Defense Health Care:

Appointment Timeliness Goals Not Met; Measurement Tools Need Improvement

HEHS-99-168: Published: Sep 30, 1999. Publicly Released: Sep 30, 1999.

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Pursuant to a congressional request, GAO reviewed the Department of Defense's (DOD) administration of its health maintenance organization, TRICARE Prime, focusing on: (1) DOD's performance in scheduling appointments; and (2) possible reasons why Prime enrollees might not obtain appointments within the appointment timeliness goals.

GAO noted that: (1) after correcting definitional discrepancies in DOD data, GAO found DOD has not achieved its goal of scheduling 98 percent of acute and routine appointments within the timeliness standards it established; (2) about 70 percent of appointments for a routine visit at military treatment facilities (MTF) were scheduled within the standard, while between 80 and 97 percent of the appointments for acute care, preventive care, or specialists were scheduled within the relevant standards; (3) DOD's analysis of appointment timeliness is consistent with GAO's findings, and DOD has reported that the MTFs' performance has fallen short of its expectations; (4) there are several reasons why active duty members and other enrollees may not obtain appointments within the standards; (5) GAO found that about 16 percent of the appointment slots were given to nonenrolled beneficiaries; (6) DOD permits nonenrollees to make appointments and obtain care in MTFs because it believes treating these beneficiaries is necessary to support medical readiness and training requirements; (7) DOD has made no analysis, however, of the extent to which this policy adversely affects the ability of the enrolled population to obtain care and treatment or the effect of any resulting shortfall on readiness and training; (8) research by the Congressional Budget Office has shown that instituting a copayment for care provided in MTFs could reduce demand for care and improve appointment timeliness by freeing up appointments for active-duty members and Prime enrollees; (9) DOD's data tools are inadequate for measuring appointment timeliness against the access standards; (10) survey weaknesses include reliance on the beneficiaries' ability to correctly recall details of the appointments, a low response rate, and no analysis of the beneficiaries who do not respond--all of which affect the accuracy of the information on how well appointment standards were met; (11) DOD also has several efforts under way to improve the data contained in the Customer Satisfaction Survey and Composite Health Care System (CHCS) appointment scheduling system; and (12) once implemented, CHCS promises to become a good source of the appointment timeliness information DOD needs to effectively manage and monitor access to care.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: According to our point of contact, CHCS is now being used to measure compliance with appointment timeliness standards. Appointments are also being linked to the appropriate access standard across the system. CHCS was modified to perform this function, alpha testing was completed in April 2000, and worldwide implementation occurred in June 2000.

    Recommendation: The Secretary of Defense should direct the Assistant Secretary of Defense (Health Affairs) to measure and monitor beneficiaries' access to health care in a more comprehensive and accurate manner by directing that CHCS be used in lieu of the Customer Satisfaction Survey to measure compliance with the appointment timeliness standards in the military medical facilities, and that the necessary modifications be made to CHCS so that appointments are linked to the appropriate access standard and standardized across the military health care system. The Secretary should direct that the results be reported at all levels--individual facility, service- and system-wide, and by the various beneficiary categories.

    Agency Affected: Department of Defense

  2. Status: Closed - Not Implemented

    Comments: DOD has emphatically stated that appointments for non-enrolled beneficiaries will not be canceled and rebooked if Prime enrollees and active duty members request appointments and none are available. While DOD recognizes that active duty should always have first access to medical care, DOD is concerned that adopting this action could jeopardize the health of non-enrolled beneficiaries.

    Recommendation: The Secretary of Defense should direct a test of a policy that appointments scheduled for nonenrolled beneficiaries are subject to cancellation if an active-duty member or other Prime enrollee requests care and no other appointment is available within the access standard. This test could be implemented in those MTFs having the greatest difficulty scheduling active-duty and enrollees within the access standards.

    Agency Affected: Department of Defense

  3. Status: Closed - Not Implemented

    Comments: DOD stated it will not impose copayments for care provided in military medical facilities. DOD considers providing care no-cost care a key component of their commitment to beneficiaries.

    Recommendation: The Secretary of Defense should test the option of instituting copayments within the MTFs comparable to those in the civilian networks to help bring about more appropriate utilization of military care and thus free up appointment space.

    Agency Affected: Department of Defense

 

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