The Department of Veterans Affairs needs to bolster its third-party patient care access to help reduce its appointment wait times, according to a recent report from the Office of Inspector General.
OIG’s report, which it conducted in response to a letter from Senator Johnny Isakson (R-GA), concluded that the VA’s Veterans Choice Program did not alleviate patient care access issues and needed better administrative support to improve.
The VA created the Veterans Choice Program in October 2014 to allow some veterans to access treatment at third-party providers.
The agency designed this program to serve veterans who faced a 30-day wait period for appointments at a VA medical center. The VA also offered patients the Veterans Choice Program if they lived 40 miles or more from a VA medical center, had to fly or take a ferry or a boat to a VA center, or faced another unusual or cumbersome barrier.
OIG conducted its review using data from November 2014 to September 2015, the first 11 months after program implementation. The review looked at average wait times for possible Veterans Choice Program appointments during authorization of care, scheduling, and care delivery.
The report investigated the Atlanta, GA, VA Health Care Program because of specific issues addressed in Senator Isakson’s letter. Additionally, OIG investigated a random sampling of seven other Veterans Choice Programs based on the number of veterans with 30-day wait times. These included:
- VA Greater Los Angeles Healthcare System, CA
- VA Eastern Colorado Health Care System, CO
- North Florida/South Georgia Veterans Health System, FL
- John J. Pershing VA Medical Center, MO
- Kansas City VA Medical Center, MO
- South Texas Veterans Health Care System, TX
- VA Salt Lake City Health Care System, UT
OIG found considerable barriers to accessing care through the Veterans Choice Program, largely during the authorization and scheduling process.
“Before receiving an appointment with a network provider, veterans had to first navigate through Choice’s authorizing and processing procedures,” OIG reported. “These procedures included eligibility reviews, decisions to opt into the program, and transfer of medical documentation by VHA to [a third-party provider].”
According to OIG, this entire process took an average of 32 days, which is two days longer than VA’s standard for completing appointment requests.
After making an appointment, veterans waited an average of 13 days to receive care, making the average start to finish wait time 45 days. OIG did not review individual cases to see if patient harm occurred during these wait times.
During the review period, VA issued 283,500 authorizations for Veterans Choice, which resulted in 149,400 cases in which patients waited at least 45 days for appointments. Nearly 36,000 patients were referred back to the VA without receiving care through the Choice Program for a number of reasons.
“About half of the returned authorizations were sent back because Choice was unable to schedule the appointment with an appropriate provider or the appointment offered to the veteran was declined,” OIG said.
“The other half of returned authorizations were sent back because they were missing VA data, veterans requested specific providers outside the network, VHA requested that the authorizations be returned, or the veterans did not show up for their appointments.”
By the end of the review period, 98,200 patients were still waiting for appointments. OIG estimated that these wait times would be approximately 72 days.
According to OIG, these barriers resulted from inadequate staffing numbers at third-party providers. VA addressed these issues following program implementation by issuing noncompliance letters to third-party providers requiring them to hire an adequate workforce and sending a memo requesting Veterans Integrated Service Networks to assist third-party providers in hiring extra personnel.
Another barrier may have resulted from patients who were concerned that they would assume all financial responsibility if they accessed care at a third-party provider.
“VHA lacked strong oversight of [third-party provider] payments to network providers,” the report explained. “If these payments are delayed, there are no safeguards to prevent the veteran from being billed for any unpaid medical claims and experiencing adverse credit reporting.”
OIG also suggested that these barriers were the result of flawed program implementation. VA was only allotted 90 days to implement the Veterans Choice Program, a timeframe that many VA leaders said was too short for the task at hand. To make implementation easier, VA outsourced many of the administrative duties to third-party providers involved in Veterans Choice.
As a result, OIG recommended that the VA Under Secretary of Health work to improve the administration process to allow veteran patients better access to healthcare.
“We recommended the Under Secretary for Health streamline procedures for accessing care, develop accurate forecasts of demand for care in the community, reduce providers’ administrative burdens, ensure veterans are not liable for authorized care, and ensure provider payments are made in a timely manner,” OIG recommended.
The VA concurred with OIG’s findings and recommendations.
The first three recommendations – streamlining procedures for care access, developing accurate forecasts of demand for care, and reducing provider administrative burden – were all slated to have been completed fall 2016. The VA noted that the final three recommendations had already been completed at the time of its receipt of the report.
The VA also released a statement following OIG’s publication of its report, highlighting that it had taken action to improve Veterans Choice before OIG’s investigation:
VCP is no longer the program it was when it rolled out. The Department has made significant improvements since the inception of the program. VA did not wait for the OIG report to publish before taking critical steps towards improving the program, including working with Congress to amend the law four times to increase Veterans access and satisfaction with VCP, including increasing the provider base, increasing the number of scheduled appointments, and implementing numerous process changes for both VA and our contract partners.
According to the VA, community care authorizations increased by 25 percent between fiscal years 2015 and 2016. Veterans Choice networks also increased by 67 percent during that same time period.
Despite these improvements, the agency acknowledges that it has significant work to do to improve timely access to veteran care, and calls on Congress to help it achieve that goal.
“Even with the improvements, we recognize more work needs to be done,” the agency wrote. “VA will continue working with Congress and all of our stakeholders and partners to deliver a community care program that meets the needs of Veterans and their families.”
“VCP continues to expand timely access to care for Veterans,” VA continued. “Over 6 million VCP appointments have been completed since VCP’s inception. VA can’t make all the necessary changes to the VCP alone. We need Congress to act on our proposed Plan to Consolidate Community Care so we can continue to build on the progress we have made.”