Inconsistent Guidance and Limited Oversight Contributed to Inaccurate Community Care Wait-Time Eligibility Calculations at the C.W. Bill Young VA Medical Center in Bay Pines, Florida

From 2020 to 2022, some schedulers at the VA medical center in Bay Pines, Florida, determined community care wait-time eligibility with a locally developed calculator that used an incorrect starting date and thus undercounted wait time by about 12 days, limiting veterans’ healthcare choices. The Orlando VA Medical Center discovered the inaccuracy after using this calculator in August 2022. The VA Office of Inspector General (OIG) conducted this review to determine the reasons behind the Bay Pines calculator’s inaccuracy and the facility’s inability to discover it, as well as the steps necessary to ensure all medical facilities correctly determine wait-time eligibility. Per the John S. McCain III, Daniel K. Akaka, and Samuel R. Johnson VA Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act of 2018, schedulers should use the file entry date—the date on which a veteran or care provider requests an appointment or consult—as the starting date to assess wait-time eligibility. Instead, in accordance with a previous law, the Bay Pines calculator used the patient indicated date, the date the provider and veteran agree is clinically indicated for care or the date the patient wants to be seen. Guidance for schedulers was also confusing, and oversight efforts were not designed to assess the accuracy of community care eligibility determinations. To address these issues, the OIG made four recommendations to the under secretary for health: ensure all scheduling guidance consistently references the dates that should be used to determine wait-time eligibility; provide ongoing oversight to ensure all facilities are using nationally approved tools to calculate wait-time eligibility; develop oversight processes to verify that schedulers are using the correct dates to calculate wait-time eligibility; and develop a mechanism to notify schedulers when it is appropriate to consider wait-time eligibility.