October 21, 2021

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Veterans Community Care Program: Improvements Needed to Help Ensure Timely Access to Care

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<div>In a September 2020 report, GAO found that the Department of Veterans Affairs (VA) established an appointment scheduling process for its new Veterans Community Care Program (VCCP) but did not specify allowable wait times for some key steps in the process. Further, GAO found that VA had not established an overall wait-time performance measure—that is, the maximum amount of time it should take for veterans to receive care from community providers. In 2013, GAO recommended that VA establish a wait-time measure under a prior VA community care program, and in 2018 again recommended that VA establish an achievable wait-time goal to receive care under the VCCP. VA has not implemented these recommendations. Potential Allowable Wait Time to Obtain Care through the Veterans Community Care Program Note: This figure illustrates potential allowable wait times in calendar days for eligible veterans who are referred to the Veterans Community Care Program through routine referrals (not urgent), and have VA medical center staff—Referral Coordination Team (RCT) and community care staff (CC staff)—schedule the appointments on their behalf. Given VA's lack of action over the prior 7 years in implementing wait-time measures for various community care programs, GAO believes that Congressional action is warranted requiring VA to establish such an overall measure for the VCCP. This should help to achieve timely health care for veterans. GAO found additional VCCP challenges needing VA action: (1) VA uses metrics that are remnants from the previous community care program and inconsistent with the time frames established in the VCCP scheduling process. (2) Few community providers have signed up to use the software VA intends for VA medical center (VAMC) staff and community providers to use to electronically share referral information with each other. (3) Select VAMCs faced challenges scheduling appointments in a timely manner and most did not have the full amount of community care staff VA's staffing tool recommended. In June 2019, VA implemented its new community care program, the VCCP, as required by the VA MISSION Act of 2018. This new program replaced or consolidated prior community care programs. Under the VCCP, VAMC staff are responsible for community care appointment scheduling. This statement summarizes GAO's September 2020 report. It describes for the VCCP: (1) the appointment scheduling process that VA established for veterans, (2) the metrics VA used to monitor the timeliness of appointment scheduling, (3) VA's efforts to prepare VAMC staff for appointment scheduling, and (4) VA's efforts to determine VAMC staffing needs. In performing that work, GAO reviewed VA documentation, such as guidance, referral timeliness data, and VAMC community care staffing data; conducted site visits to five VAMCs; and interviewed VA and VAMC officials. In its September 2020 report, GAO recommended that Congress consider requiring VA to establish an overall wait-time measure for the VCCP. GAO also made three recommendations to VA, including that it align its monitoring metrics with the VCCP appointment scheduling process. VA did not concur with this recommendation, but concurred with the other two. GAO maintains that all recommendations are warranted. For more information, contact Sharon M. Silas at (202) 512-7114 or silass@gao.gov.</div>

What GAO Found

In a September 2020 report, GAO found that the Department of Veterans Affairs (VA) established an appointment scheduling process for its new Veterans Community Care Program (VCCP) but did not specify allowable wait times for some key steps in the process. Further, GAO found that VA had not established an overall wait-time performance measure—that is, the maximum amount of time it should take for veterans to receive care from community providers. In 2013, GAO recommended that VA establish a wait-time measure under a prior VA community care program, and in 2018 again recommended that VA establish an achievable wait-time goal to receive care under the VCCP. VA has not implemented these recommendations.

Potential Allowable Wait Time to Obtain Care through the Veterans Community Care Program

Note: This figure illustrates potential allowable wait times in calendar days for eligible veterans who are referred to the Veterans Community Care Program through routine referrals (not urgent), and have VA medical center staff—Referral Coordination Team (RCT) and community care staff (CC staff)—schedule the appointments on their behalf.

Given VA’s lack of action over the prior 7 years in implementing wait-time measures for various community care programs, GAO believes that Congressional action is warranted requiring VA to establish such an overall measure for the VCCP. This should help to achieve timely health care for veterans.

GAO found additional VCCP challenges needing VA action:

(1) VA uses metrics that are remnants from the previous community care program and inconsistent with the time frames established in the VCCP scheduling process.

(2) Few community providers have signed up to use the software VA intends for VA medical center (VAMC) staff and community providers to use to electronically share referral information with each other.

(3) Select VAMCs faced challenges scheduling appointments in a timely manner and most did not have the full amount of community care staff VA’s staffing tool recommended.

Why GAO Did This Study

In June 2019, VA implemented its new community care program, the VCCP, as required by the VA MISSION Act of 2018. This new program replaced or consolidated prior community care programs. Under the VCCP, VAMC staff are responsible for community care appointment scheduling.

This statement summarizes GAO’s September 2020 report. It describes for the VCCP: (1) the appointment scheduling process that VA established for veterans, (2) the metrics VA used to monitor the timeliness of appointment scheduling, (3) VA’s efforts to prepare VAMC staff for appointment scheduling, and (4) VA’s efforts to determine VAMC staffing needs.

In performing that work, GAO reviewed VA documentation, such as guidance, referral timeliness data, and VAMC community care staffing data; conducted site visits to five VAMCs; and interviewed VA and VAMC officials.

What GAO Recommends

In its September 2020 report, GAO recommended that Congress consider requiring VA to establish an overall wait-time measure for the VCCP. GAO also made three recommendations to VA, including that it align its monitoring metrics with the VCCP appointment scheduling process. VA did not concur with this recommendation, but concurred with the other two. GAO maintains that all recommendations are warranted.

For more information, contact Sharon M. Silas at (202) 512-7114 or silass@gao.gov.

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