Veterans Community Care Program: Improvements Needed to Help Ensure Timely Access to Care

GAO-20-643 Published: Sep 28, 2020. Publicly Released: Sep 28, 2020.
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Fast Facts

The Department of Veterans Affairs implemented the Veterans Community Care Program in June 2019—replacing similar programs that allow eligible veterans to receive care from non-VA providers.

We reviewed how the VA implemented the new program and found:

The VA hasn't established a timeliness goal for veteran care

Few community providers use the VA's new software system to exchange information electronically with VA medical centers

Few VA medical centers have the recommended number of staff for the program

We made recommendations to improve veterans' access, including a suggestion that Congress consider requiring VA to set a timeliness goal.

Military IDs and a stethoscope on an American Flag.

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Highlights

What GAO Found

The Department of Veterans Affairs (VA) established an appointment scheduling process for the Veterans Community Care Program (VCCP) that allows up to 19 days to complete several steps from VA providers creating a referral to community care staff reviewing that referral. However, as the figure shows, VA has not specified the maximum amount of time veterans should have to wait to receive care through the program. GAO previously recommended in 2013 the need for an overall wait-time measure for veterans to receive care under a prior VA community care program. Subsequent to VA not implementing this recommendation, GAO again recommended in 2018 that VA establish an achievable wait-time goal as part of its new community care program (the VCCP).

Potential Allowable Wait Time to Obtain Care through the Veterans Community Care Program

Potential Allowable Wait Time to Obtain Care through the Veterans Community Care Program

Note: This figure illustrates potential allowable wait times in calendar days for eligible veterans who are referred to the VCCP through routine referrals (non-emergent), and have VA medical center staff—Referral Coordination Team (RCT) and community care staff (CC staff)—schedule the appointments on their behalf.

VA has not yet implemented GAO's 2018 recommendation that VA establish an achievable wait-time goal. Under the VA MISSION Act, VA is assigned responsibility for ensuring that veterans' appointments are scheduled in a timely manner—an essential component of quality health care. Given VA's lack of action over the prior 7 years implementing wait-time goals for various community care programs, congressional action is warranted to help achieve timely health care for veterans.

Regarding monitoring of the initial steps of the scheduling process, GAO found that VA is using metrics that are remnants from the previous community care program, which are inconsistent with the time frames established in the VCCP scheduling process. This limits VA's ability to determine the effectiveness of the VCCP and to identify areas for improvement.

Why GAO Did This Study

In June 2019, VA implemented its new community care program, the VCCP, as required by the VA MISSION Act of 2018. Under the VCCP, VAMC staff are responsible for community care appointment scheduling; their ability to execute this new responsibility has implications for veterans receiving community care in a timely manner.

GAO was asked to review VCCP appointment scheduling. This report examines, among other issues, the VCCP appointment scheduling process VA established and VA's monitoring of that process.

GAO reviewed documentation, such as scheduling policies, and referral data related to the VCCP and assessed VA's relevant processes. GAO conducted site visits to five VAMCs in the first region to transition to VA's new provider network, and interviewed VAMC staff and a non-generalizable sample of community providers receiving referrals from those VAMCs. GAO also interviewed VA and contractor officials.

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Recommendations

GAO recommends that Congress consider requiring VA to establish an overall wait-time measure for the VCCP. GAO is also making three recommendations to VA, including that it align its monitoring metrics with the VCCP appointment scheduling process. VA did not concur with one of GAO's recommendations related to aligning monitoring metrics to VCCP scheduling policy time frames. GAO continues to believe this recommendation is valid, as discussed in the report.

Matter for Congressional Consideration

Matter Status Comments
Congress should consider requiring VA to establish an overall wait-time performance measure for veterans to receive care under the VCCP that will permit VA to measure and monitor the timeliness of VCCP appointments and compare timeliness to that of VA medical facilities. (Matter for Consideration 1)
Open
In July 2021, VA officials stated that they restarted plans to establish an overall wait-time performance measure for the Veterans Community Care Program. VA's Office of Community Care is collaborating with other offices within VA to develop an accurate and appropriate measure for the Veterans Community Care Program, and a potential database to track that measure. VA undertook testing of a potential measure and database in July 2021.

Recommendations for Executive Action

Agency Affected Recommendation Status
Department of Veterans Affairs
Priority Rec.
This is a priority recommendation.
The Under Secretary of Health should align its monitoring metrics with the time frames established in the VCCP scheduling process. (Recommendation 1)
Open
In February 2022, VA officials stated that while the agency previously non-concurred with the recommendation, it has now matured enough in its practices and ability to track data to act on the recommendation. VA officials stated that it updated and released VHA Directive 1232, Consult Processes and Procedures, in January 2022, which reflects metrics for VA medical centers to follow specific to time frames established in the Veterans Community Care Program (VCCP) appointment scheduling process. First, VA aligned the time VA medical center staff have to take action on a community care referral to 2 business days from the date the referral is entered. Second, VA created a timeliness metric of an average of 7 calendar days from the date a referral is entered to the date the referral is first scheduled. Third, VA created a timeliness metric for a referral to be completed within 90 days of the patient indicated date. VA officials are estimating to complete the recommendation in March 2022.
Department of Veterans Affairs The Under Secretary of Health should conduct a review of community provider enrollment and use of the HSRM to include identifying and taking steps to remove any challenges to community provider enrollment and use; and, if determined appropriate, establish a requirement for community providers to use the HSRM; and (Recommendation 2)
Open
VA agreed with our recommendation, and in February 2022, VA officials stated that approximately 13 percent of the community providers receiving VA referrals are using the HealthShare Referral Manager. VA is working to increase adoption of the system through continued enhancements and the use of focus groups. In addition, VA is working with the VA Office of Information Technology to improve the provider experience in regards to security requirements, including an escalation pathway when there are registration issues. VA is also working on an outreach plan to identify community providers that do not currently utilize the HealthShare Referral Manager, and is working with the associated VA medical facilities to help improve provider engagement. VA is expecting completion of this recommendation in October 2022.
Department of Veterans Affairs The Under Secretary of Health should direct VAMC leadership to assess their community care staffing and resource needs, and develop a plan to address any identified risks to their ability to schedule appointments in a timely manner, including strategies to adjust staff levels and address recruitment and retention challenges as needed. (Recommendation 3)
Open
VA agreed with our recommendation, and in February 2022, stated that the Office of Community Care (OCC) is conducting staffing level updates every 90 days to monitor community care staffing gains and losses across VA, Veterans Integrated Service Networks, and VA medical centers. VA officials stated that an update of the OCC Staffing Tool is required, but must be rebuilt on a new platform. VA expects to implement this recommendation by October 2022.

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