VA and DOD Patient Care
The Department of Veterans Affairs (VA) and the Department of Defense (DOD) are responsible for providing timely, high-quality health care to veterans and to servicemembers and their families, but they both need to improve their ability to do so.
There have been numerous reports of VA medical facilities failing to provide timely and accessible care—in some cases, delays in care or failure to provide care reportedly resulted in harm to veterans. There have also been concerns about DOD's ability to provide access to certain types of care, particularly mental health care, to servicemembers.
Both VA and DOD need to improve their health care programs and processes—particularly access to health care in department facilities, VA's community care program, and the quality of care and patient safety in DOD and VA medical facilities.
Access to Health Care
- VA enrollment processes. Enrollment is generally the first step veterans take to access health care. However, improvements are needed in how VA implements enrollment processes by defining the role of its medical facilities in reviewing pending enrollment applications, and improving the oversight of this process.
- VA access to care. Not all newly enrolled veterans have been able to access primary care within VA, while other veterans experienced wide variation in the amount of time they waited for primary and specialty care. To address this issue, VA needs to ensure the reliability of its data on veterans’ wait times, and ensure that VA medical facilities are consistently implementing its scheduling policy.
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)
- DOD mental health access. While DOD has efforts underway to improve access to mental health care, it still needs to ensure the availability of certain providers, such as psychiatrists.
- DOD TRICARE access. The National Defense Authorization Act of 2017 established a new self-managed preferred provider network option for servicemembers and their families called TRICARE Select, and mandated that DOD develop an implementation plan for it. The plan was developed prior to DOD's decision to have the contractors propose access standards, such as the amount of time it takes to schedule an appointment, that DOD must approve. Instead, the implementation plan states that TRICARE Select will use access standards used by another TRICARE option. DOD needs to make sure that this plan reflects the actual approach it plans to use for ensuring access standards for health care appointments.
VA's Community Care Program
- Community care access. In 2014, Congress established a temporary program—called the Veterans Choice Program—which provided funding for veterans to obtain health care services from non-VA community providers when they faced long wait times, lengthy travel distances, or other challenges accessing care at VA medical facilities. In 2019, VA will establish a permanent Veterans Community Care Program and will need to ensure that veterans receive care in a timely manner and do not experience the long delays many veterans experienced under the Choice Program.
Average Wait Times for Choice Program Appointments in 2016, According to Separate Non-Generalizable Analyses by GAO and the Veterans Health Administration (VHA)
Note: GAO excluded from its analysis the amount of time the TPA took to schedule the appointment and the overall wait time because its sample selection methodology differed from VHA’s in a way that would have skewed these two averages but not the averages for the other segments of the process.
Community provider payments. Due to increases in veterans’ use of community care, VA and its third party administrators have had difficulty processing claims in a timely manner—which may make community providers less willing to participate in this program. VA needs to collect data and monitor compliance with claims processing timeliness to ensure that timely payments are made to community providers, and needs to develop a written plan to modernize its claims processing system.
Median Number of Days to Pay Clean Claims through VA's Third Party Administrators (TPA), November 2014 through June 2018
- Community care for women. VA needs to monitor female veterans’ access to sex-specific care, such as mammograms, through its Community Care Program.
Quality of Care and Patient Safety
- VA provider quality and safety concerns. VA medical facilities are responsible for reviewing any concerns that arise about the quality and safety of the care their providers deliver. VA needs to ensure that these concerns are adequately addressed, including reporting incompetent or unsafe providers to a national database and state licensing boards.
- VA opioid safety. VA has been working to address opioid safety for veterans and has made progress in reducing opioid prescriptions. However, VA still needs to ensure that all opioid safety goals are met, and that providers are consistently adhering to evidence-based strategies for minimizing the risk associated with opioid prescribing (such as urine drug screenings).
- VA outpatient clinics. VA-operated community-based outpatient clinics provide millions of veterans with primary and mental health care. VA needs to improve oversight of these clinics to ensure that they provide one standard of high-quality care for all veterans.
- VA and DOD health care for women. VA has policies in place to help ensure the privacy, safety, and dignity of female veterans when they receive care at its medical facilities—but it needs to make sure that these policies are consistently followed. Women also represent a significant percentage of the population eligible for DOD health care services and concerns have been raised about the quality of DOD's women's health care services.
Interactive Graphic of Domestic Military Hospitals Offering Maternity and Neonatal Care Services
- DOD adverse events. Adverse medical events are unintended incidents that could result in harm to a patient. DOD’s Defense Health Agency needs to improve how it tracks adverse events that occur in DOD military treatment facilities.
GAO-18-671: Published: Sep 28, 2018. Publicly Released: Sep 28, 2018.
The VA's Veterans Choice Program allows veterans to get health care from providers not directly employed by VA (community providers), such as when facing long wait times at VA facilities. VA uses contractors to pay providers for their services to veterans. But contractor payment times have varied, sometimes causing delays in providers' payments. The result: providers may not want to continue part...
GAO-18-281: Published: Jun 4, 2018. Publicly Released: Jun 4, 2018.
If services are not readily accessible at VA medical facilities, the Veterans Choice Program allows eligible veterans to receive care from non-VA providers. Congress created the temporary program in 2014, aiming to alleviate the excessive wait times some veterans faced at VA. However, we found that it’s unclear if the Choice Program improved the timeliness of veterans’ care because VA’s dat...
GAO-18-380: Published: May 29, 2018. Publicly Released: May 29, 2018.
The VA has been working to address opioid safety for veterans and has made progress in reducing opioid prescriptions. For example, VA has started a program to educate providers on best practices related to pain management and the optimal use of opioids. However, we found that VA has not fully met all of its opioid safety goals. Its health care providers also are not consistently adhering to evide...
GAO-18-378: Published: Apr 26, 2018. Publicly Released: Apr 26, 2018.
Medical errors, system vulnerabilities, or process failures can permanently or temporarily harm—or kill—patients. In military health facilities, it's critical to track and analyze these "sentinel events" to help prevent them in the future. The military services and the Defense Health Agency both track such events. Agency officials told us they spend 80 hours a month reconciling their records...
GAO-18-375: Published: Apr 12, 2018. Publicly Released: Apr 12, 2018.
Community-based outpatient clinics are an increasingly important part of the Department of Veterans Affairs’ health care system, providing millions of veterans with services like primary and mental health care. Most of them are operated by VA, but others are operated by contractors. We found weaknesses in VA's oversight of community-based outpatient clinics, leading us to make four recommendati...
GAO-18-63: Published: Nov 15, 2017. Publicly Released: Nov 27, 2017.
The Department of Veterans Affairs requires its medical centers to review a doctor’s care if quality or safety concerns arise. If VA medical center officials decide a doctor should no longer provide care to veterans, they are required to inform hospitals and other health care entities by reporting to a national database and to the states where the doctor is licensed. However, at the 5 VA medica...
GAO-17-709: Published: Sep 5, 2017. Publicly Released: Sep 5, 2017.
To receive health care through the Department of Veterans Affairs, veterans must provide various information to prove eligibility. We found that how VA reviews applications and enrolls veterans can lead to delays and errors. Enrollment staff—spread across VA's central enrollment center and network of 170 medical centers—frequently missed VA's 5-day timeliness standard, and sometimes incorrect...
GAO-17-52: Published: Dec 2, 2016. Publicly Released: Dec 2, 2016.
Are women veterans getting the medical care they need? The Department of Veterans Affairs has policies in place to help ensure the privacy, safety, and dignity of women veterans when they receive care at its medical facilities. For example, exam rooms must have privacy curtains and exam tables must face away from doors. However, we found many instances of noncompliance with these policies. We al...
GAO-16-795: Published: Sep 19, 2016. Publicly Released: Sep 19, 2016.
GAO found that the Department of Veterans Affairs' (VA) contractors—Health Net Federal Services (Health Net) and TriWest Healthcare Alliance (TriWest)—complied with contractual requirements to verify the credentials of physicians under one community care program, but were deficient in doing so under another program. Based on GAO's review of selected physicians, GAO found that the contractors a...
GAO-16-596: Published: Jun 23, 2016. Publicly Released: Jun 23, 2016.
Almost all of the domestic military hospitals in the Department of Defense’s (DOD) Military Health System (MHS) offered general women’s health care services, including general maternity, neonatal, and gynecological care, with fewer offering specialty care services. Specifically, according to officials from the three military services and the National Capital Region (NCR) (which includes two mi...
GAO-16-353: Published: May 11, 2016. Publicly Released: May 11, 2016.
To help ensure that veterans are provided timely and accessible health care services, the Veterans Health Administration (VHA) of the Department of Veterans Affairs (VA) has purchased care from non-VA community providers through its care in the community programs since as early as 1945. VHA's agency-wide data show that in fiscal year 2015, it processed about 66 percent of claims within the agency'...
GAO-16-416: Published: Apr 28, 2016. Publicly Released: Apr 28, 2016.
The Department of Defense's (DOD) Military Health System (MHS) makes a variety of inpatient and outpatient mental health care available to active duty servicemembers and activated National Guard and Reserve servicemembers (reservists) domestically and overseas through its TRICARE health care system. The type of care includes psychological testing and assessment, psychotherapy, medication managemen...
GAO-16-328: Published: Mar 18, 2016. Publicly Released: Apr 18, 2016.
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 prima...
GAO-16-24: Published: Oct 28, 2015. Publicly Released: Oct 28, 2015.
The way in which the Department of Veterans Affairs' (VA) Veterans Health Administration (VHA) calculates veteran mental health wait times may not always reflect the overall amount of time a veteran waits for care. VHA uses a veteran's preferred date (determined when an appointment is scheduled) to calculate the wait time for that patient's full mental health evaluation, the primary entry point fo...