- A recent report from the VA Office of Inspector General shows that appointment wait times at the VA are longer than the agency is reporting.
According to the brief, these inaccuracies are keeping patients from accessing Veterans Choice, a program that allows patients facing wait times of thirty days or longer to receive care at a non-VA healthcare facility.
OIG conducted an audit of the Veterans Integrated Support Network 6 (VISN 6), which is in charge of allocating VA health resources, such as Veterans Choice, in Virginia and North Carolina. The audit, conducted between April 2016 and January 2017, only assessed wait times and did not look at clinical quality.
The audit showed that 36 percent of new patient appointments in VISN 6 had wait times longer than 30 days. The estimated average wait time for those appointments was 59 days.
For primary care appointments, 33 percent of patients had wait times longer than 30 days, although VA recorded that only 17 percent of patients faced wait times greater than 30 days.
Similarly, OIG found that 16 percent of patients receiving mental healthcare faced wait times longer than 30 days, as did 39 percent of patients accessing specialty care. These findings did not match VA’s data, which showed that 5 percent of mental healthcare patients and 8 percent of specialty care patients faced long wait times.
According to OIG, these discrepancies occurred because VISN 6 staff did not accurately input appointment data into the electronic appointment scheduling software. Appointment protocol required VISN 6 staff to list a patient’s preferred appointment time, and OIG found that staff did not always meet that requirement, resulting in inaccurate appointment wait time statistics.
“Requiring schedulers to document those occasions where a veteran has a preferred appointment date is an internal control that mitigates the opportunities for schedulers to routinely and inappropriately designate all scheduled appointments as preferred appointment dates in order to show substantially reduced wait times,” OIG explained.
VA schedulers inaccurately recorded appointment data 74 percent of the time, giving the appearance that 30-day wait times occurred less often than they did in reality.
Inaccurate reports of 30-day wait times are problematic because they potentially limit the number of patients authorized to receive care through Veterans Choice, a program that allows patients facing wait times longer than 30 days to access non-Veteran healthcare.
OIG also found appointment access issues for those patients who did receive authorization for the Veterans Choice program.
“With respect to those veterans in VISN 6 who received their care through Choice, we estimated that 82 percent of the appointments during the relevant time period had wait times longer than 30 days,” OIG wrote in a report summary. “This occurred primarily because medical facilities did not ensure they had sufficient staffing resources to provide timely access to Choice care.”
According to the agency, wait time issues occurred because of two staffing problems.
First, VA ran into issues facilitating communication between patients and Health Net, the civilian service that schedules appointments for veterans accessing care through Veterans Choice. Previously, VA served as a middleman between Health Net and patients, making the scheduling process lengthy and complicated.
In November 2015, VA allowed Health Net to work directly with patients to book appointments, however this change did not completely eradicate all appointment scheduling issues.
Second, VA did not have enough staff to meet Veterans Choice needs. To operate the Veterans Choice program, staff needed to process Choice requests, authorizations, and patient returns. OIG determined that given the staffing numbers and workload, Veterans Choice staff were tasked with double the work appropriate for a single employee.
To mitigate these scheduling issues, OIG issued four recommendations to the then-Under Secretary for Health, David Shulkin. These recommendations pertained to monitoring controls for scheduling requirements, wait time data, and Veterans Choice.
OIG also issued six recommendations to the VISN 6 Director to improve controls for healthcare access.
“This included ensuring staff used clinically indicated and preferred appointment dates consistently, medical facilities conduct required scheduler audits, staffing resources are adequate to ensure timely access to health care through Choice, and consults are managed effectively,” OIG reported.
In response to the recommendations, then-Under Secretary Shulkin concurred, stating that it would implement the bulk of the recommendations by July, 2017. By the time of his response, Schulkin said three of the recommendations had already been completed.
Shulkin did push back against some of the report’s conclusions, stating that OIG did not use the same methodology for calculating appointment wait times as VA uses. According to Shulkin, the discrepancies between patient wait times were not as problematic as the OIG report indicated.
“I cannot concur with some of the conclusions in this report nor use them for management decisions,” Shulkin wrote.
OIG asserted that even had it used the same wait time calculations, there still would have been a widespread discrepancy in wait time data, pointing to needed changes throughout VA.
This is not the first time OIG has found issues with appointment scheduling at the VA. In April 2016, OIG conducted an audit finding that patients faced wait times between 22 and 71 days for primary care appointments.
Another recent OIG audit found that the Veterans Choice program needs better support, showing that the program did not alleviate long primary care wait times due to bureaucratic barriers limiting the Choice program.