Veterans Community Care Program: VA has taken action for veterans’ access to care, but COVID-19 has highlighted ongoing planning challenges

What the GAO found

During the COVID-19 pandemic, the Department of Veterans Affairs (VA) has taken action regarding veterans’ access to care through the Veterans Community Care Program (VCCP). For example, VA has recommended that VA medical facility staff schedule telehealth appointments whenever possible to reduce veterans’ risk of exposure to COVID-19. VA has also instructed facility staff to prioritize appointment scheduling and monitor referrals. Nonetheless, for referrals created between January 2020 and January 2021, GAO’s analysis below shows that approximately 172,000 referrals (3%) remain unplanned as of March 24, 2021.

Status of Veterans Community Care Program referrals created between January 2020 and January 2021, as of March 24, 2021

Note: A referral is complete once the veteran attends the appointment and the VA staff receives the provider’s medical documentation. A canceled reference is returned to the GO supplier who placed the order. A discontinued recommendation is no longer desired or necessary. A VA facility’s baseline data was not reported after October 2020.
^aThe number of unplanned referrals created from January 2020 to May 2020 is too small to display in this figure.

Staff at six select VA medical facilities told GAO that they face new and previously identified challenges in scheduling VCCP appointments during COVID-19. For example, staff at all six facilities said wait times for community care have increased during the pandemic. However, because VA does not have an overall measure of wait times for VCCP, the effect of COVID-19 on the timeliness of appointments is unknown. The GAO previously identified and made recommendations to address VA’s lack of wait time metrics in its previous community care programs in 2013 and 2018. Since VA had not implemented these recommendations for the previous 7 years, in 2020, the GAO has recommended congressional action to require VA to establish a VCCP wait time metric.

Staff at the six facilities said they were also facing problems with understaffed community care offices and increased referral volume as veterans returned to seek care. The GAO previously recommended in 2020 that VA direct its medical facilities to assess community care staffing needs. VA has taken steps to address these concerns, but has not yet implemented this recommendation.

Why GAO Did This Study

In June 2019, VA implemented a new community care program – the VCCP – under which eligible veterans can receive care from community providers. The GAO has previously reported on the challenges VA has faced in monitoring its community care programs, including the VCCP. VA’s ability to ensure veterans have timely access to care under the VCCP is especially important as VA continues to respond to the COVID-19 pandemic.

The CARES Act includes a provision for GAO to report on its ongoing monitoring and surveillance efforts related to the COVID-19 pandemic. This report describes (1) VA’s response to the COVID-19 pandemic as it relates to VCCP and (2) the challenges that some VA medical facilities have experienced in scheduling VCCP appointments.

The GAO reviewed VA documentation, such as guidance for VCCP appointment scheduling, and reviewed VCCP referral and appointment data. GAO interviewed VA officials and its two third-party administrators, as well as community care leadership and staff at six VA medical facilities, which were selected, in part, based on complexity, rurality, and location. the location.