In some cases, delays have reportedly resulted in harm to patients. There have been numerous reports of VAMCs failing to provide timely care to veterans, including specialty care. VHA lacks a detailed system-wide policy for how VAMCs should manage patient no-shows and cancelled appointments for outpatient specialty care, making it difficult to compare timeliness in providing this care system-wide.Ĭonsequently, concerns remain about the reliability of VHA's consult data, as well as VHA's oversight of the consult process. As a result, VAMCs may not be benefitting from the challenges and solutions other VAMCs have discovered regarding managing the consult process. VHA does not have a formal process by which VAMCs can share best practices for managing consults. As a result, questions remain about whether VAMCs appropriately closed these consults and if VHA's consult data accurately reflect whether veterans received the care needed in a timely manner, if at all. However, VHA did not require VAMCs to document their rationales for closing them. VHA does not routinely assess how VAMCs are managing their local consult processes, and thus is limited in its ability to identify systemic underlying causes of delays.Īs part of its consult initiative, VHA required VAMCs to review a backlog of thousands of unresolved consults-those open more than 90 days-and if warranted to close them. VHA officials reported overseeing the consult process primarily by reviewing data on the timeliness of consults however, GAO found limitations in VHA's oversight, including oversight of its initiative designed to standardize aspects of the consult process. VHA's limited oversight of consults impedes its ability to ensure VAMCs provide timely access to specialty care. As a result, the consults remained open in the system, making them appear as though the requested care was not provided within 90 days.
Further, for all but 1 of the 28 consults for which VAMCs provided care within 90 days, an extended amount of time elapsed before specialty care providers properly documented in the consult system that the care was provided. VAMC officials cited increased demand for services, and patient no-shows and cancelled appointments among the factors that lead to delays and hinder their ability to meet VHA's timeliness guideline. For example, for 4 of the 10 physical therapy consults GAO reviewed for one VA medical center (VAMC), between 108 and 152 days elapsed with no apparent actions taken to schedule an appointment for the veteran. Specifically, GAO found that for 122 of the 150 consults reviewed-requests for evaluation or management of a patient for a specific clinical concern-specialty care providers did not provide veterans with the requested care in accordance with VHA's 90-day timeliness guideline. Based on its review of a non-generalizable sample of 150 consults requested from April 2013 through September 2013, GAO found that the Department of Veterans Affairs' (VA) Veterans Health Administration's (VHA) management of the consult process has not ensured that veterans always receive outpatient specialty care in a timely manner, if at all.
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