Audit of VHA’s Management of Primary Care Panels

OIG evaluated whether the Veterans Health Administration (VHA) effectively managed providers’ primary care panels to maximize access to primary care providers by evaluating new enrollee processing into panels as well as the panel sizes. Provider panels define both VHA’s capacity to provide managed outpatient care and provider efficiency based on the number of veterans managed for primary care. In the first seven months of FY 2015, VHA had not effectively managed provider panels to maximize access. VHA facilities’ methods for processing and scheduling veterans into panels varied, and veterans encountered an average wait of 29 days from the date they enrolled until the facility scheduled their appointment. The average of 29 days was not included in VHA’s wait time calculation. VHA facilities had panels below VHA’s panel size recommendations with six of the seven facilities showing panels 13 to 30 percent below the model. This occurred because VHA lacked standard procedures for processing new enrollees, did not track the wait-time from the enrollment to scheduling, and did not ensure compliance with recommended panel sizes. As a result, VHA’s recorded wait times did not accurately reflect the wait experienced. VHA’s recorded wait time showed about 8 percent of newly enrolled veterans waited more than 30 days when OIG determined about 53 percent of newly enrolled veterans completed their first appointment more than 30 days past the determined eligibility date. Lower panel sizes equated to almost $169 million in underutilized provider salaries paid in fiscal year 2015. OIG recommended the Acting Under Secretary for Health establish standardized new enrollee scheduling procedures that properly track wait times and ensure facilities either set panel sizes at VHA’s model goals or justify deviations. The Acting Under Secretary for Health concurred with the recommendations and OIG will monitor VHA’s progress until all proposed actions are completed.