Veterans Community Care Program: Improvements Needed to Ensure Timely Access to Care
What the GAO found
The Department of Veterans Affairs (VA) has established an appointment process for the Veterans Community Care Program (VCCP) that allows up to 19 days to complete multiple steps from VA providers creating a referral community care staff reviewing this referral. However, as the figure shows, VA has not specified the maximum time veterans should wait to receive care under the program. The GAO previously recommended in 2013 the need for a comprehensive measure of wait times for veterans to receive care under a previous community care program. After VA failed to implement this recommendation, the GAO again recommended in 2018 that VA establish an achievable wait time goal as part of its new Community Care Program (the VCCP).
Potential allowable wait time for care under the Veterans Community Care Program
Note: This figure illustrates the potential allowable wait times in calendar days for eligible veterans who are referred to VCCP through routine (non-emergency) referrals and who have VA Medical Center staff – the team (RCT) and community care staff (CC staff)—schedule appointments on their behalf.
VA has not yet implemented the 2018 GAO recommendation that VA establish an achievable wait time goal. Under the VA MISSION Act, VA is given the responsibility of ensuring that veterans’ appointments are scheduled in a timely manner, an essential part of quality health care. Given VA’s lack of action over the previous 7 years in implementing wait time goals for various community care programs, congressional action is warranted to help obtain health care in timely for veterans.
In terms of monitoring the initial stages of the planning process, GAO found that VA uses metrics that are holdovers from the previous community care program, which are inconsistent with the timelines established in the VCCP planning process. This limits VA’s ability to determine the effectiveness of VCCP and identify areas for improvement.
Why GAO Did This Study
In June 2019, VA implemented its new community care program, the VCCP, as required by the VA MISSION Act of 2018. Under the VCCP, VAMC staff are responsible for scheduling appointments for community care; their ability to carry out this new responsibility has implications for veterans receiving timely community care.
GAO has been asked to review the scheduling of VCCP appointments. This report examines, among other issues, the VCCP appointment process established by VA and VA’s oversight of this process.
GAO reviewed documentation, such as planning policies and baselines related to VCCP and assessed relevant VA processes. GAO conducted site visits to five VAMCs in the first region to transition to the new VA provider network, and interviewed VAMC staff and a non-generalizable sample of community providers receiving referrals from these VAMCs. The GAO also interviewed VA and contractor officials.