June 28, 2022

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VA Health Care: Reported Outpatient Medical Appointment Wait Times Are Unreliable

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<div>What GAO FoundIn brief, GAO found that (1) VHA's reported outpatient medical appointment wait times are unreliable, (2) there was inconsistent implementation of certain elements of VHA's scheduling policy that could result in increased wait times or delays in scheduling timely medical appointments, and (3) VHA is implementing or piloting a number of initiatives to improve veterans' access to medical appointments. Specifically, VHA's reported outpatient medical appointment wait times are unreliable because of problems with correctly recording the appointment desired date--the date on which the patient or provider would like the appointment to be scheduled--in the VistA scheduling system. Since, at the time of our review, VHA measured medical appointment wait times as the number of days elapsed from the desired date, the reliability of reported wait time performance is dependent on the consistency with which VA medical centers (VAMC) schedulers record the desired date in the VistA scheduling system. However, aspects of VHA's scheduling policy and related training documents on how to determine and record the desired date are unclear and do not ensure replicable and reliable recording of the desired date by the large number of staff across VHA who can schedule medical appointments, which at the time of our review was estimated to be more than 50,000. During our site visits, we found that at least one scheduler at each VAMC did not record the desired date correctly, which, in certain cases, would have resulted in a reported wait time that was shorter than the patient actually experienced for that appointment. Moreover, staff at some clinics told us they change medical appointment desired dates to show clinic wait times within VHA's performance goals. Although VHA officials acknowledged limitations of measuring wait times based on desired date, and told us that they use additional information, such as patient satisfaction survey results, to monitor veterans' access to medical appointments, reliable measurement of how long veterans wait for appointments is essential for identifying and mitigating problems that contribute to wait times.Why GAO Did This StudyThis statement discusses overcoming barriers for quality mental health care for veterans--particularly those who are returning from deployment. In 2011, GAO reported that the number of veterans receiving mental health care had increased each year from fiscal year 2006 to 2010, and veterans who served in Afghanistan and Iraq accounted for an increasing proportion of veterans receiving mental health care during this period. GAO also reported on the key barriers that may hinder veterans from accessing mental health care from the Department of Veterans Affairs (VA), which included difficulty scheduling appointments. More recently, in December 2012, GAO reported on problems with VA's oversight of outpatient medical appointment scheduling processes and measurement of outpatient medical appointment wait times.This statement highlights key findings from our December 2012 report that describes needed improvements in the reliability of the Veterans Health Administration (VHA's) reported medical appointment wait times, scheduling oversight, and VHA initiatives to improve access to timely medical appointments.For more information, please contact Debra A. Draper at (202) 512-7114 or draperd@gao.gov.</div>

What GAO Found

In brief, GAO found that (1) VHA’s reported outpatient medical appointment wait times are unreliable, (2) there was inconsistent implementation of certain elements of VHA’s scheduling policy that could result in increased wait times or delays in scheduling timely medical appointments, and (3) VHA is implementing or piloting a number of initiatives to improve veterans’ access to medical appointments. Specifically, VHA’s reported outpatient medical appointment wait times are unreliable because of problems with correctly recording the appointment desired date–the date on which the patient or provider would like the appointment to be scheduled–in the VistA scheduling system. Since, at the time of our review, VHA measured medical appointment wait times as the number of days elapsed from the desired date, the reliability of reported wait time performance is dependent on the consistency with which VA medical centers (VAMC) schedulers record the desired date in the VistA scheduling system. However, aspects of VHA’s scheduling policy and related training documents on how to determine and record the desired date are unclear and do not ensure replicable and reliable recording of the desired date by the large number of staff across VHA who can schedule medical appointments, which at the time of our review was estimated to be more than 50,000. During our site visits, we found that at least one scheduler at each VAMC did not record the desired date correctly, which, in certain cases, would have resulted in a reported wait time that was shorter than the patient actually experienced for that appointment. Moreover, staff at some clinics told us they change medical appointment desired dates to show clinic wait times within VHA’s performance goals. Although VHA officials acknowledged limitations of measuring wait times based on desired date, and told us that they use additional information, such as patient satisfaction survey results, to monitor veterans’ access to medical appointments, reliable measurement of how long veterans wait for appointments is essential for identifying and mitigating problems that contribute to wait times.

Why GAO Did This Study

This statement discusses overcoming barriers for quality mental health care for veterans–particularly those who are returning from deployment. In 2011, GAO reported that the number of veterans receiving mental health care had increased each year from fiscal year 2006 to 2010, and veterans who served in Afghanistan and Iraq accounted for an increasing proportion of veterans receiving mental health care during this period. GAO also reported on the key barriers that may hinder veterans from accessing mental health care from the Department of Veterans Affairs (VA), which included difficulty scheduling appointments. More recently, in December 2012, GAO reported on problems with VA’s oversight of outpatient medical appointment scheduling processes and measurement of outpatient medical appointment wait times.

This statement highlights key findings from our December 2012 report that describes needed improvements in the reliability of the Veterans Health Administration (VHA’s) reported medical appointment wait times, scheduling oversight, and VHA initiatives to improve access to timely medical appointments.

For more information, please contact Debra A. Draper at (202) 512-7114 or draperd@gao.gov.

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