When veterans need specialty health care—e.g., mental health or cardiology—timely delivery is key. We testified on our work in this area.
The Department of Veterans Affairs has standards for how quickly these appointments are scheduled after referral. In January 2023, we reported that appointments at the VA were scheduled on time more often than community care appointments.
We also noted that there were no VA standards for how long veterans should have to wait to receive care at the VA or in the community.
VA has made some progress on our related recommendations—notably, VA recently established a wait time standard for VA facility appointments.
What GAO Found
In January 2023, GAO reported that the Department of Veterans' Affairs' (VA) Veterans Health Administration (VHA) had set timeliness standards for how long it should take, following a referral, to get a specialty care appointment scheduled at either a VHA facility or with a community care provider. However, GAO found that VHA did not have timeliness standards for how many days until the appointment occurs—that is, how long the veteran has to wait to receive care. GAO recommended then that VHA develop a standard for the number of days within which appointments with VHA facility providers should occur. VHA recently implemented this recommendation. In the January 2023 report, GAO also reiterated a similar recommendation from a 2018 report—that VHA develop a standard for the number of days within which an appointment with a community care provider should occur. VHA agreed with the 2018 recommendation and has taken steps to address it but has not yet fully implemented it.
Scheduling of appointments at VHA facilities must take place within 3 business days of referral and community care appointments within 7 days, according to VHA's standards. However, in January 2023 GAO found that VHA facilities were more timely in scheduling appointments at VHA facilities than in scheduling community care appointments, according to VHA data (see figure).
Percentage of Referrals Meeting Scheduling Timeliness Standards by Veterans Affairs Medical Center, Third Quarter Fiscal Year 2022
Further, GAO found in January 2023 that VA's analysis that informed the establishment of the community care scheduling timeliness standard of 7 days was limited. GAO recommended then that VHA conduct a comprehensive analysis of scheduling data from all VHA facilities to determine whether the community care standards are achievable and revise them as necessary. VHA agreed with this recommendation but has not yet fully implemented it.
Why GAO Did This Study
VHA operates the largest health care delivery system in the U.S., providing health care to approximately 6 million veterans in fiscal year 2022. In the last decade, Congress has taken steps to expand the ability of eligible veterans to receive care from community health care providers. GAO and others have identified challenges VHA has had in scheduling appointments both with VHA facility providers and community care providers in a timely manner.
This statement focuses on (1) VHA's timeliness standards for specialty care appointments and any gaps in those standards; and (2) VHA facilities' performance in meeting those standards. This statement is based on GAO reports that were issued in January 2023, September 2020, and June 2018. See GAO-23-105617, GAO-20-643, and GAO-18-281. GAO's methodologies are detailed in those reports. This statement also includes updated information on the status of the recommendations made in those reports.
GAO has made six recommendations to VHA to address gaps in the timeliness standards for appointments at VHA facilities and with community care providers. VA generally agreed and has implemented two of these recommendations but has not fully implemented the remaining four as of October 2023.