VA has set a goal of scheduling referrals for private sector appointments within seven days, but less than 40% of its medical centers are doing so even half the time. SDI Productions / Getty Images
VA Is Much Slower at Setting Appointments When Sending Vets to the Private Sector for Care
The department is failing to meet its less ambitious goals for health care appointments outside its own system.
Veterans are receiving appointments for health care within the government system much more quickly than when they are referred out to the private sector, according to a new report.
The Veterans Affairs Department is struggling to meet its own standards to schedule appointments for “community care”—those outside the VA system—the Government Accountability Office found in its review. VA has set a goal of scheduling referrals for private sector appointments within seven days, but less than 40% of its medical centers are doing so even half the time. Less than 10% of the facilities are doing so at least three-quarters of the time. VA has a shorter goal of just three days to schedule appointments within its own system and 90% of its medical facilities are meeting that target for at least half of instances.
VA “has faced longstanding challenges with scheduling [Veterans Health Administration] facility and community care appointments as well as ensuring veterans’ timely access to care,” GAO said. It has taken some steps to improve the system, but the department “faces continued challenges in developing an appointment scheduling process that will provide veterans with timely access to care.”
In fiscal 2021, VA referred 2 million veterans to the private sector for care. Patients must meet certain eligibility requirements related to availability of the treatment at VA, distance they live from a facility or time until an internal appointment is available. After a policy change last year, veterans must also affirmatively approve of being sent outside the VA system. In some cases, GAO noted, veterans may be eligible for private care based on wait times within VA but still receive faster appointments if they stay within the department for care.
Deceptive practices to hide true wait times led to a national scandal in 2014 and multiple legislative overhauls aimed at creating more transparency and allowing veterans to receive medical care faster, including dramatic expansions of community care. The VA inspector general found last year the department is still in some instances relying on misleading information in its public reports on how long patients wait for medical appointments.
GAO criticized VA for failing to create realistic expectations for how long a private sector appointment will take, noting department officials relied on incomplete and old data to come up with the seven-day target. A metric that is more achievable would allow VA to determine if it should make changes to the community care scheduling process. The auditors also knocked the department for failing to create goals for how long it should take for veterans to actually receive care, not just measuring the time until an appointment is scheduled.
“Having such a standard in place for community care appointments, as well as a corresponding standard for VHA appointments at VHA facilities, would help ensure that veterans are receiving timely access to specialty care at VHA facilities and in the community,” GAO said.
VA management agreed with both recommendations. Officials noted the department has deployed new tools to monitor individual medical centers and identify those that are performing poorly. VA has deployed teams to those facilities and helped create action plans to improve performance. Still, GAO said VA is failing to ensure its schedulers receive the proper training to align with improvements to its processes.