Veterans' Community Care: VA Needs Improved Oversight of Behavioral Health Medical Records and Provider Training
Fast Facts
Medical providers at the VA can refer veterans to behavioral health providers outside VA for treatment of conditions like depression. These providers should send medical records back to VA after caring for a veteran. Such exchanges help ensure that a veteran receives coordinated care.
We found that VA doesn't monitor whether these records are sent back, and a significant portion of the medical records were missing for the referrals we reviewed.
We recommended VA improve its monitoring of these exchanges, as well as whether these outside providers have taken training on treating veterans.
Highlights
Why This Matters
Increasingly, veterans seeking health care have been referred by Department of Veterans Affairs (VA) medical centers to community providers outside VA. The quality of the care those veterans receive can be affected by how successfully community and VA providers exchange medical records, as well as community providers’ ability to understand the unique needs of veterans.
GAO Key Takeaways
Veterans used over 350,000 referrals to receive behavioral health services (e.g., psychotherapy for depression) from community providers in fiscal years 2021 through 2023. Many veterans who were cared for by community providers later returned to VA medical centers for further care. To coordinate this care, community providers must send medical documentation (e.g., diagnoses, prescriptions, progress notes) to VA after the veteran’s initial and final visits for each referral.
VA does not monitor whether these medical record exchanges are completed across all medical centers. But we found that 33 percent of these referrals were missing records for initial visits, when we reviewed the data that VA has readily available. Further, no such data are available for final visits, so the extent to which those exchanges are completed is unknown.
Likewise, VA is not monitoring the extent to which community providers complete any of eight core trainings on opioid safety, suicide prevention, and other veteran-centric topics. We found that about 2 percent of the community providers with a behavioral health referral from fiscal years 2021 through 2023 had completed one or more of these trainings.
Medical Records for Behavioral Health Referrals, Fiscal Years 2021 Through 2023
How GAO Did This Study
We analyzed VA data on its behavioral health referrals from fiscal years 2021 through 2023 and community providers’ completion of core trainings. We reviewed VA’s medical record exchange guidance, and interviewed VA officials, staff from five VA medical centers, and representatives from three veteran service organizations.
Recommendations
We are making five recommendations to VA, including for it to establish goals and performance measures and monitor the extent to which medical documentation exchanges and core community provider trainings have been completed.
VA concurred with one recommendation and concurred in principle with the other four recommendations, as discussed in the report.
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Veterans Health Administration | The VHA Under Secretary for Health should ensure that IVC develops guidance for VA medical centers' efforts in obtaining final medical documentation after all visits provided to a veteran under each referral have been completed. (Recommendation 1) |
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
|
| Veterans Health Administration | The VHA Under Secretary for Health should ensure that IVC establishes goals and related performance measures for VA medical centers in obtaining initial and final medical documentation from community providers. (Recommendation 2) |
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
|
| Veterans Health Administration | The VHA Under Secretary for Health should ensure that IVC establishes a process for regularly using performance information for VA medical centers in obtaining initial and final medical documentation from community providers to assess its progress toward established goals. (Recommendation 3) |
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
|
| Veterans Health Administration | The VHA Under Secretary for Health should ensure that IVC establishes and monitors goals and related performance measures for community providers' completion of core trainings and ensures that community providers complete the required training course. (Recommendation 4) |
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
|
| Veterans Health Administration | The VHA Undersecretary for Health should direct IVC to take steps to ensure that it and its contractors communicate clear and accurate information to community providers regarding IVC's core trainings, including whether training is recommended or required. (Recommendation 5) |
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
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