Appointment Management During the COVID-19 Pandemic

The Veterans Health Administration (VHA) took measures to protect patients and employees from COVID-19 by canceling face-to-face appointments that were not urgent and converting some of them to virtual appointments. The VA Office of Inspector General (OIG) assessed VHA’s appointment management strategies and the status of canceled appointments. The review team found that about five million appointments (68 percent) canceled from March 15 through May 1, 2020, had evidence of follow up or other tracking. Patients completed appointments predominantly by telephone and some by video. Other appointments were tracked for future follow-up in VA’s scheduling system. However, about 2.3 million cancellations (32 percent) had no indication of follow up or tracking at the time of review. The review team also examined whether medical facilities followed VHA’s guidance on annotating the appointment cancellations. Doing so consistently would have allowed facilities to better determine which appointments needed to be rescheduled. However, VHA’s guidance changed over time, and facilities applied it inconsistently. Facilities also did not consistently follow guidance on leaving consults open so that medical providers could reschedule them. In addition, the team noted that canceling appointments in batches could mask the instances where patients were not contacted about the cancellations. The OIG’s ongoing surveillance of VHA data shows that overall, from March 15 through June 15, 2020, VHA has canceled nearly 11.2 million appointments and needs to follow up on about 3.3 million of those cancellations. The OIG recommended that VHA coordinate a well defined rescheduling strategy with all facilities and provide oversight to facilities that have a significant rate of appointments with no evidence of follow up or tracking. The OIG also recommended VHA ensure facilities do not solely rely on appointment annotations when rescheduling. Finally, the OIG recommended that facilities take appropriate action on canceled or discontinued consults.