VA Health Care:
Appointment Scheduling Oversight and Wait Time Measures Need Improvement
GAO-13-372T, Mar 14, 2013
What GAO Found
Outpatient medical appointment wait times reported by the Veterans Health Administration (VHA), within the Department of Veterans Affairs (VA), are unreliable. Wait times for outpatient medical appointmentsreferred to as medical appointmentsare calculated as the number of days elapsed from the desired date, which is defined as the date on which the patient or health care provider wants the patient to be seen. The reliability of reported wait time performance measures is dependent on the consistency with which schedulers record the desired date in the scheduling system. However, aspects of VHAs scheduling policy and training documents for recording desired date are unclear and do not ensure consistent use of the desired date. Some schedulers at VA medical centers (VAMC) that GAO visited did not record the desired date correctly, which, in certain cases, would have resulted in a reported wait time that was shorter than the patient actually experienced for that appointment. VHA officials acknowledged limitations of measuring wait times based on desired date, and described additional information used to monitor veterans access to medical appointments; however, reliable measurement of how long patients are waiting for medical appointments is essential for identifying and mitigating problems that contribute to wait times.
While visiting VAMCs, GAO also found inconsistent implementation of certain elements of VHAs scheduling policy that impedes VAMCs from scheduling timely medical appointments. For example, four clinics across three VAMCs did not use the electronic wait list to track new patients that needed medical appointments as required by VHA scheduling policy, putting these clinics at risk for losing track of these patients. Furthermore, VAMCs oversight of compliance with VHAs scheduling policy, such as ensuring the completion of required scheduler training, was inconsistent across facilities. VAMCs also described other problems with scheduling timely medical appointments, including VHAs outdated and inefficient scheduling system, gaps in scheduler staffing, and issues with telephone access. For example, officials at all VAMCs GAO visited reported that high call volumes and a lack of staff dedicated to answering the telephones impede scheduling of timely medical appointments.
VHA is implementing a number of initiatives to improve veterans access to medical appointments such as use of technology to interact with patients and provide care, which includes the use of secure messaging between patients and their health care providers. VHA also is piloting a new initiative to provide health care services through contracts with community providers that aims to reduce travel and wait times for veterans who are unable to receive certain types of care within VHA in a timely way.
Why GAO Did This Study
VHA provided nearly 80 million outpatient medical appointments to veterans in fiscal year 2011. Although access to timely medical appointments is important to ensuring veterans obtain needed care, long wait times and inadequate scheduling processes have been persistent problems.
This testimony is based on a December 2012 report, VA Health Care: Reliability of Reported Outpatient Medical Appointment Wait Times and Scheduling Oversight Need Improvement (GAO-13-130), that described needed improvements in the reliability of VHAs reported medical appointment wait times, scheduling oversight and VHA initiatives to improve access to timely medical appointments. To conduct that work, GAO made site visits to 23 clinics at four VAMCs, the latter selected for variation in size, complexity, and location. GAO also reviewed VHAs policies and interviewed VHA officials.
What GAO Recommends
In its December 2012 report, GAO recommended that VHA take actions to (1) improve the reliability of its medical appointment wait time measures, (2) ensure VAMCs consistently implement VHAs scheduling policy, (3) require VAMCs to allocate staffing resources based on scheduling needs, and (4) ensure that VAMCs provide oversight of telephone access and implement best practices to improve telephone access for clinical care. VA concurred with GAOs recommendations.
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