From the U.S. Government Accountability Office, www.gao.gov Transcript for: Timely Access to Outpatient Specialty Heath Care for Veterans Description: Audio interview by GAO staff with Debra Draper, Director, Health Care Related GAO Work: GAO-14-808: VA Health Care: Management and Oversight of Consult Process Need Improvement to Help Ensure Veterans Receive Timely Outpatient Specialty Care Released: October 2014 [ Background Music ] [ Narrator: ] Welcome to GAO's Watchdog Report, your source for news and information from the U.S. Government Accountability Office. It's October 2014. Delays in VA medical center care have reportedly harmed some veterans. In 2012, VA found that its consult data were not adequate to determine the extent to which veterans received timely outpatient specialty care. A team led by Debra Draper, a director in GAO's Health Care team, recently reviewed VA's management of the consult process. GAO's Sarah Kaczmarek sat down with Debra to talk about what they found. [ Sarah Kaczmarek: ] How much of a delay are veterans facing in receiving timely specialty care appointments? [ Debra Draper: ] In our work, we found that veterans are facing delays in many of the medical centers. We included five medical centers in our review and we found issues in all five medical centers. And this includes initial triaging of a consult request, that is, a consult request is when a primary care physician, typically a primary care physician, will request a specialty care provider to assess an individual for a particular clinical concern or to perform some type of specialty care procedure. So we found that the seven-day guideline that VA has was not always met and that was in about 1 in 5 consult requests that we reviewed. For about 4 in 5 consult requests we reviewed, we found that care was not provided within VA's 90-day timeliness guideline, we did find major delays in care being provided. [ Sarah Kaczmarek: ] How big is this problem, and how many veterans are potentially impacted by this? [ Debra Draper: ] Across the 5 medical centers that were included in our review we found delays in all 5 medical centers. So it's a big problem, and as I mentioned, we found that for 80 percent of the consults we reviewed, that care was not provided within the 90-day guideline. For example, we had one medical center where there were 4 of the 10 physical therapy consults we reviewed, of those, between 108 and 152 days elapsed between the time the consult request was submitted to when the care was provided; and for 3 of those, the consult request was actually returned to the primary care provider without the care ever being provided. [ Sarah Kaczmarek: ] Your report points to some key limitations with VA's oversight. Can you tell me about some of the main challenges here? [ Debra Draper: ] Overall we found that VA's oversight of the consult process is limited and cannot ensure that veterans are receiving timely access to specialty care. VA does not routinely assess how the medical centers local consult processes so they can't really determine how well those processes are working and whether veterans are receiving timely care. VA has not required medical centers to document how they're closing out consults, so, often consults are closed and there's no apparent reason for why the consult was closed, and in some of those cases the veterans never received care. They also don't have a formal process where medical centers can share best practices and the problem with that is a lot of times medical centers will have encountered something related to the management of consults. They've run into issues or challenges and they've dealt with that and then another medical center will come along and deal with the same issue but because the best practices aren't shared they don't understand what other medical centers have had to deal with. And then finally for VA, patient no-shows and cancelled appointments are a big problem and VA does not have a system-wide process for how to handle those, so what happens when you have patient no-shows and cancelled appointments, it does take up time in the schedule so that's really a wasted slot for someone who could have used that care. [ Sarah Kaczmarek: ] What recommendations is GAO making to VA then in this report? [ Debra Draper: ] We have quite a few recommendations that we're making to VA, really the objective to improve the oversight of specialty care consult process and to make sure that veterans are actually receiving the care that they need. We recommended that VA ensure that specialty care providers, including residents who maybe serving on a temporary basis, are appropriately documenting the consults and closing them out in the electronic system. We're also recommending that VA routinely assess the consult process at the local medical center level. At this point, they don't really do any independent verification of what local medical centers are doing. We also recommend that--that VA require medical centers to document the rationales for closing consults. As I mentioned earlier, that often times, it is unclear why they're closing a consult that's not properly documented. [ Sarah Kaczmarek: ] Finally for veterans, what do you see as the bottom line of this report? [ Debra Draper: ] Well, what we found was that there are delays in care, and we found this in every facility that we visited. And we found that care was not always being provided in a timely manner. And I think for veterans, you know, they really have to advocate for their own care, and if they feel like care is not being provided in a timely basis, there are certain actions they can take. They can contact the local medical center patient advocate, they could talk to local medical center leadership, and you know, in some cases, it may be appropriate to even contact the VA's Office of the Inspector General. [ Background Music ] [ Narrator: ] To learn more, visit GAO.gov and be sure to tune in to the next episode of GAO's Watchdog Report for more from the congressional watchdog, the U.S. Government Accountability Office.