Report Description:

The VA Office of Inspector General (OIG) assessed the reliability of wait time data and evaluated whether Veterans Integrated Service Network (VISN) 15 provided timely access to health care within its medical facilities and through Choice, and whether they appropriately managed consults. The OIG estimated that new patients waited an average of about 18 days, and 18 percent of the appointments for new patients at VISN 15 facilities had wait times longer than 30 days. This was higher than the estimated 10 percent that the Veterans Health Administration’s (VHA) electronic scheduling system showed. Staff did not correctly record clinically indicated dates for about 38 percent of the new patient appointments, which understated wait times by about 15 days. Inaccurate wait time data resulted in veterans not being identified as eligible for Choice. With respect to veterans in VISN 15 who received care through Choice, the OIG estimated that the overall average wait time was 32 days. The audit estimated that 41 percent of the appointments had wait times longer than 30 days, and those veterans waited an average of 58 days. Facilities did not have adequate procedures to monitor the aging of veteran referrals from facilities to TriWest, and did not consistently monitor the aging of the authorized Choice care. Regarding consults, facility staff discontinued or canceled an estimated 27 percent inappropriately, which led to veterans experiencing additional delays, or not receiving the requested care. Clinicians and staff were still unclear on specific consult management procedures. The Office of Healthcare Inspections identified clinical concerns with six patients, and determined that one patient likely had an adverse outcome as a result of a delay in care. The OIG made 11 recommendations—three to the Office of the Under Secretary for Health and eight to the VISN 15 Director. VHA and VISN 15 provided responsive action plans.