VA and DOD Health Care

There have been numerous reports of the Department of Veterans Affairs’ (VA) medical facilities failing to provide timely and accessible care. In some cases, such delays in care or failure to provide care reportedly resulted in harm to veterans. Similarly, there have also been concerns about the Department of Defense’s (DOD) ability to provide quality care to servicemembers.

There are a number of ways that VA and DOD could improve their health care programs.

For instance:

• The Veterans Community Care Program was implemented in June 2019 to allow eligible veterans to receive care from non-VA providers. However, the VA hasn't established a timeliness metric for veterans to receive care. Additionally, most VA medical centers in VA’s first region to implement its new community provider network did not have the recommended number of staff to manage appointment scheduling under the Veterans Community Care Program.
• Veterans rely on long-term care from the VA for everything from occasional help around the house to round-the-clock care. Eligibility is primarily based on the extent of a service-connected disability.  Use of long-term care increased 14% and VA’s obligations went up 33% from FY 2014-2018.  VA projects that demand will continue to increase and spending will double by 2037.  Some key challenges to meeting long-term care needs for veterans include finding enough workers, providing care where geographically needed, and providing specialty care.

VA Projections for Long-Term Care Expenditures, FYs 2017-2037

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• VA medical facilities had a vacancy rate of 11% in 2018, which included 24,000 medical and dental jobs. The VA needs to develop the next generation of leaders and fill key positions.
• Millions of beneficiaries are eligible for DOD health care. DOD issued a plan in February 2020 for a required restructure of its medical treatment facilities, which called for decreasing capability at 43 of them and closing 5. DOD’s restructuring review included assessing the adequacy of nearby civilian health care.  However, the review was based in part on incomplete and inaccurate information and may overstate the adequacy of available civilian care.
• Congress mandated the Defense Health Agency to begin administering DOD’s medical treatment facilities in 2017. However, there have been issues with how DHA provides health care at these facilities. For example, some facilities didn't verify all medical licenses before providers treated patients.
• DOD and the VA are taking steps to help prevent suicides among servicemembers and veterans by establishing prevention strategies and offices to oversee their efforts. However, DOD needs to assess its non-clinical efforts, such as suicide prevention training, for effectiveness. The VA also needs to ensure proper staffing levels for its local suicide prevention teams, and identify and analyze suicides that happen on its campuses.
• DOD's more than 73,000 enlisted medical personnel serve in roles ranging from paramedics to imaging technicians, and must be ready to use their wartime medical skills to care for injured and ill servicemembers. However, DOD could do more to define, track, and assess wartime medical skills.  For example, the Army does not consistently track skills training in its official system, and none of the services have developed targets for training completion.  

Army medical personnel conduct medical evacuation training

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• The VA faced supply chain challenges during the COVID-19 pandemic. In response, it took steps such as establishing central storage facilities for critical medical supplies.  The VA has several linked initiatives to update its supply chain, but needs to ensure that it has a comprehensive strategy for supply chain management that includes all ongoing efforts.
• DOD expects that its health care beneficiaries will be able to access specialty care within 3 days after an urgent referral. Analysis of these referrals at military treatment facilities found that more than half met the 3-day expectation—but about 9% waited 3 weeks or longer. In addition, the new electronic health record system that DOD implemented in 2017 has kept it from monitoring most of the measures it uses for quality of care. 
• The VA relies on electronic health records for patient care, risk management for its patient population, and health research.  VA started transferring records to a new system, which initially deployed in October 2020.  However, there were problems with the quality of the transferred data.  For example, the VA identified errors in allergy, medication, and immunization data, which may pose risks for patient safety.