- Research from the Government Accountability Office (GAO) found that veterans waited an average 24 days to receive care at any care facility that is administered by the Veterans Choice Program.
The program allows veterans to receive care from non-Veterans Health Administration (VHA) providers when VHA providers are unavailable. The Department of Veteran Affairs (VA) uses two contractors, or third-party administrators (TPAs), that schedule patient appointments after receiving referrals from VA medical centers (VAMC.)
Specifically, the Veterans Choice Program offers veterans the ability to visit a provider outside of the VHA network if the next available medical appointment is longer than 30 days. A veteran’s provider can also determine a necessary date for care.
Veterans that live more than 40 miles driving distance from the nearest VHA provider, live in a county without a full-service VHA facility, or has specific health needs that can’t be treated within a VHA are also eligible to use outside facilities.
The provisions of the program aim to enable veterans who live in rural or health facility-isolated communities to receive proper healthcare. However, the GAO report reveals that the Veterans Choice Program cuts provider availability by only six days.
The final analysis determined that even though the VA program offers a solution for providing proper care to veterans, these patients could experience a maximum wait time of 81 days based upon the time it takes VAMCs and TPAs to properly administrate.
“GAO’s preliminary analysis indicates that selected veterans experienced lengthy overall wait times for Choice Program care in 2016. For example, among the non-generalizable sample of 55 routine care authorizations GAO reviewed, VAMCs took an average of 24 calendar days to send veterans’ referrals to the TPAs, and the TPAs took an average of 14 calendar days to accept these referrals and opt veterans into the program.”
Patient outcomes for veterans are also at risk because VHA is unable to determine their own average wait times according to the report, and large groups of veterans are recommended to the Veterans Choice Program based on demographic findings.
Through the years 2015 and 2016, 142,535 of reported veterans (10 percent) lived 40 plus miles away from a VA facility, and were recommended to the program. About 500,000 veterans (35%) had 30-plus day wait times for appointments and 787,500 (55% of reported veterans, found that services at VA facilities did have proper medical services for their care needs.
With a large portion of veterans meeting the requirements for the Choice Program, both VAMCs and TPAs have extensive administrative requirements that still pose large wait times for veterans.
According to VA policies, VAMCs have at least 21 days to confirm if a veteran wants to contact a TPA for admittance into the Choice Program. That 21-day period consists of one 7-day period where a VA physician determines if the Veterans Choice Program is necessary for the patient, and a 14-day period for the VAMC to contact the veteran after initial referral to confirm admittance into the Choice Program.
After receiving the referral from the VAMC, the TPA then has another 21-day period to schedule a veteran’s routine care appointments.
The TPA has a two-day period to accept the VAMCs referral and accept it if contains sufficient information to schedule an appointment. There is also a four-day period during which the veteran is contacted again by phone to confirm enrollment into the Choice Program. There is a ten-day period for veterans to respond to the TPAs followed by a five day period to successfully schedule a choice appointment.
While GAO has not made any recommendations on their findings yet, veterans experience administrative disparities between the VAMCs and TPAs in order to receive health through notable care boundaries and barriers.
The VHA experienced a recent scandal where veterans faced significant decreases in care because VA providers were leaving their positions and veterans extremely high wait times for receiving care, with 40 perishing while waiting for care. The Veterans Choice Program was proposed as a deterrent to those care barriers for veterans.