Veterans Community Care Program: Improvements Needed to Help Ensure Timely Access to Care
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.
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
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.
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
|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)||Congress passed the Consolidated Appropriations Act, 2023, on December 29, 2022, which requires the Veterans Health Administration (VHA) to establish a specific wait time measure (the number of days from the date of request for the appointment to the first next available appointment) for veterans eligible for care under the Veterans Community Care Program (VCCP) and require the VCCP third-party administrators to furnish care within this standard. Once implemented, this would allow VA to monitor timeliness under the VCCP and compare it to VA medical facilities timeliness. Based on the enactment of this Act, we consider the intent of our Congressional Matter to be addressed.|
Recommendations for Executive Action
|Department of Veterans Affairs||
Priority Rec.The Under Secretary of Health should align its monitoring metrics with the time frames established in the VCCP scheduling process. (Recommendation 1)
Between VHA Directive 1232, Consult Processes and Procedures, and the Consult Timeliness Standard Operating Procedure, Veterans Health Administration (VHA) has defined some time frames for VHA medical centers to follow when scheduling appointments under the Veterans Community Care Program (VCCP). However, VHA has not yet defined a timeliness standard for when a veteran should receive care. Congress passed the Consolidated Appropriations Act, 2023, on December 29, 2022, which requires the Veterans Health Administration (VHA) to establish a specific wait time measure (the number of days from the date of request for the appointment to the first next available appointment) for veterans eligible for care under the VCCP and require the VCCP third-party administrators to furnish care within this standard. In February 2023, VA officials stated that they are currently evaluating the technical, logistical, and financial implications of operationalizing the requirements.
|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)||
VA agreed with our recommendation, and in January 2023, provided updated numbers that show an increasing number of community providers are utilizing the HealthShare Referral Manager (HSRM) to receive referrals electronically. VA officials stated that the remaining providers generally receive referrals from HSRM's offline referral form, most often by email or fax. Officials stated that they have also determined that they will not establish a requirement for providers to use HSRM, but will continue to focus on HSRM adoption by community providers who receive a high volume of referrals and providers in high-risk specialties. Officials provided documentation describing their initiatives to increase HSRM use, including (1) educating local VA medical centers about the importance of HSRM through recurring and ad-hoc trainings, (2) proactively reaching out to high-referral volume community providers, and (3) hosting public events to elicit feedback on HSRM use. Based on VHA's actions, we are closing this recommendation.
|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)||
VA agreed with our recommendation, and in January 2023, stated that it last updated its staffing tool in March 2022 to enable each VA medical facility to quantify resource needs and identify the recommended number of administrative and clinical staff based on current workload data, systems, and processes. VA also stated that VA medical facilities make quarterly updates to the staffing tool, which is then used by the facility community care offices to support position requests and for discussions with leadership regarding community care staffing levels. In addition, the Veterans Health Administration (VHA) submits staffing tool results to Congress every 180 days. VHA has also updated its process for scheduling appointments with community care providers with a new procedure for reviewing referrals, called the Referral Coordination Initiative. Under this initiative, VHA transitioned responsibilities for community care appointments from multiple clinical employees to designated referral coordination teams at each VA medical facility. In January 2023, VHA stated that community care staffing needs are expected to evolve further over the next year as VA medical facilities continue to recruit staff and implement new business processes, like the use of referral coordination teams and enhanced technological tools to expedite referral management and appointment scheduling. Although VA has made some progress in implementing this recommendation, we have asked for more evidence to show how VA uses the tool to help VA medical facilities develop plans to address any identified scheduling risks or to address recruitment and retention challenges.