Patient Scheduling Still Problematic at VA Medical Settings

April 19, 2016 - In a perfect world, the Department of Veterans Affairs’ (VA) patient scheduling system works effectively so veterans are able to access primary care physicians easily. Unfortunately, many veterans continue to face extremely long wait times or don’t even get the opportunity to see a doctor, according to a report by the Government Accountability Office (GAO).

The GAO report sampled about 180 veterans who were newly enrolled for primary health at the VA and Veterans Health Administration (VHA). Sixty out of 180 veterans were not seen by doctors for primary care. Almost half of them were unable to access primary care because VA medical center staff did not schedule appointments in accordance with VHA policy. Some veterans did not see doctors due to limited appointment availability.

Those who were able to see doctors experienced wait times that varied between 22 to 71 days even though some of the medical records stated that they had “zero-day” wait times. VHA’s scheduling policy was not up to federal standards. Its data did not capture the time veterans waited before they were contacted by schedulers. As a result, veterans experienced long wait times.  

“VA healthcare is a high-risk area,” GAO said. “In several cases, newly enrolled veterans were never contacted to schedule appointments, due to medical center staff failing to comply with VHA policies for scheduling such appointments or medical center staff being unaware of veterans’ requests.”

One veteran in the study applied for VHA healthcare benefits in December 2014. At that time, he requested to be contacted for an initial appointment. A VA medical center contacted him to schedule a primary care appointment 43 days later. Although the medical center’s data showed that the veteran waited only two days to see a doctor, he actually had to wait 76 days from the time he first contacted VHA.  

VHA has not been providing many veterans with timely access to healthcare because they don’t have adequate data and oversight mechanisms in place, GAO said.

Wait times for veterans continues to be a huge problem that has not gone unnoticed. While GAO blames VA medical centers for not following proper scheduling policies, others blame them for falsifying data. According to recent USA Today article, supervisors instructed employees to falsify patient wait times at VA medical facilities in at least seven states.

Overall, wait times for primary care are not being monitored enough. GAO found that VHA only monitors a portion of the overall time it takes newly enrolled veterans to access primary care. In order to comply with federal internal control standards, they need to monitor all wait times. VHA’s data used for monitoring and oversight was not capturing veterans’ overall experiences, such as the time newly enrolled veterans had to wait before they were contacted by a scheduler, GAO said.

Veterans also use primary care serves as a gateway to other VHA health care services, such specialty care. When veterans need specialty care, such as cardiology, they are typically first referred to a specialist by their primary care provider. If they don’t have access to primary care access is a timely manner, they also can’t reach specialists when they need to.

GAO found that VHA did a better job handling follow-up care than it did scheduling primary care appointments. Most veterans were able to access follow-up primary care within the time frames outlined in VHA Policy.

However, 13 out of 51 veterans were not seen for follow-up appointments within 30 days of their return-to-clinic dates. Veterans were not always notified that they needed to schedule follow-up appointments. Out of the 13 veterans who were not seen for follow-up appointments, six were not notified because VA medical center staff did not properly implement their recall reminder process. Other veterans were not seen for follow-up appointments due to a lack of available appointments.

Veterans who make a request to schedule an appointment should be contacted in a timely manner, GAO said. The full amount of time it takes newly enrolled veterans to wait to receive primary care should also be monitored. VHA should also issue an updated scheduling policy. At the end of the report, VA showed it agreed with all of the recommendations and identified actions it could take to implement them.

Findings from the report came from an audit of six VA medical centers. GAO reviewed these centers from January 2015 to March 2016.  

VHA is within the Department of Veterans Affairs (VA) and operates one of the largest health care systems in the US. Every year, about 380,000 veterans become enrolled in VHA's healthcare system for the first time. This trend has persisted for the last decade at least. In 2014, VHA provided care to approximately 6.6 million veterans and spent about $58 billion for their care.

Both aging and young veterans returning from military operations in the Middle East enter the VHA healthcare system via primary care services. Demand for their outpatient primary care services has continue to increase over the last ten years. From 2005 to 2014, outpatient primary care medical appointments that VHA provided increased by 17 percent, the GAO report said.

As more veterans need access to healthcare, more pressure will most likely be placed on the VHA healthcare system to improve its patient scheduling practices and wait times.

“Providing our nation’s veterans with timely access to primary care is a critical responsibility of VHA. As primary care services are often the entry point to the VA health care system for newly enrolled veterans, the ability to access primary care and establish a relationship with a VHA provider can be instrumental in the ongoing management of a veteran’s overall health care needs,” GAO said.