VA Health Care:

Actions Needed to Improve Newly Enrolled Veterans' Access to Primary Care

GAO-16-328: Published: Mar 18, 2016. Publicly Released: Apr 18, 2016.

Additional Materials:

Contact:

Debra A. Draper
(202) 512-7114
draperd@gao.gov

 

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What GAO Found

GAO found that not all newly enrolled veterans were able to access primary care from the Department of Veterans Affairs' (VA) Veterans Health Administration (VHA), and others experienced wide variation in the amount of time they waited for care. Sixty of the 180 newly enrolled veterans in GAO's review had not been seen by providers at the time of the review; nearly half were unable to access primary care because VA medical center staff did not schedule appointments for these veterans in accordance with VHA policy. The 120 newly enrolled veterans in GAO's review who were seen by providers waited from 22 days to 71 days from their requests that VA contact them to schedule appointments to when they were seen, according to GAO's analysis. These time frames were impacted by limited appointment availability and weaknesses in medical center scheduling practices, which contributed to unnecessary delays.

VHA's oversight of veterans' access to primary care is hindered, in part, by data weaknesses and the lack of a comprehensive scheduling policy. This is inconsistent with federal internal control standards, which call for agencies to have reliable data and effective policies to achieve their objectives. For newly enrolled veterans, VHA calculates primary care appointment wait times starting from the veterans' preferred dates (the dates veterans want to be seen), rather than the dates veterans initially requested VA contact them to schedule appointments. Therefore, these data do not capture the time these veterans wait prior to being contacted by schedulers, making it difficult for officials to identify and remedy scheduling problems that arise prior to making contact with veterans. Further, ongoing scheduling errors, such as incorrectly revising preferred dates when rescheduling appointments, understated the amount of time veterans waited to see providers. Officials attributed these errors to confusion by schedulers, resulting from the lack of an updated standardized scheduling policy. These errors continue to affect the reliability of wait-time data used for oversight, which makes it more difficult to effectively oversee newly enrolled veterans' access to primary care.

Illustration of How the Time It Takes a Veteran to See a Provider May Differ from the Wait Time Calculated by the Veterans Health Administration (VHA)

Illustration of How the Time It Takes a Veteran to See a Provider May Differ from the Wait Time Calculated by the Veterans Health Administration (VHA) img  data-cke-saved-src=

Why GAO Did This Study

Primary care services are often the entry point for veterans needing care, and VHA has faced a growing demand for outpatient primary care services over the past decade. On average, 380,000 veterans were newly enrolled in VHA's health care system each year in the last decade.

GAO was asked to examine VHA's efforts to provide timely access to primary care services. This report examines, among other things, (1) newly enrolled veterans' access to primary care and (2) VHA's related oversight. GAO interviewed officials from six VA medical centers selected to provide variation in factors such as geographic location, clinical services offered, and average primary care wait times; reviewed a randomly selected, non-generalizable sample of medical records for 180 newly enrolled veterans; and interviewed VHA and medical center officials on oversight of access to primary care. GAO evaluated VHA's oversight against relevant federal standards for internal control.

What GAO Recommends

GAO recommends that VHA (1) ensure veterans requesting appointments are contacted in a timely manner to schedule one; (2) monitor the full amount of time newly enrolled veterans wait to receive primary care; and (3) issue an updated scheduling policy. VA concurred with all of GAO's recommendations and identified actions it is taking to implement them.

For more information, contact Debra A. Draper at (202) 512-7114 or draperd@gao.gov.

Recommendations for Executive Action

  1. Status: Open

    Comments: In its report, GAO recommended the Secretary of Veterans Affairs, direct the Under Secretary for health, to review VHA's processes for identifying and documenting newly enrolled veterans requesting an appointment and revise as appropriate to ensure that all veterans requesting appointments are contacted in a timely manner to schedule one; and implement an oversight mechanism to ensure VA medical centers are appropriately implementing the processes. VA agreed with this recommendation, and as of July 2016, VA officials indicated they were in the process of implementing this recommendation. Specifically, officials indicated they were conducting an internal review of new enrollee requests for appointments, and identifying comprehensive information that VA Medical Centers need to appropriately schedule appointments for newly enrolled Veterans. They also indicated they needed to modify their existing internal reporting to include the elapsed time from application to the first scheduled primary care appointment. They listed a target completion date of December 31, 2016.

    Recommendation: The Secretary of Veterans Affairs should direct the Under Secretary for Health to review VHA's processes for identifying and documenting newly enrolled veterans requesting appointments, revise as appropriate to ensure that all veterans requesting appointments are contacted in a timely manner to schedule them, and institute an oversight mechanism to ensure VA medical centers are appropriately implementing the processes.

    Agency Affected: Department of Veterans Affairs

  2. Status: Open

    Comments: In its report, GAO recommended the Secretary of Veterans Affairs, direct the Under Secretary for health, to monitor the full amount of time newly enrolled veterans wait to be seen by primary care providers, starting with the date veterans requested they be contacted to schedule appointments. VA officials agreed with this recommendation, and of July 2016 indicated they were in the process of implementing this recommendation. Specifically, VA officials indicated they were developing new internal reports to capture additional information regarding veterans' appointment requests and the timeliness in scheduling appointments. They also indicated they were developing enhancement to scheduler training to better enable timely scheduling of appointments. They stated their target date for implementing the recommendation was December 31, 2016.

    Recommendation: The Secretary of Veterans Affairs should direct the Under Secretary for Health to monitor the full amount of time newly enrolled veterans wait to be seen by primary care providers, starting with the date veterans request they be contacted to schedule appointments. This could be accomplished, for example, by building on the data collection efforts currently being implemented under the "Welcome to VA" program.

    Agency Affected: Department of Veterans Affairs

  3. Status: Open

    Comments: In its report, GAO recommended the Secretary of Veterans Affairs, direct the Under Secretary for health, to finalize and disseminate a comprehensive national scheduling directive, which consolidates memoranda and guidance disseminated since July 2014 on changes to scheduling processes and procedures, and provide VA medical center staff appropriate training and support to fully and correctly implement the directive. VA officials agreed with this recommendation, and finalized a revised scheduling directive in July, 2016. In July 2016 officials indicated they were in the process of disseminating the new directive to staff, and had begun training 32,000 schedulers on the new directive. Officials indicated they have a target completion date of November 2016 for this recommendation.

    Recommendation: The Secretary of Veterans Affairs should direct the Under Secretary for Health to finalize and disseminate a comprehensive national scheduling directive, which consolidates memoranda and guidance disseminated since July 2014 on changes to scheduling processes and procedures, and provide VA medical center staff appropriate training and support to fully and correctly implement the directive.

    Agency Affected: Department of Veterans Affairs

 

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