WASHINGTON, DC — A community care scheduling system currently in use at about 20% of VA facilities is reportedly cutting what can be a laborious scheduling process down to a handful of minutes. As VA continues to rely more heavily on community care, legislators are wondering why the department is not fast-tracking the program for a national roll-out.
In 2020, VA launched a three-year pilot program at the Orlando, FL, VAMC to test the feasibility and scalability of an External Provider Scheduling (EPS) program. Through the system, providers agree to share their scheduling grids with VA, allowing VA schedulers to search and sort appointments by availability, drive-time from the veteran and more. VA can then schedule appointments without having to make a separate call to the provider, effectively eliminating one of the more labor-intensive aspects of the community care scheduling process.
The pilot project was successful, and, in 2023 VA awarded the contract for the EPS to WellHive Software. The EPS is currently active in 36 VA sites, with another 18 expected to go online by the end of FY2025.
“When veterans are referred to community care, the scheduling process should be simple, fast and focused on their healthcare, but for too long that has not been the case,” declared Rep. Tom Barrett (R-MI) at a House VA Technology Modernization Subcommittee hearing. “To schedule a community care appointment, VA staff must pick up the phone again and again, often calling the veteran and the provider multiple times to schedule an appointment. It’s a tedious, manual, multistep process that can stretch over hours into weeks, delaying care for the men and women who earned it. It’s inefficient, and it’s unsustainable.”
Barrett added, “As the demand for community care continues to grow, VA can’t afford to continue scheduling millions of appointments over the phone.”
Asked what the barrier is for getting community providers to buy into the system, WellHive President Chris Faraji said, “It’s more of an awareness issue and understanding the benefits of the EPS platform. Once providers understand that, the technical part is very straightforward. We’re merely putting connections in and establishing that so we’re able to see those clinical [scheduling] grids.”
There’s no charge to the providers for the service, he said.
As for why VA is not pushing for a nationwide roll-out of the system, Lisa Arfons, MD, VA’s deputy assistant undersecretary for integrated veteran care, said that, by starting with a smaller number of facilities, they can better hand-sell the program to providers in each region. It also allowed VA to learn lessons as they go, so changes can occur as needed.
“[One of the lessons] is the importance of having medical center directors engaged,” she said. “They are healthcare leaders within their communities, so many of them have trusted relationships already with community providers. Also, medical center directors set the culture and the tone … and staff very much look to them to set that direction.”
According to Arfons, there are currently more than 5,200 provider services active in the EPS across 60 specialties, including primary care, behavioral health, dermatology, optometry, chiropractic care, dental and orthopedics. The platform onboards new provider services at a rate of over 100 per week.
“EPS is no longer an experiment,” she declared. “It is a proven tool.”
The next proposed step in the evolution of the EPS platform is using it to improve the still-nascent veteran self-scheduling process. VA has offered the option for veterans to schedule their own community care appointments since 2020. According to Faraji, the EPS would provide the technology to make the process more seamless.
“Through self-scheduling, veterans will be able to directly book appointments with participating community care providers, dramatically reducing administrative hurdles and improving access,” Faraji said in his written testimony.
Two pilot sites are preparing to go live with the option this July.
Shortly following the hearing, VA announced it would no longer require a referral to community care approved by a second doctor. This rule shift puts into effect a provision in the Senator Elizabeth Dole 21st Century Veterans Health and Benefits Improvement Act signed into law in December. Language in the bill prohibits administrators from overriding a referral made by a veteran’s referring clinician.
“We are putting veterans first at the department, and that means placing a premium on customer service and convenience,” VA Secretary Doug Collins said in a statement. “This important change will help us do just that.”
According to the bill’s language, VA was required to make the change within 90 days of the enactment of the legislation, which has Democrats who backed the legislation wondering about the reason for the delay.
“[They are] trying to take a victory lap for finally implementing a provision … they were required by law to put in place more than a month ago,” said Sen. Richard Blumenthal (D-NH). “Dozens of other critical, time-sensitive provisions from this comprehensive, bipartisan law remain unaddressed.”
