Patient Care Access News

GAO Reports Find Patient Access to Care Issues at IHS, DOD

Two GAO reports detail some regulatory issues at the Department of Defense and Indian Health Service which hinder patient access to care.

By Sara Heath

The Indian Health System (IHS) is not keeping up to standards with regard to patient access to care, a new report from the Government Accountability Office stated.


The GAO investigation found that wait times for primary care at IHS facilities is exorbitant on two fronts: first, patients often must wait months before they can schedule an appointment, and second, once the appointment has been made, patients often wait a long time before the meeting with their doctor begins.

IHS is unable to properly mitigate these issues due to a lack of overarching standards across the agency. Without any comprehensive assessment of patient access to care, or attempt to create universal standards at all facilities, IHS falls short in effectively improving patient access to care.

“IHS has not conducted any systematic, agency-wide oversight of the timeliness of primary care provided in its federally operated facilities and, as a result, cannot ensure that patients have access to timely primary care,” GAO wrote in its full report.

According to a GAO report summary, IHS cannot determine the extent to which it has these patient access to care issues because there is no standard to which each facility must be held.

“The lack of systematic, agency-wide oversight of the timeliness of primary care appointments prevents IHS from knowing the extent to which it is meeting the goal of providing accessible primary care services to American Indian and Alaska Native (AI/AN) people and is also inconsistent with federal internal control standards,” GAO wrote.

Insufficient numbers of  primary care staff, as well as outdated technology, serve as considerable barriers to adequate appointment scheduling, IHS told GAO.

Going forward, GAO suggested that IHS take two action steps, including implementing a set of standards for primary care access. It also suggested that IHS implement a monitoring system to examine these steps across all of its primary care facilities so that it can mitigate issues as they arise.

The Indian Health Service isn’t the only governmental health system receiving a warning from the GAO.  The Department of Defense is also having difficulty with patient access to care. In this instance, patients are not able to access adequate mental health care through the DOD and Military Health System.

According to a separate GAO report, DOD is meeting a majority of its standards for mental health appointment types. The agency reportedly falls short with regard to routine appointments.

“DOD data on domestic and overseas direct care from April 2014 through August 2015 show that MHS-wide DOD's access to care standards were generally met for three of four mental health appointment types,” GAO explained in its report.

“However, in the case of routine appointments—initial appointments for a new or exacerbated condition—data show that other than the Air Force, MHS routine mental health appointments generally did not meet the 7-day access standard.”

According to DOD officials, several standard procedures cause these discrepancies in patient access to care, including substandard coding procedures.

“DOD and service officials attributed this to several factors, including some appointments being incorrectly coded, thus negatively impacting the routine appointment access results,” GAO noted.

DOD also told GAO that a large portion of its services include follow-up appointments, which lack an overarching set of standards that would enable GAO to govern them.

“Additionally, the data show that about 59 percent of mental health appointments are follow-up appointments, which generally do not have an official DOD access standard,” GAO wrote.

“Federal internal control standards call for agencies to have sufficient information to monitor agency performance. By not establishing and monitoring a follow-up appointment standard, DOD cannot hold the military services accountable for the majority of mental health care provided in the direct care system.”

GAO determined that DOD and the Military Health System need to implement standard operating procedures across all of its service offerings, namely its follow-up care procedures. DOD reportedly concurred with this decision.


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