From the U.S. Government Accountability Office, www.gao.gov Transcript for: Veterans Choice Program Description: The Veterans Choice Program was designed to keep wait times under 30 days for veterans to receive care. Is it working? Listen to find out. Related GAO Work: GAO-18-281: Veterans Choice Program: Improvements Needed to Address Access-Related Challenges as VA Plans Consolidation of its Community Care Programs Released: June 2018 [ Background Music ] [ Sharon Silas: ] Ultimately the intent of the program was to help alleviate wait times for Veterans to receive medical care. [ Matt Oldham: ] Welcome to GAO's Watchdog Report, your source for news and information from the U.S. Government Accountability Office. I'm Matt Oldham. Under certain circumstances, the VA pays for Veterans to get care from a community provider. If a Veteran lives too far from a VA medical facility, if the VA can't directly provide for the Veteran's needs, or if an appointment can't be made within 30 days, Veterans may be eligible for outside services. I'm with Sharon Silas, a director in our Health Care team, to talk about a GAO report on the Veterans Choice Program. Thank you for taking the time to speak with me, Sharon. [ Sharon Silas: ] Thanks, Matt. [ Matt Oldham: ] So how did the Veterans Choice Program come about? [ Sharon Silas: ] Well, in 2014 there was a series of media reports covering excessive wait times for Veterans to receive medical care at VA medical facilities. A number of these reports were really focused on a particular facility in Phoenix, Arizona, but there were also reports about lengthy wait times in other facilities across the U.S. In response, Congress held a number of hearings. And then in August of 2014, they enacted the Veterans Access, Choice, and Accountability Act, which created the Veterans Choice Program. In essence, the Choice Program provides Veterans with access to care through community providers. Rather than having Veterans go through a VA facility, they can go to a provider in their community. And ultimately, the intent of the program was to help alleviate wait times for Veterans to receive medical care. [ Matt Oldham: ] So if one of the conditions for a Veteran to participate in the Veterans Choice Program is the amount of time it would take them to get an appointment at a VA facility, how much sooner can a Veteran be seen through the Veterans Choice Program? [ Sharon Silas: ] The Choice Act requires that Veterans receive Choice Program care within 30 days. However, during the course of our review, we found that the data that VA was using to monitor wait times through the Choice Program were unreliable and incomplete. VA was not fully capturing the full process for Veterans to receive care. We also examined the policies and processes for the program. And what we found was that contrary to the Choice Act's 30-day wait time requirement, VA had designed a process that could actually take up to 70 days for a Veteran to receive care from a Choice provider. We also examined the timeliness of care for a non-generalizable sample of Veterans who were referred to the Choice Program in 2016. And based on our analysis, we found that on average it was at least 64 days for a Veteran to receive routine care through the Choice Program. We also examined an analysis conducted by VA on the Choice Program. And their analysis also showed that on average it was at least 51 calendar days for Veterans to receive routine care through the Choice Program. [ Matt Oldham: ] So what caused the delays in Veterans' access to Choice Program care that you found in the report? [ Sharon Silas: ] First off, the Choice Program's referral and appointment scheduling processes were quite complex and staff lacked the care coordination tools that could have alleviated some of the administrative burden of the increased workloads. We also identified numerous changes to policies and processes that also added to the workload but also created a tremendous amount of confusion amongst the VA administrative staff and the providers that were participating in the program. And then lastly, we found that VA's contractors did not always have a sufficient number, mix, and geographic distribution of community providers in the networks with which they could arrange care for the Veterans. So even though we found these factors that contributed to delays, we also found that VA had taken some actions throughout the Choice Program's implementation that were intended to help improve Veterans' access to care. So for example, VA did eventually implement a few tools to be more efficient with the referrals and the scheduling of Veterans' appointments. VA also established pilot programs at some of the facilities to test out whether they could achieve efficiencies by having VA staff do the scheduling of appointments rather than the contractors. [ Background Music ] [ Matt Oldham: ] It sounds like the VA is doing what it can to improve access to medical care for Veterans, but there is some room for improvement. So I asked Sharon what her team recommended. [ Sharon Silas: ] Well, what we found was that VA had taken many steps to try to improve Veterans' access to care. But VA facilities' implementation of certain actions were not always widespread. And also, VA had not fully evaluated the effectiveness of some of the actions they had taken. So in this report, we made a number of recommendations that are intended to do a few things. First, improve VA's ability to monitor Veterans' access and wait times for community care. And then we have a number of recommendations that are really targeted toward facilitating more seamless information sharing, more clearly communicating policy and process changes. [ Matt Oldham: ] Finally, what do you believe is the bottom line of your report? [ Sharon Silas: ] Well, the bottom line is, is that the Choice Program was originally intended to be a temporary program. So at some point the program is going to end. But we do know that VA plans to continue to deliver community care through a similar program in the future. It's going to be really critical for VA to incorporate lessons learned from the Choice Program into the design and implementation of the future program in order to avoid similar challenges with providing Veterans access to community care. [ Matt Oldham: ] Sharon Silas is a director in our Health Care team, and she led a GAO report looking at improvements to the VA's Veterans Choice Program. Thank you for your time, Sharon. [ Sharon Silas: ] Thank you. [ Background Music ] [ Matt Oldham: ] And thank you for listening to the Watchdog Report. To hear more podcasts, subscribe to us on Apple Podcasts. [ Background Music ] [ Matt Oldham: ] For more from the congressional watchdog, the U.S. Government Accountability Office, visit us at gao.gov.