Report Summary

Title: Review of VHA’s Implementation of the Veterans Choice Program
Report Number: 15-04673-333 Download
Report
Issue Date: 1/30/2017
City/State:
VA Office: Veterans Health Administration (VHA)
Report Author: Office of Audits and Evaluations
Report Type: Audit
Release Type: Unrestricted
Summary:

We conducted this review at the request of Senator Johnny Isakson, Chairman of the Senate Committee on Veterans’ Affairs, who expressed concerns about the implementation of the Veterans Choice Program (Choice) and the barriers facing veterans trying to access it. Our review focused on whether veterans were experiencing barriers accessing Choice during its first year of implementation. Choice, as part of the Patient Centered Community Care (PC3) Program, provided care for eligible veterans, when the local VHA medical facilities lack available specialists, have long wait times, or are geographically inaccessible. We reviewed monthly reports to identify average wait times for multiple stages of the Choice process, including the authorization of care, scheduling, and the delivery of health care to veterans. We determined several barriers exist in accessing care through Choice, to include cumbersome authorization and scheduling procedures, inadequate provider networks, and potential veteran liability for treatment costs. After being scheduled with a Choice provider, on average the veteran waited about 13 days to receive care. VHA identified approximately 1.2 million instances in which veterans could not receive VHA appointments from November 1, 2014 through September 30, 2015. During this period, about 283,500 eligible veterans opted into Choice, and 149,000 of these received an appointment with a Choice provider. We calculated a 13 percent rate of Choice utilization (based on appointments provided compared veteran eligible to receive care). We were unable to determine why the other 87 percent did not access Choice. We recommended the Under Secretary for Health streamline procedures for accessing care, develop accurate forecasts of demand for care in the community, reduce providers’ administrative burdens, ensure veterans are not liable for authorized care, and ensure provider payments are made in a timely manner. The Under Secretary for Health concurred with our findings and recommendations.