Travel Times for Most Chattanooga-Area Veterans to VA Hospitals in Murfreesboro and Nashville Exceeded VA’s Guidelines

Almost all (99 percent) of the 16,379 Chattanooga-area enrolled veterans,  as of September 2001, faced travel times that exceeded VA guidelines for  travel to the nearest VA hospitals in Murfreesboro and Nashville. Travel Times to Obtain Outpatient Primary Care Frequently Exceeded VA Guidelines

In fiscal year 2001, more than half (about 8,400) of the 16,379 Chattanooga- area enrolled veterans faced travel times that exceeded VA’s 30-minute  travel guideline for accessing care at VA’s nearest primary care clinic. Draft CARES Plan Would Enhance Access for Some Veterans but Diminish Access for Others

VA’s draft CARES plan includes a proposal to shorten Chattanooga-area  veterans’ travel times by purchasing inpatient care from non-VA hospitals  in Chattanooga. We  estimate that 14 percent of the Chattanooga-area veterans’ workload  would be affected by the shift, given that an estimated 54 percent of the  total workload would be handled in Nashville, compared to 40 percent in  fiscal year 2002. Opening New Clinics Would Shorten Travel and Appointment Waiting Times for Outpatient Primary and Specialty Care

The draft CARES plan calls for opening new community-based clinics and  other changes that would reduce travel and waiting times for enrolled  veterans residing in the 18-county Chattanooga area. In fiscal year 2001,  about 8,400 Chattanooga-area enrolled veterans faced travel times for  primary care that exceeded VA’s 30-minute guideline. The remaining 5,700 enrolled veterans would continue  to face travel times longer than VA’s 30-minute guideline. Recommendations for Executive Action

We recommend that as part of his deliberations concerning whether  additional access improvements for Chattanooga-area veterans beyond  those contained in the draft CARES plan are warranted, the Secretary of  Veterans Affairs explore alternatives such as    purchasing inpatient care locally for a larger proportion of Chattanooga- area veterans’ workload, particularly focusing on those veterans who may  experience longer travel times as a result of the proposed shift of inpatient  workload from Murfreesboro to Nashville;    expediting the opening of the four proposed community-based clinics; and    providing primary care locally for more of those veterans whose access  will remain outside VA’s travel guideline, despite the opening of the four  clinics. Appendix I: Scope and Methodology

Our objectives were to (1) assess how Chattanooga-area veterans’ access  to inpatient hospital and outpatient primary and specialty care compared  to the Department of Veterans Affairs’ (VA) established travel time and  appointment waiting time guidelines and (2) determine how VA’s draft  Capital Asset Realignment for Enhanced Services (CARES) plan could  affect Chattanooga-area veterans’ access to such care.
Why GAO Did This Study

Veterans residing in Chattanooga, Tennessee, have had difficulty accessing Department of Veterans Affairs (VA) health care. In response, VA has acted to reduce travel times to medical facilities and waiting times for appointments with primary and specialty care physicians. Recently, VA released a draft national plan for restructuring its health care system as part of a planning initiative known as Capital Asset Realignment for Enhanced Services (CARES). GAO was asked to assess Chattanooga-area veterans' access to inpatient hospital and outpatient primary and specialty care against VA's guidelines for travel times and appointment waiting times and to determine how the draft CARES plan would affect Chattanooga-area veterans' access to such care.

What GAO Found

Almost all (99 percent) of the 16,379 enrolled veterans in the 18-county Chattanooga area, as of September 2001, faced travel times that exceeded VA's guidelines for accessing inpatient hospital care. During fiscal year 2002, only a few Chattanooga-area veterans were admitted to non-VA hospitals in Chattanooga--constituting about 5 percent of inpatient workload. In addition, over half (8,400) of Chattanooga-area enrolled veterans faced travel times that exceeded VA's 30-minute guideline for outpatient primary care. Also, waiting times for scheduling initial outpatient primary and specialty care appointments frequently exceeded VA's 30-day guideline. VA's draft CARES plan would shorten travel times for some Chattanooga-area veterans but lengthen travel times for others. Under the plan, the amount of inpatient care VA purchases from non-VA hospitals in Chattanooga would increase from 5 percent to 29 percent, thereby reducing those veterans' travel times to within VA's guidelines. The plan also proposes to shift some inpatient workload from VA's Murfreesboro hospital to its Nashville hospital. As a result, an estimated 54 percent of inpatient workload for Chattanooga-area enrolled veterans will be provided in Nashville compared to 40 percent in fiscal year 2002, thereby lengthening some veterans' travel times by about 20 minutes. The plan also proposes opening four new community-based clinics, which would bring about 2,700 more Chattanooga-area enrolled veterans within VA's 30-minute travel guideline for primary care, leaving about 5,700 enrolled veterans with travel times for such care that exceed VA's guideline. These clinics likely would not open before fiscal year 2011, given priorities specified in the plan.