2.) Preventive measures consist of periodic health assessments that provide screening, counseling, risk assessment, and patient education. VA’s goal is for its medical centers to perform at least 65 percent of selected surgical procedures on an outpatient basis. Most VA medical centers now have outpatient surgery capability, and the percentage of such surgeries has increased nationwide from 34 to 66 percent between fiscal year 1993 and mid-fiscal year 1997. 3.) (See table 1.) At the Pittsburgh medical center, officials estimated that savings from an increase in outpatient surgeries for fiscal year 1997 totaled more than $7.5 million through May 31, 1997. Savings and Efficiency Gains From Integrations

Integrations within and among medical centers have helped generate savings and increase operational efficiency. VA Is Taking Steps to Improve Access to Health Care

Veterans’ access to health services is improving as VA hospitals reinvest the savings from efficiency initiatives and restructure their service delivery. VA hospitals have increased the number of primary care teams, added or improved space to accommodate additional primary care patients, shortened appointment waiting times, increased the number of locations providing community-based care, and redefined the role of VA inpatient nursing home care. Use of Primary Care Has Improved Access

VA has improved veterans’ access to health care through the use of primary care. Appointments enable VA to improve scheduling of its workload and resources, reducing the time patients spend waiting for an appointment as well as that spent waiting upon arrival to be seen. The medical centers we reviewed showed sizable growth in the numbers of veterans assigned to primary care teams. Some of the medical centers we visited have shortened appointment waiting times for specialty care as access to primary care has improved. For example, the Brockton/West Roxbury medical center now schedules its smoking cessation clinics in the evenings and other medical clinics on weekends to improve access. Monitoring Changes to Health Care Services Is Important

VA headquarters’ monitoring of changes to the health care system is important because network and medical center directors are responding to incentives to change VA’s health care delivery. Without such indicators, it is difficult for VA to ensure that service delivery changes do not compromise the appropriateness of the health care veterans receive. VA officials told us they have begun to develop some outcome measures. To assess VA’s progress in increasing the efficiency of its health care system, we examined VA records documenting effects of efficiency initiatives, including increased outpatient visits, decreased bed-days of care and operating beds, reduction and reassignment of staff, and integration of services.
Why GAO Did This Study

GAO reviewed the Department of Veterans Affairs' (VA) efforts to improve and monitor veterans' access to health care.

What GAO Found

GAO noted that: (1) VA has taken important steps to improve the efficiency of its health care system and veterans' access to it; (2) VA medical centers have increased efficiency by expanding the use of outpatient care; (3) for example, VA has increased the percentage of surgical procedures performed on an outpatient basis from 34 percent in fiscal year 1993 to 66 percent by mid-fiscal year 1997; (4) this has allowed it to reduce bed-days of care, operating beds, and staff; (5) at the Pittsburgh, Pennsylvania, medical center, the increase in outpatient surgeries saved more than $7.5 million from October 1995 through May 31, 1997; (6) preventive care, including health assessments and patient education, has also increased, which VA officials told GAO can lead to efficiencies because patients can be kept healthier, avoiding expensive hospital stays; (7) furthermore, VA is increasing efficiency by integrating services both within and among medical centers; (8) VA is improving access to health care in several ways; (9) for example, VA has begun to emphasize primary care, in which generalist physicians see patients initially and coordinate any specialty care that patients may need; (10) by increasing the number of primary care teams, VA has improved access to routine care and expedited referrals to specialty care; (11) VA is also improving access to health care by providing outpatient care at additional community-based outpatient clinics, expanding evening and weekend hours for clinics, and exploring other innovations; (12) these efforts have shortened the time veterans spend waiting for an appointment as well as that spent waiting to be seen upon arrival for an appointment; (13) all of the medical centers GAO visited have established primary care teams and increased the number of veterans assigned to primary care; (14) as networks and medical centers continue to respond to incentives to improve the efficiency of their operations, headquarters' monitoring of the impact of such responses is necessary to help ensure that they do not compromise the appropriateness of health care veterans receive; and (15) GAO found that although VA has implemented health care monitoring mechanisms to assess some of the changes networks and medical centers are introducing, these mechanisms have not fully succeeded.