Military Health Care:

Factors Affecting Contractors' Ability to Schedule Appointments

HEHS-00-137: Published: Jul 14, 2000. Publicly Released: Jul 14, 2000.

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Pursuant to a congressional request, GAO provided information on TRICARE centralized appointment scheduling, focusing on the: (1) proportion of appointments scheduled by TRICARE contractors for beneficiaries in the four TRICARE regions with centralized systems; and (2) factors that affect the contractors' ability to schedule appointments.

GAO noted that: (1) contractors scheduled only about one quarter of the appointments during November 1999 in the four regions where TRICARE contractors have appointment-making responsibility; (2) the percentage of appointments scheduled by the contractors varied among the regions, ranging from about 17 percent to about 63 percent; (3) in general, contractors scheduled a higher percentage of appointments for clinics that provide primary care services (42 percent) than for clinics providing specialty care, such as dermatology, cardiology, and orthopedics (17 percent); (4) in the four regions, the Department of Defense (DOD) and its military treatment facilities (MTF) have restricted the types and number of appointments available to the contractors for scheduling; (5) some MTF physicians and other professional staff told GAO that they want to retain control over the appointing process because they do not trust contractors to accurately schedule appointments and to ensure that any medical instructions can be provided prior to the visit, such as instructions about fasting; (6) when comparing like clinics within different MTFs the percentage of appointments scheduled by contractors varies substantially, suggesting that physicians' and other staff's desire to retain appointment control may be the driving factor, rather than the need to provide medical instructions; (7) when contractors do not have access to appointments because of DOD and MTF restrictions, beneficiaries requesting appointments from contractors may be transferred from the appointment center to the MTF clinic, or told to call MTF clinics themselves; (8) thus, what was meant to be a simplified, more user-friendly appointment process is now a complex and confusing process in which beneficiaries are unsure whether to call the contractor or the MTF to schedule appointments; (9) to improve its appointment system, DOD is in the process of reducing and standardizing the number of appointment types and names used throughout the military health care system; (10) currently thousands of appointment types and names are used; and (11) although reduction and standardization could simplify the appointment-making process, until DOD decides on and implements a more uniform process for making appointments, there will continue to be differences in how beneficiaries access the military health care system.

Recommendation for Executive Action

  1. Status: Closed - Implemented

    Comments: The Acting Assistant Secretary of Defense/Health Affairs through three initiatives is improving the effectiveness of the appointment scheduling process. Managed Care Support Contract (MCSC) representation has been incorporated at Appointment Standardization Integrated Program Team (IPT) meetings. This will ensure that MCSC personnel are team members of any appointments business process improvements decided upon. Second, the Appointment Standardization (APS) IPT reduced and standardized the number of appointment types and other Composite Health Care System (CHCS) data elements. Finally, the Department has conducted pilot programs in three TRICARE Regions in which the scheduling functions will move to on-site TRICARE Service Centers to better utilize contractor personnel to simplify the appointing process. While moving scheduling functions to on-site Service Centers did not occur due to logistical difficulties, the other actions will improve access to care for the patients, maximize the use of Managed Care Support personnel, simplify the appointing process for MTF and MCSC appointments personnel and provide one standardized appointing model for booking across the entire Military Health System (MHS). The Department issued a change order to the Managed Care Support Contracts to implement the standardized/simplified business rules. This change should better utilize contractor appointments personnel and improve beneficiary service. The goal is to implement a more uniform process for making appointments that puts the right patient, with the right provider in the right appointment at the right time.

    Recommendation: To clarify and standardize the appointment-making process to the extent practical, the Secretary of Defense should direct the Assistant Secretary of Defense (Health Affairs) to assess the effectiveness of the current appointment-scheduling process and determine how that process could be optimized, including a determination of the role contractors should play. The Assistant Secretary should then implement the selected appointment-scheduling process system-wide.

    Agency Affected: Department of Defense

 

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