Veterans Health Care: VA Actions Needed to Ensure Timely Scheduling of Specialty Care Appointments
Fast Facts
When veterans need specialty care—e.g., mental health or cardiology—it's important to deliver it quickly. But it's been difficult. In 2020, the Veterans Health Administration changed how it schedules specialty care appointments at VHA facilities and with providers in the community.
VHA's standard is for appointments to be scheduled within 3 business days from referral at VHA facilities and within 7 days for community care. Some FY2022 data showed that VHA appointments were scheduled on time more often than community care appointments.
We recommended examining all scheduling data to determine if community care standards are realistic, and more.
Highlights
What GAO Found
The Veterans Health Administration (VHA) updated its process for scheduling specialty care appointments in 2020. This included both appointments at VHA facilities and with providers in the community. Under VHA's updated process, referral coordination teams at each VA medical center review referrals for specialty care, such as mental health treatment or cardiology, and discuss care options with veterans.
According to the timeliness standards that VHA has established for specialty care appointment scheduling, appointments at VHA facilities must be scheduled within 3 business days from the date a VHA provider enters a referral and community care appointments must be scheduled within 7 days. VHA data from the third quarter of fiscal year 2022 indicate that VA medical centers performed better scheduling timely referrals for VHA facility appointments than community care. VHA officials said they are considering reexamining the community care standard. VHA's limited analysis on scheduling timeliness that VHA officials conducted in 2021 lacked information for the current standard. Conducting a comprehensive analysis of scheduling timeliness data from all VA medical centers could help VHA determine whether the community care standard is achievable or adjustments to the standard or scheduling process are needed.
Percentage of Referrals Meeting Timeliness Standards by Veterans Affairs Medical Center, Third Quarter Fiscal Year 2022
In May 2022, VHA developed training materials on the updated scheduling process for both the providers who enter referrals and those who review them for the referral coordination team. However, VHA does not require this training. Doing so would help ensure that providers have the information needed to perform their duties and help ensure veterans' timely access to care.
Why GAO Did This Study
VHA operates the largest health care delivery system in the United States, providing health care to 6.4 million veterans in fiscal year 2021. In the last decade, Congress has taken steps to expand the ability for eligible veterans to receive care from community providers, such as when they cannot access care in a timely manner from VHA directly. GAO and others have previously identified challenges VHA has had in scheduling appointments in a timely manner. The Johnny Isakson and David P. Roe, M.D. Veterans Health Care and Benefits Improvement Act of 2020 included requirements for VHA related to appointment scheduling and related oversight and training. It also includes a provision for GAO to review VHA's efforts.
This report, among other objectives, describes VHA's updated specialty care scheduling process; examines VHA's scheduling timeliness standards; and examines VHA's efforts to provide training on the updated scheduling process. GAO reviewed VHA documentation on the scheduling process and scheduling timeliness data for the third quarter of fiscal year 2022, the most recent data available. GAO also interviewed VHA officials and officials at six VA medical centers that were randomly selected based on facility complexity and geography.
Recommendations
GAO is making three recommendations, including that VHA conduct a comprehensive analysis of scheduling timeliness data from all VA medical centers and require training. VA concurred with the recommendations and identified steps it would take to implement them.
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Department of Veterans Affairs |
Priority Rec.
The Undersecretary for Health should develop a timeliness standard for the number of days within which veterans' appointments with VHA facility providers should occur. (Recommendation 1) |
The Department of Veterans Affairs (VA) agreed with our recommendation. In February 2023, VA said it would align timeliness standards for care at VHA facilities with the designated access standards that VHA has for community care. Subsequently in May 2023, VA reported that it had established an access standard for VHA facility care effective in the first quarter of fiscal year 2023. According to VA documentation, this standard specifies that the average number of days a new patient should have to wait for an appointment to occur should be less than 20 days primary care and mental health and 28 days for specialty care from the date of the request. Documentation that officials provided on the standard shows that they have outlined expectations for each VHA facility to improve performance towards meeting the standard each quarter until the 20- and 28-day goals are met and once the goal is reached, VHA facilities should sustain their performance.
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| Department of Veterans Affairs | The Undersecretary of Health should conduct a comprehensive analysis of appointment scheduling data from all VAMCs to determine whether the community care timeliness standards are achievable and revise them as necessary. (Recommendation 2) |
VA agreed with this recommendation. In May 2023, VA officials reported that the Veterans Health Administration (VHA) had conducted an analysis of community care scheduling for referrals VHA facilities scheduled from October 2022 through January 2023 against the timeliness standards to determine whether these standards were achievable. Documentation that VA provided shows that through this analysis, VHA validated our findings that many VHA facilities were not achieving the current timeliness standard of scheduling an appointment within 7 days of the file entry date. In response, VHA documentation shows that the Department established a goal for each VHA facility to reduce the average number of days it takes to schedule appointments by specific percentage targets over time, with targets through February 2024, in an effort to meet the 7-day scheduling standard. As of March 2024, officials said that most VHA facilities are showing improvement in reducing the amount of time to schedule community care appointments. In addition, officials said VHA is updating its standard operating procedure on scheduling timeliness to specify the current goal and remove older guidance. When VA completes these activities, we will evaluate the extent to which they have addressed our recommendation.
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| Department of Veterans Affairs | The Undersecretary of Health should require referring providers and RCT clinical reviewers to complete the role-based Referral Coordination Initiative training that VHA developed and track completion of the training to ensure familiarity with its updated scheduling process for VHA facility and community care appointments. (Recommendation 3) |
VA agreed with our recommendation. As of March 2024, VA officials reported that they continue to work on updating available trainings on the referral management process to ensure that they fully reflect the process and ensure that the documentation Referral Coordination Team (RCT) reviewers complete is standardized. Officials said that they continue to provide training during national calls, while they update the courses in the Veterans Health Administration's (VHA) training system. Officials said that once the updated courses are ready, they will instruct VHA facilities to assign the courses to facility RCT staff by role, as appropriate. VA officials said that they will highly recommend that staff complete the training and will be monitoring training completion by role at the national level. In addition, in March 2024, officials reported that the Department anticipates publishing a new referral management directive in July 2024. According to officials, VHA will require providers to receive referral management training, which will include Referral Coordination Initiative role-based training, within 90 days of the directive's publication. Further, VA officials said VHA will track providers' completion of this mandatory training. VA officials said they expect to complete these activities by October 2024. At that time, we will look at VA's steps to monitor referring providers and RCT reviewers' completion of training to evaluate whether the steps VA has taken address our recommendation.
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