VA and DOD Patient Care
The Department of Veterans Affairs (VA) and the Department of Defense (DOD) are responsible for providing timely, high-quality health care to veterans and to servicemembers and their families, but they both need to improve their ability to do so.
There have been numerous reports of VA medical facilities failing to provide timely and accessible care—in some cases, delays in care or failure to provide care reportedly resulted in harm to veterans. There have also been concerns about DOD's ability to provide access to certain types of care, particularly mental health care, to servicemembers.
Both VA and DOD need to improve their health care programs and processes—particularly access to health care in department facilities, VA's community care program, and the quality of care and patient safety in DOD and VA medical facilities.
Access to Health Care
- VA enrollment processes. Enrollment is generally the first step veterans take to access health care. However, improvements are needed in how VA implements enrollment processes by defining the role of its medical facilities in reviewing pending enrollment applications, and improving the oversight of this process.
- VA access to care. Not all newly enrolled veterans have been able to access primary care within VA, while other veterans experienced wide variation in the amount of time they waited for primary and specialty care. To address this issue, VA needs to ensure the reliability of its data on veterans’ wait times, and ensure that VA medical facilities are consistently implementing its scheduling policy.
Illustration of How the Time It Takes a Veteran to See a Provider May Differ from the Wait Time Calculated by the Veterans Health Administration (VHA)
- DOD mental health access. While DOD has efforts underway to improve access to mental health care, it still needs to ensure the availability of certain providers, such as psychiatrists.
- DOD TRICARE access. The National Defense Authorization Act of 2017 established a new self-managed preferred provider network option for servicemembers and their families called TRICARE Select, and mandated that DOD develop an implementation plan for it. The plan was developed prior to DOD's decision to have the contractors propose access standards, such as the amount of time it takes to schedule an appointment, that DOD must approve. Instead, the implementation plan states that TRICARE Select will use access standards used by another TRICARE option. DOD needs to make sure that this plan reflects the actual approach it plans to use for ensuring access standards for health care appointments.
VA's Community Care Program
- Community care access. In 2014, Congress established a temporary program—called the Veterans Choice Program—which provided funding for veterans to obtain health care services from non-VA community providers when they faced long wait times, lengthy travel distances, or other challenges accessing care at VA medical facilities. In 2019, VA will establish a permanent Veterans Community Care Program and will need to ensure that veterans receive care in a timely manner and do not experience the long delays many veterans experienced under the Choice Program.
Average Wait Times for Choice Program Appointments in 2016, According to Separate Non-Generalizable Analyses by GAO and the Veterans Health Administration (VHA)
Note: GAO excluded from its analysis the amount of time the TPA took to schedule the appointment and the overall wait time because its sample selection methodology differed from VHA’s in a way that would have skewed these two averages but not the averages for the other segments of the process.
Community provider payments. Due to increases in veterans’ use of community care, VA and its third party administrators have had difficulty processing claims in a timely manner—which may make community providers less willing to participate in this program. VA needs to collect data and monitor compliance with claims processing timeliness to ensure that timely payments are made to community providers, and needs to develop a written plan to modernize its claims processing system.
Median Number of Days to Pay Clean Claims through VA's Third Party Administrators (TPA), November 2014 through June 2018
- Community care for women. VA needs to monitor female veterans’ access to sex-specific care, such as mammograms, through its Community Care Program.
Quality of Care and Patient Safety
- VA provider quality and safety concerns. VA medical facilities are responsible for reviewing any concerns that arise about the quality and safety of the care their providers deliver. VA needs to ensure that these concerns are adequately addressed, including reporting incompetent or unsafe providers to a national database and state licensing boards.
- VA opioid safety. VA has been working to address opioid safety for veterans and has made progress in reducing opioid prescriptions. However, VA still needs to ensure that all opioid safety goals are met, and that providers are consistently adhering to evidence-based strategies for minimizing the risk associated with opioid prescribing (such as urine drug screenings).
- VA outpatient clinics. VA-operated community-based outpatient clinics provide millions of veterans with primary and mental health care. VA needs to improve oversight of these clinics to ensure that they provide one standard of high-quality care for all veterans.
- VA and DOD health care for women. VA has policies in place to help ensure the privacy, safety, and dignity of female veterans when they receive care at its medical facilities—but it needs to make sure that these policies are consistently followed. Women also represent a significant percentage of the population eligible for DOD health care services and concerns have been raised about the quality of DOD's women's health care services.
Interactive Graphic of Domestic Military Hospitals Offering Maternity and Neonatal Care Services
- DOD adverse events. Adverse medical events are unintended incidents that could result in harm to a patient. DOD’s Defense Health Agency needs to improve how it tracks adverse events that occur in DOD military treatment facilities.
Podcasts
High-Risk Issues
Recommended Links
- Interactive Graphic: Domestic Military Hospitals Offering Maternity and Neonatal Care Services
- WatchBlog: Mental Health Care in the Military
Related Key Issues Pages
- Air Quality
- Border Security and Immigration
- Children's Health and Safety
- Elder Abuse
- Health Information Technology
- Health Care Quality
- Drug Misuse
- Improper Payments
- Improving Federal Programs that Serve Tribes and Their Members - High Risk Issue
- Managing Risks and Improving VA Health Care
- Medicaid - High Risk Issue
- Medical Product Oversight - High Risk Issue
- Medicare - High Risk Issue
- Prescription Drug Spending
- Supports and Services for Transitioning Veterans
- Toxic Chemicals - High Risk Issue
- Tribal and Native American Issues
- VA and DOD Health Care Management
- Women and Gender in Public Policy
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- Sharon Silas
- Acting Director, Health Care
- silass@gao.gov
- (202) 512-7114
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- Debra Draper
- Director, Health Care
- draperd@gao.gov
- (202) 512-7114
