Veterans Face Extended Delays for Referrals for Specialty Care Outside VA Facilities, Watchdog Finds

Less than half of veterans are receiving Department of Veterans Affairs referrals for specialty care from outside doctors on time, a new report published Wednesday by the Government Accountability Office found.

Those specialist visits can be crucial because veterans often have complicated or chronic illnesses and, while the VA system excels at treating service-connected conditions such as prosthetics and musculoskeletal injuries, it may lack certain specialists or capacity in the immediate area near a veteran. The referral program to community care is designed to ensure that veterans get the care they need when they need it.

Current scheduling standards are three business days within the VA for a specialty referral and seven days for scheduling an appointment with a community care provider, a doctor outside of a VA facility.

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The GAO found that in the third quarter of 2022, more than 90% of all VA medical centers scheduled at least half their appointments within three business days. But fewer than 40% of the facilities scheduled appointments within the 7-day time frame set for community care.

In some locations, veterans waited an average of 12 days to have their specialty care appointment scheduled in house and nearly 34 days in the community.

The data is important, GAO officials said, because the disparity may affect whether the VA has the information it needs as it weighs changing access standards for community care, as VA officials have said the department may do to curb rising costs.

"VHA's [Veterans Health Administration] use of a limited data set to inform its appointment scheduling timeliness standard is inconsistent with best practices related to performance management," wrote Sharon Silas, GAO's director for health care. "If VHA conducted a comprehensive analysis ... it could have a sounder basis for determining whether the standard is achievable or whether revisions to its standard for community care appointments or other adjustments to its scheduling process may be necessary."

The 2018 VA Mission Act overhauled the department's private-sector health care programs for veterans, consolidating a number of civilian-care programs into a single community care program available to more veterans, with the costs covered by the department.

Under at least one of its predecessor programs, VA Choice, veterans were eligible for community care only if they lived more than 40 linear miles from a VA medical facility or were unable to get an appointment within 30 days.

But the Mission Act expanded access standards to include veterans who face drive times of at least 30 minutes to a primary or mental health appointment or 60 minutes for specialty care, or those who must wait 20 days or more to be seen for primary care or 28 days for specialty care.

In 2020, the VA updated its specialty care scheduling standards to the 3- and 7-day metric for in-house and community specialty referrals to improve service.

VA Secretary Denis McDonough told Congress in June that the department was considering changing the access standards for the community health care program to slow its growing impact on its overall health care budget.

According to McDonough, community care accounted for 33% of the VA's total health care demand last year, up from 26% in 2021.

"Care overall, as you have seen in the budget, is growing. Care in the community as a portion of that is growing. ... My hunch is that we should change access standards," McDonough told lawmakers in a Senate Veterans Affairs Committee budget hearing.

The VA's fiscal 2023 budget includes $118.7 billion for medical services, with $37.3 billion set aside for community care.

VA wait times for in-house and community care are a hot-button issue, with lawmakers on both sides of the aisle critical of the department for not establishing a standard for the maximum number of days a veteran must wait for his or her appointment either in a VHA facility or out in the community.

At stake is the size and scope of health care administered in VA facilities by the department and access to non-VA providers. In 2020, the GAO released a report saying that the VA lacked the wait-time performance measures needed to determine whether the community care program actually reduced veterans' wait times for receiving care.

With the change of power in the U.S. House of Representatives, access to community care -- a priority of the Trump administration -- and efforts by the Biden administration to return more patients to VA health facilities are likely to receive increased scrutiny.

With their report, GAO officials said steps should be taken before any changes are made, to include setting a timeliness standard for the number of days within which VA appointments should occur and analyzing whether the current community care standards are achievable. If not, they should be revised, the GAO recommended.

In its response to the report, the VA concurred.

"The [Office of Integrated Veterans Care] acknowledges the need to revisit the community care timeliness standards," VA officials wrote in the response.

-- Patricia Kime can be reached at Patricia.Kime@Military.com. Follow her on Twitter @patriciakime

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