Value-Based Care News

Veterans Health Administration Mismanaging the Consult Process

By Ryan Mcaskill

A new study from the Government Accountability Office found problems with the how the VHA oversees specialty care.

- Last week, the Government Accountability Office (GAO) released the results of its review of the Department of Veterans Affairs’ (VA) Veterans health Administration’s (VHA) management of the consult process. It was determined that a majority of consults reviewed are not providing care in a timely manner, if at all.

The review focused on a non-generalizable sample of 150 consults requested from April 2013 through September 2013. These included requests for evaluation or management of a patient for a specific clinical concern. It was discovered that 122 of the 150 consults did not provide the requested care in accordance with VHA’s 90-day timeliness guideline.

The goal of the study was to examine the extent to which VHA’s consult process has ensured veterans’ timely access to outpatient specialty care and how VHA oversees the consult process to ensure veterans are receiving outpatient specialty care in accordance with its timeliness guidelines. GAO reviewed documents and interviewed officials to make its determination.

According to the report, officials for the VA medical center cited increase demand for services, patient no-shows and cancelled appointments and the limited oversight by the VHS which impedes its ability to ensure timely access to speciality care. The lack oversight specifically, creates several problems in the consult process. These include:

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  • • VHA does not routinely assess how VAMCs are managing their local consult processes, and is limited in its ability to identify systemic underlying causes of delays

    • VAMCs are required to review the backlog of thousands of unresolved consults and close any that are warranted. However, there is no process for documenting why they were closed, making it difficult to determine if they were closed properly.

    • There is no official process for sharing best practices among VAMCs. This hurts overall processes as organizations are not able to benefit from the challenges of others have faced and overcome.

    • Lacks a detailed system-wide policy for how VAMCs should be manage patient no-shows and cancelled appointments for outpatient specialty care, making it difficult to compare timeliness in providing this care system-wide.

    “There have been numerous reports of VAMCs failing to provide timely care to veterans, including specialty care. In some cases, delays have reportedly resulted in harm to patients,” the report reads. “In 2012, VHA found that its consult data were not adequate to determine the extent to which veterans received timely outpatient specialty care. In May 2013, VHA launched an initiative to standardize aspects of the consult process at its 151 VAMCs and improve its ability to oversee consults.”

    The GAO recommends that VHA take actions to improve its oversight of consults including routine access to VAMC’s local consult processes, require VAMCs to document rationales for closing unresolved consults, develop a formal process for sharing information and develop a policy for managing patient no-shows. The VA agreed with all of these finds and stated it would provide examples of its progress.