GAO Advises VA to Improve Specialty Appointment Scheduling Compliance

More than half of all veterans lack timely specialty care access within the Department of Veterans Affairs (VA) specialty appointment scheduling standards, according to a recent report from the Government Accountability Office (GAO).

The report, which examined the VA scheduling process and scheduling timeliness, noted that the VA struggled to meet its appointment standards for specialty care from community care providers.

Over the last few years, Congress has taken several actions to address timely care access challenges veterans face at VA medical facilities; however, they have not succeeded as the VA anticipated.

“VHA has faced longstanding challenges with scheduling VHA facility and community care appointments as well as ensuring veterans’ timely access to care,” Sharon Silas, GAO's director for healthcare, wrote in the report.

“Since 2020, VHA has taken steps to update its appointment scheduling process for specialty care referrals—including providing veterans with more information about their options for care, creating new tools for oversight, and developing training for schedulers,” Silas continued. “However, VHA faces continued challenges in developing an appointment scheduling process that will provide veterans with timely access to care.”

In 2020, the Veterans Health Administration (VHA) updated its process for scheduling appointments with VHA providers and community care providers by establishing the Referral Coordination Initiative, a new procedure for reviewing referrals for specialty care.

VHA’s updated process meant that specialty appointments at VHA facilities needed to be scheduled within three business days, and community care appointments were expected to be scheduled within seven days from the file entry date.

According to GAO findings, during the third quarter of 2022, less than 40 percent of VA medical facilities scheduled more than half of their specialty community care appointments within the appointment scheduling period of seven days.

However, some veteran patient appointment wait times lasted nearly 34 days for specialty community care appointments.

VHA facility appointments were more likely to meet scheduling standards, with nearly 90 percent of all facilities scheduling appointments within three business days.

VHA has limited data on scheduling timeliness in 2021 and needs more information for the current standard. GAO recommended that officials conduct a comprehensive analysis of scheduling timeliness data from all VA medical facilities to determine the achievability of the community care standard.

“VHA officials said they recognize that many VAMCs have struggled to meet the seven-day timeliness standard for scheduling community care appointments that VHA implemented by March 2022,” Silas stated. “VHA officials also told us that because the current standard is based on data analysis that is a few years old—having been conducted between 2020 and 2021—the department is considering conducting another review of the community care timeliness standard.”

Additionally, GAO recommended that the VHA require training materials for the Referral Coordination Team to ensure familiarity with the scheduling process and avoid user errors that may lead to delays.

“In May 2022, VHA developed training materials on the updated scheduling process for both the providers who enter referrals and those who review them for the referral coordination team,” the GAO report stated. “However, VHA does not require this training. Doing so would help ensure that providers have the information needed to perform their duties and help ensure veterans' timely access to care.”