: Published: Jan 30, 2004. Publicly Released: Jan 30, 2004.
Veterans residing in Chattanooga, Tennessee, have had difficulty accessing Department of Veterans Affairs (VA) health care. In response, VA has acted to reduce travel times to medical facilities and waiting times for appointments with primary and specialty care physicians. Recently, VA released a draft national plan for restructuring its health care system as part of a planning initiative known as Capital Asset Realignment for Enhanced Services (CARES). GAO was asked to assess Chattanooga-area veterans' access to inpatient hospital and outpatient primary and specialty care against VA's guidelines for travel times and appointment waiting times and to determine how the draft CARES plan would affect Chattanooga-area veterans' access to such care.
Almost all (99 percent) of the 16,379 enrolled veterans in the 18-county Chattanooga area, as of September 2001, faced travel times that exceeded VA's guidelines for accessing inpatient hospital care. During fiscal year 2002, only a few Chattanooga-area veterans were admitted to non-VA hospitals in Chattanooga--constituting about 5 percent of inpatient workload. In addition, over half (8,400) of Chattanooga-area enrolled veterans faced travel times that exceeded VA's 30-minute guideline for outpatient primary care. Also, waiting times for scheduling initial outpatient primary and specialty care appointments frequently exceeded VA's 30-day guideline. VA's draft CARES plan would shorten travel times for some Chattanooga-area veterans but lengthen travel times for others. Under the plan, the amount of inpatient care VA purchases from non-VA hospitals in Chattanooga would increase from 5 percent to 29 percent, thereby reducing those veterans' travel times to within VA's guidelines. The plan also proposes to shift some inpatient workload from VA's Murfreesboro hospital to its Nashville hospital. As a result, an estimated 54 percent of inpatient workload for Chattanooga-area enrolled veterans will be provided in Nashville compared to 40 percent in fiscal year 2002, thereby lengthening some veterans' travel times by about 20 minutes. The plan also proposes opening four new community-based clinics, which would bring about 2,700 more Chattanooga-area enrolled veterans within VA's 30-minute travel guideline for primary care, leaving about 5,700 enrolled veterans with travel times for such care that exceed VA's guideline. These clinics likely would not open before fiscal year 2011, given priorities specified in the plan.
Recommendation for Executive Action
Status: Closed - Implemented
Comments: As part of its review of Chattanooga-area veterans' access to VA health care, GAO recommended that when deliberating CARES decisions, the Secretary explore improving these veterans' access to inpatient and outpatient care. In addition to expediting the opening of two outpatient clinics in the Chattanooga area (which GAO noted last year in accomplishment report GAO-04-3265A), VA now purchases selected inpatient services from local providers and is explore expanding these purchases. Also, VA considered, but decided not to purchase primary care for those Chattanooga-area veterans whose travel times would remain outaide VA guidelines, despite the opening of new VA outpatient clinics.
Recommendation: As part of his deliberations concerning whether additional access improvements for Chattanooga-area veterans beyond those contained in the draft CARES plan are warranted, the Secretary of Veterans Affairs should explore alternatives such as (1) purchasing inpatient care locally for a larger proportion of Chattanooga-area veterans' workload, particularly focusing on those veterans who may experience longer travel times as a result of the proposed shift of inpatient workload from Murfreesboro to Nashville; (2) expediting the opening of the four proposed community-based clinics; and (3) providing primary care locally for more of those veterans whose access will remain outside VA's travel guideline, despite the opening of the four clinics.
Agency Affected: Department of Veterans Affairs