Home > GAO-18-281 > Recommendations

Veterans Choice Program:
Improvements Needed to Address Access-Related Challenges as VA Plans Consolidation of its Community Care Programs

GAO-18-281, Published: Jun 4, 2018. Publicly Released: Jun 4, 2018.

Recommendations

Recommendations for Executive Action

  1. Recommendation: The Under Secretary for Health should establish an achievable wait-time goal for the consolidated community care program that VA plans to implement that will permit VHA to monitor whether veterans are receiving VA community care within time frames that are comparable to the amount of time they would otherwise wait to receive care at VHA medical facilities. (Recommendation 1)
  2. Priority Recommendation
  3. Agency Affected: Department of Veterans Affairs, Office of the Under Secretary for Health
  4. Status: Open
  5. Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

  1. Recommendation: The Under Secretary for Health should design an appointment scheduling process for the consolidated community care program that VA plans to implement that sets forth time frames within which (1) veterans' referrals must be processed, (2) veterans' appointments must be scheduled, and (3) veterans' appointments must occur, which are consistent with the wait-time goal VHA has established for the program. (Recommendation 2)
  2. Priority Recommendation
  3. Agency Affected: Department of Veterans Affairs, Office of the Under Secretary for Health
  4. Status: Open
  5. Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

  1. Recommendation: The Under Secretary for Health should establish a mechanism that will allow VHA to systematically monitor the average number of days it takes for VAMCs to prepare referrals, for VAMCs or TPAs to schedule veterans' appointments, and for veterans' appointments to occur, under the consolidated community care program that VA plans to implement. (Recommendation 3)
  2. Agency Affected: Department of Veterans Affairs, Office of the Under Secretary for Health
  3. Status: Open
  4. Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

  1. Recommendation: The Under Secretary for Health should implement a mechanism to prevent veterans' clinically indicated dates from being modified by individuals other than VHA clinicians when veterans are referred to the consolidated community care program that VA plans to implement. (Recommendation 4)
  2. Agency Affected: Department of Veterans Affairs, Office of the Under Secretary for Health
  3. Status: Open
  4. Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

  1. Recommendation: The Under Secretary for Health should implement a mechanism to separate clinically urgent referrals and authorizations from those for which the VAMC or the TPA has decided to expedite appointment scheduling for administrative reasons. (Recommendation 5)
  2. Agency Affected: Department of Veterans Affairs, Office of the Under Secretary for Health
  3. Status: Open
  4. Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

  1. Recommendation: The Under Secretary for Health should (1) establish oversight mechanisms to ensure that VHA is collecting reliable data on the reasons that VAMC or TPA staff are unsuccessful in scheduling veterans' appointments through the consolidated community care program VA plans to implement, and (2) demonstrate that it has corrected any identified deficiencies. (Recommendation 6)
  2. Agency Affected: Department of Veterans Affairs, Office of the Under Secretary for Health
  3. Status: Open
  4. Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

  1. Recommendation: The Secretary of Veterans Affairs should ensure that the contracts for the consolidated community care program VA plans to implement include performance metrics that will allow VHA to monitor average driving times between veterans' homes and the practice locations of community providers that participate in the TPAs' networks. (Recommendation 7)
  2. Agency Affected: Department of Veterans Affairs
  3. Status: Open
  4. Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

  1. Recommendation: The Secretary of Veterans Affairs should establish a system for the consolidated community care program VA plans to implement to help facilitate seamless, efficient information sharing among VAMCs, VHA clinicians, TPAs, community providers, and veterans. Specifically, this system should allow all of these entities to electronically exchange information for the purposes of care coordination. (Recommendation 8)
  2. Priority Recommendation
  3. Agency Affected: Department of Veterans Affairs
  4. Status: Open
  5. Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

  1. Recommendation: The Under Secretary for Health should conduct a comprehensive evaluation of the outcomes of the two appointment scheduling pilots it established at the Alaska and Fargo VA Health Care Systems (where VAMC staff, rather than TPA staff, are responsible for scheduling veterans' Choice Program appointments), which should include a comparison of the timeliness with which VAMC staff and TPA staff completed each step of the Choice Program appointment scheduling process, as well as the overall timeliness with which veterans received appointments. (Recommendation 9)
  2. Agency Affected: Department of Veterans Affairs, Office of the Under Secretary for Health
  3. Status: Open
  4. Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

  1. Recommendation: The Under Secretary for Health should issue a comprehensive policy directive and operations manual for the consolidated community care program VA plans to implement and ensure that these documents are reviewed and updated in a timely manner after any significant changes to the program occur. (Recommendation 10)
  2. Agency Affected: Department of Veterans Affairs, Office of the Under Secretary for Health
  3. Status: Open
  4. Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.