Not All Newly Enrolled Veterans in Our Review Were Able to Access Primary Care; Others Experienced Wide Variation in the Amount of Time They Waited for Care

		Newly Enrolled Veterans Did Not Always Receive Primary Care Appointments Due to Weaknesses in VHA’s Appointment Scheduling Process and Other Factors

Our review of medical records for a sample of veterans at six VA medical  centers found several problems in medical centers processing veterans’  requests that VA contact them to schedule appointments, and thus not all  newly enrolled veterans were able to access primary care. Veterans Experienced Wide Variation in the Amount of Time They Waited for Primary Care Due to Limited Appointment Availability and Weaknesses in Scheduling Practices

Based on our review of medical records for a sample of veterans across  the six VA medical centers in our review, 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 at each medical center ranged from 22 days to 71  days. VHA’s Oversight of Veterans’ Access to Primary Care Is Hindered in Part by Data Weaknesses

		VHA Monitors Only a Portion of the Time It Takes Newly Enrolled Veterans to Access Primary Care

A key component of VHA’s oversight of veterans’ access to primary care,  particularly for newly enrolled veterans, relies on monitoring appointment  wait times. Our review of medical records for 120 newly enrolled veterans found that,  on average, the total amount of time it took to be seen by primary care  providers was much longer when measured from the dates veterans  initially requested VA contact them to schedule appointments than it was  when using appointment wait times calculated using veterans’ preferred  dates as the starting point. Scheduling Errors Continue to Affect the Reliability of Wait-Time Data, Including for Primary Care

Ongoing problems continue to affect the reliability of wait-time data,  including for primary care, used by VHA, VISN, and VA medical center  officials for monitoring and oversight. We found that schedulers incorrectly revised patients’ preferred dates to  later dates, inconsistent with VHA policy, under two scheduling scenarios:  1. They indicated that high  turnover among schedulers and the lack of an updated standardized  scheduling policy make it more difficult to train schedulers and to direct  these staff to current policy, which increases the likelihood of errors. Consequently, data used for monitoring and oversight do  not capture the time newly enrolled veterans wait prior to being contacted  by a scheduler, making it difficult for officials to effectively identify and  remedy scheduling problems that arise prior to making contact with  veterans. (2)  Monitor the full amount of time newly enrolled veterans wait to be  seen by primary care providers, starting with the date veterans  request they be contacted to schedule appointments. In its  written comments, VA concurred with all three of the report’s  recommendations, and identified actions it is taking to implement them. Appendix I: Prior GAO Recommendations Related to Oversight of Veterans’ Access to Primary and Specialty Care

Our prior work has found weaknesses in the Department of Veterans  Affairs’ (VA) Veterans Health Administration’s (VHA) ability to effectively  oversee timely access to health care for veterans.
Why GAO Did This Study

Primary care services are often the entry point for veterans needing care, and VHA has faced a growing demand for outpatient primary care services over the past decade. On average, 380,000 veterans were newly enrolled in VHA's health care system each year in the last decade.
GAO was asked to examine VHA's efforts to provide timely access to primary care services. This report examines, among other things, (1) newly enrolled veterans' access to primary care and (2) VHA's related oversight. GAO interviewed officials from six VA medical centers selected to provide variation in factors such as geographic location, clinical services offered, and average primary care wait times; reviewed a randomly selected, non-generalizable sample of medical records for 180 newly enrolled veterans; and interviewed VHA and medical center officials on oversight of access to primary care. GAO evaluated VHA's oversight against relevant federal standards for internal control.

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.

What GAO Recommends

GAO recommends that VHA (1) ensure veterans requesting appointments are contacted in a timely manner to schedule one; (2) monitor the full amount of time newly enrolled veterans wait to receive primary care; and (3) issue an updated scheduling policy. VA concurred with all of GAO's recommendations and identified actions it is taking to implement them.