WASHINGTON — Both houses of Congress held hearings last month focusing on concerns about the rollout of the MISSION Act, which consolidates VA’s community healthcare services.
The House Veterans’ Affairs health subcommittee grilled VA officials about the long wait times and the lack of quality metrics when it comes to how long a veteran should wait to get an appointment. At the Senate hearing three weeks later, VA officials declined to attend.
In a letter to the Senate Veterans’ Affairs Committee, VA Secretary Robert Wilkie said that the refusal to attend was because VA was only given a week’s notice about the hearing rather than the traditional two weeks.
“I do not know why something as important as the implementation of the MISSION Act doesn’t rise to that importance at the VA,” said Sen. Jon Tester (D-MT) at the hearing. “This committee has serious issues with the implementation of the MISSION Act, and it’s unfortunate that VA couldn’t be here to participate in finding solutions for these problems.”
Tester sought to find out exactly how VA officials planned to lower the time between a veteran requesting an appointment from a non-VA community provider and actually having the appointment. The topic was explored at the House hearing on Sept. 30, with VA officials agreeing that wait times were too long, but they avoided getting into specifics of how the problem can be fixed.
41.9 Days for Routine Specialty Care
VA’s most recent data show that veterans wait an average of 41.9 days for routine specialty care from a community provider. Of that wait, 21.9 days is accounted for by VA’s internal scheduling process.
First, the request is processed by VA’s Referral Coordination Team, which works with veterans to determine their care and scheduling preferences—a process that takes an average of two weeks. Then the request is referred to VA’s community care staff, who begin reviewing the referral and, if approved, begin contacting community providers.
Subcommittee chair Rep. Julia Brownley (D-CA) called the three-week scheduling process “bureaucratic and administratively burdensome.”
In contrast, the internal scheduling process for making an appointment with a VA specialty care provider takes less than a third of that time—about 6.8 days.
A recent report from the Government Accountability Office (GAO) pointed to the lack of access standards governing community care as a significant flaw in VA’s community care provider system. VA has an access standard for VA providers of 20 days for primary care and 28 days for specialty care. If a veteran cannot receive an appointment in those timeframes, they are eligible to seek community care.
VA should have similar maximum wait-time standards for community care, the GAO report recommends. GAO’s investigators made the same recommendation to VA regarding previous community care programs in 2013 and 2018.
As it stands, once VA’s internal scheduling process is complete and the community care staff has made an appointments, there is no goal for the number of days that should elapse before a veteran sees that provider.
“Without that overall measure, VA and others are not able to know whether veterans are receiving timely access to medical care,” explained Sharon Silas, GAO’s director of healthcare.
The GAO has recommended that Congress might want to step in and legislate access standards, if VA is unwilling. VA officials agree about the problem, but not a legislative solution.
“We are as concerned as you are with timeliness of care,” said Steven Lieberman, MD, MBA, VA’s acting principal deputy under secretary for health. “We certainly have always believed in performance metrics. For urgent referrals we want to ensure the veteran is seen within two days. We are certainly monitoring how long it takes to schedule an appointment, which is certainly too long.”
Lieberman said he expects VA to see improvements in that 21.9-day average between request and scheduling.
“Ultimately our goal will be to have that appointment scheduled within three days,” he said. “It’s a big goal to attain, but we’ll get there over time.”
But as for a metric determining a maximum time a veteran should have to wait to be seen by a community provider, Lieberman said that VA cannot agree to GAO’s recommendation.
“Things have changed in healthcare,” he declared. “If I want to have cataract surgery and I want to go to the community because I’m eligible and I want to see the best cataract surgeon in the state, I may have to wait longer.”
According to Lieberman, VA held a roundtable with community providers who told the department “they don’t measure wait times in the community because it doesn’t reflect what their customers want.”
“One size does not fit all,” Lieberman told the subcommittee. “It’s all based on clinical need and the preference of the veteran for when to be seen and who to be seen by. We’re really looking at what is the gold standard in the community.”
Despite VA’s preference, the agency might be forced to adopt wait times. Taking GAO’s recommendation, Brownley introduced the VA Community Care Wait Time Transparency Act. The legislation would require VA to establish a goal for the maximum number of days a veteran should wait from request to appointment completion. It would also require the department to create a public-facing website that would publish average wait times for care in the community much like the existing site for VA facility wait times. Veterans would be able to search by ZIP code, medical specialty and medical center.