	Problems Newly Enrolled Veterans Faced in Accessing Primary Care and Obtaining Timely Access to Care

Our review of medical records for a sample of newly enrolled veterans at  six VA medical centers found several problems in medical centers’  processing of veterans’ requests that VA contact them to schedule  appointments, and thus not all newly enrolled veterans were able to  access primary care. VA medical center staff did not follow VHA scheduling policy. For the 120 newly enrolled veterans across the six VA medical centers in  our review who requested care and were seen by primary care providers,  we found the average number of days between newly enrolled veterans’  initial requests that VA contact them to schedule appointments and the  dates the veterans were seen by primary care providers ranged from 22  days to 71 days. Appointments were not always available when veterans wanted  to be seen, which contributed to delays in receiving care. VHA’s Oversight of Veterans’ Access to Primary Care Is Hindered in Part by Data Weaknesses

VHA’s oversight of veterans’ access to primary care is hindered, in part,  by data weaknesses and the lack of a comprehensive scheduling policy,  both of which are inconsistent with federal internal control standards. These standards call for agencies to have reliable data and effective  policies to achieve their objectives, and for information to be recorded and  communicated to the entity’s management and others who need it to  carry out their responsibilities. For newly  enrolled veterans, VHA calculates primary care appointment wait times  starting from veterans’ preferred dates, rather than the dates veterans  initially requested that VA contact them to schedule appointments. Therefore,  these data do not capture the time veterans wait prior to being contacted  by schedulers, making it difficult for officials to identify and remedy  scheduling problems that may arise prior to making contact with veterans. Further, ongoing scheduling errors, such as incorrectly revising preferred  dates when rescheduling appointments, understated the amount of time  veterans waited to see providers. Officials  attributed these errors to confusion by schedulers resulting from the lack  of an updated standardized scheduling directive, which VHA rescinded  and replaced with an interim directive in July 2014. As in our previous  work, we continue to find scheduling errors that affect the reliability of  wait-time data used for oversight, which make it difficult to effectively  oversee newly enrolled veterans’ access to primary care.
Why GAO Did This Study

This testimony summarizes the information contained in GAO's March 2016 report, entitled VA Health Care: Actions Needed to Improve Newly Enrolled Veterans' Access to Primary Care , GAO-16-328 .

What GAO Found

GAO found that not all newly enrolled veterans were able to access primary care from the Department of Veterans Affairs' (VA) Veterans Health Administration (VHA), and others experienced wide variation in the amount of time they waited for care. Sixty of the 180 newly enrolled veterans in GAO's review had not been seen by providers at the time of the review; nearly half were unable to access primary care because VA medical center staff did not schedule appointments for these veterans in accordance with VHA policy. The 120 newly enrolled veterans in GAO's review who were seen by providers waited from 22 days to 71 days from their requests that VA contact them to schedule appointments to when they were seen, according to GAO's analysis. These time frames were impacted by limited appointment availability and weaknesses in medical center scheduling practices, which contributed to unnecessary delays.
VHA's oversight of veterans' access to primary care is hindered, in part, by data weaknesses and the lack of a comprehensive scheduling policy. This is inconsistent with federal internal control standards, which call for agencies to have reliable data and effective policies to achieve their objectives. For newly enrolled veterans, VHA calculates primary care appointment wait times starting from the veterans' preferred dates (the dates veterans want to be seen), rather than the dates veterans initially requested VA contact them to schedule appointments. Therefore, these data do not capture the time these veterans wait prior to being contacted by schedulers, making it difficult for officials to identify and remedy scheduling problems that arise prior to making contact with veterans. Further, ongoing scheduling errors, such as incorrectly revising preferred dates when rescheduling appointments, understated the amount of time veterans waited to see providers. Officials attributed these errors to confusion by schedulers, resulting from the lack of an updated standardized scheduling policy. These errors continue to affect the reliability of wait-time data used for oversight, which makes it more difficult to effectively oversee newly enrolled veterans' access to primary care.