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VA Choice Program Protocol Creates Long Patient Wait Times

The VA's Veterans Choice Program still causes veterans to face long appointment wait times, despite agency goals to keep wait times under 30 days.

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Source: Thinkstock

By Sara Heath

- Protocol at the Department of Veterans Affairs for scheduling Veterans Choice Program appointments causes veterans to wait up to 81 days for treatment, despite VA goals to administer care within 30 days of requesting a doctor’s appointment, according to a report from the Government Accountability Office (GAO).

The Veteran’s Choice Program was enacted in 2015 to help veterans facing significant care barriers to access treatment at non-VA health facilities. Veterans qualify for the Choice Program if they meet the following criteria:

  • the next available medical appointment with a VHA provider is more than 30 days from the veteran’s preferred date or the date the veteran’s physician determines he or she should be seen;
  • the veteran lives more than 40 miles driving distance from the nearest VHA facility with a full-time primary care physician;
  • the veteran needs to travel by air, boat, or ferry to the VHA facility that is closest to his or her home;
  • the veteran faces an unusual or excessive burden in traveling to a VHA facility based on geographic challenges, environmental factors, or a medical condition;
  • the veteran’s specific healthcare needs, including the nature and frequency of care needed, warrants participation in the program;
  • the veteran lives in a state or territory without a full-service VHA medical facility.

According to GAO, wait times longer than 30 days are the second most common reason for veteran referral to the Choice Program. The most common reason was that the VA did not offer the service the veteran sought.

Despite the fact that Veterans Choice commonly served veterans needing more timely access to care, GAO found that veterans can wait up to 81 days for an appointment through the Choice Program.

“Our preliminary analysis of VA’s process indicates that veterans who are referred to the Choice Program for routine care because services are not available in a timely manner at VA could potentially wait up to 81 calendar days to obtain care,” the agency wrote in its report.

READ MORE: What Providers Should Know to Improve Patient Access to Healthcare

“This is in contrast to VA’s wait time goal for the Choice Program, which is that time-eligible veterans receive routine care no more than 30 calendar days from the date an appointment is deemed clinically appropriate by a VA health care provider.”

A veteran first must qualify for the program via the above-mentioned criteria to obtain an appointment through Veteran’s Choice. Once the VA identifies Choice-qualified veterans, it invites the veteran to receive care at a non-VA facility and the veteran must opt into the program.

From there, the VA must compile the patient’s medical records and submit them to a third-party administrator (TPA). Upon receipt, the TPA determines the best facility for the veteran to receive treatment.

The TPA confirms that the patient has opted into the program, and then schedules the appointment for the veteran.

Veterans Choice protocol allows this process to be lengthy, GAO reported. VA may take 21 days to determine if a patient needs Choice care, authorize Choice care, and collect all necessary health data.

READ MORE: VA Leader Promises Patient Care Access, Scheduling Improvements

Contractors may take 30 days to contact and schedule with non-VA providers.

Non-VA providers may take 30 days to schedule an appointment.

According to GAO, long wait times for Veterans Choice did indeed occur. In 2016, it took VA medical centers (VAMCs) 24 days to contact TPAs following the veteran’s initial need for care.

 It also took TPAs an average of 14 days to receive patient data and confirm patient opt-in. Following appointment scheduling, veteran patients waited an average of 26 days to see their clinician.

GAO found that of the 88 Veterans Choice referrals it inspected, 53 were rejected by TPAs for non-VA care. These patients then waited an average of 111 days to receive care through a VA community program, alternative VA care, or another Veterans Choice submission.

READ MORE: VA Boosts Patient Access to Care, Engagement Strategies

According to GAO, the VA is in the process of making improvements. The VA is co-locating VAMCs and TPAs, as well as implementing web-based communication tools between the two entities, to make the exchange of patient information easier. The agency is also automating the Veterans Choice authorization process.

TPAs will also be required to return Veterans Choice requests if it does not meet scheduling timeline requirements, and the VA is experimenting with VAMC scheduling as well.

The Veteran’s Choice Program is set to expire this coming summer, although there are still some funds allocated to the program that could allow it to keep running, according to a report from Hope Yen of the Associated Press.

During an address to the House Committee on Veterans Affairs yesterday, VA Secretary David Shulkin requested an extension for the Veterans Choice Program, stating that although the program is imperfect, it does benefit several veterans and needs more time for improvement.

“There is no time to waste,” Shulkin said in prepared comments to the House Veterans Affairs Committee. “Many veterans are using the choice program today, and it is important to continue to care for and support those veterans.”

Late last week, the VA’s Office of Inspector General also released a report pertaining to the Veteran’s Choice program and veteran appointment wait times. According to the OIG report, VA administrators have been inaccurately recording veteran appointment wait times, barring some patients from access to the Choice Program to which they were entitled.

VA schedulers inaccurately recorded appointment wait times 74 percent of the time, giving the appearance that 30-day wait times occurred less often than they did in reality, OIG found.

The VA responded by stating that it was in the midst of implementing some of OIG’s recommendations, and would completely implement the rest of the recommendations by July 2017.

Secretary 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 in response to the OIG report.

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