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
On January 5, 2021, Congress passed the Johnny Isakson and David P. Roe, M.D. Veterans Health Care and Benefits Improvement Act of 2020, which required VA to establish a process and requirements for scheduling Veterans Community Care Program (VCCP) appointments within 60 days of enactment that includes the maximum number of days allowed to complete each step of the process. However, in January 2021, VA stated it no longer plans to establish an overall wait-time performance measure for the VCCP, noting it does not have control over community providers' scheduling capabilities. GAO continues to believe the development of an overall wait-time performance measure for the VCCP is important to allow VA to evaluate timely access and to identify any deficiencies in its appointment scheduling process or networks of community providers.

Recommendations for Executive Action

Agency Affected Recommendation Status
Department of Veterans Affairs
Priority Rec.
This is a priority recommendation.
1. The Under Secretary of Health should align its monitoring metrics with the time frames established in the VCCP scheduling process. (Recommendation 1)
Open
In April 2021, VA continues to disagree with the recommendation and states it will not take further action to close this recommendation. Although VA responded to our report by stating that the department already monitors key steps in the Veterans Community Care Program scheduling process that align with policy, we continue to believe this recommendation is valid for two reasons. First, VA's response did not address an issue we found for one of the metrics it monitors, which is inconsistent with the guidance it asks staff to follow when reviewing a referral. Second, VA has not yet established time frames to account for the entire Veterans Community Care Program appointment scheduling process, and therefore, is unable to align any of its metrics to achieve a yet-established goal. To implement this recommendation, VA needs to review, and if needed, update the time frames in its Veterans Community Care Program scheduling process, and then align its monitoring metrics accordingly.
Department of Veterans Affairs 2. 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
In April 2021, VA maintained their position from September 2020 that they agreed with the recommendation and believe they've taken action to warrant closure. However, we have requested documentation of those actions, including specific actions VA is taking to remove challenges to community provider enrollment for the HealthShare Referral Manager.
Department of Veterans Affairs 3. 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 April 2021, stated that facility community care offices are utilizing a staffing tool to capture recommended administrative and clinical staffing levels. In addition, VA is in the process of implementing its Referral Coordination Initiative, collaborating across offices to develop robust staffing models for its Referral Coordination Teams, and expanding recruitment and retention efforts of facility scheduling staff. VA expects to implement this recommendation by June 2021.

Full Report

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