Since Implementation of Veterans Choice Program, Wait Times are Longer for Specialty Community Care vs VA Specialty Care
In 2014, Congress authorized the Veterans Choice Program (VCP), which allowed Veterans to access care in the community if they lived more than 40 miles from the closest VA healthcare facility, could not schedule an appointment within 30 days or by the date clinically necessary (whichever was sooner), or experienced other specific hardships. Since the rollout of VCP, approximately two million Veterans have used the program. This cross-sectional study sought to: 1) Determine whether VA wait times declined after VCP implementation, 2) Compare appointment wait times for specialty care in VA versus community medical centers, and 3) Identify the proportions of community care wait times that were attributable to VA administrative processes. Using VA administrative data, investigators identified new consultation requests in four specialties: cardiology, gastroenterology, orthopedics, and urology, which were selected because they are high-volume purchased services under VCP. From January 2013 to December 2019, VA completed 6.9 million in-house consultations and paid for an additional 869,000 consultations in the community for 3,135,530 million Veterans who sought care in the four specialties. Mean appointment wait times for VA care from 2013 to 2019 were then assessed, identifying changes in access after the implementation of VCP.
- Within the VA healthcare system, orthopedics experienced the largest decline in mean wait times – from 53 days to 30 days. Lesser declines were observed for urology (42 days to 34 days) and gastroenterology (58 days to 51 days). Wait times for cardiology did not differ over time.
- Mean wait times for specialty care were lower at most VA medical centers compared with community care alternatives, even after accounting for administrative delays. Mean wait times at VA vs community facilities were 33 vs 38 days for cardiology; 54 vs 60 days for gastroenterology; 36 vs 44 days for orthopedics, 36 vs 51 days for urology, and 41 vs 49 days overall.
- Findings indicate that the implementation of VCP in 2014 was not associated with lower specialty care wait-times, suggesting policies that liberalize Veterans' eligibility for community care may be insufficient to lower Veterans' wait times in underserved areas.
- Wait times may not reflect Veteran preferences with scheduling or differences in quality of care.
- Analyses did not account for recent passage of the 2018 MISSON Act, which streamlined community care eligibility for Veterans, or internal VA processes to determine an individual Veteran’s eligibility.
- A portion of VA referrals to community care may be misclassified as in-house consultations, and ‘specialty’ is not recorded for some community referrals.
- From available data, investigators were unable to identify consultation urgency or to conclude whether or not wait times were clinically appropriate
This study was funded through VA HSR&D’s Quality Enhancement Research Initiative (QUERI). Dr. Pizer is part of QUERI’s Partnered Evidence-Based Policy Resource Center (PEPReC) in Boston, MA.
Griffith K, Ndugga N, and Pizer S. Appointment Wait Times for Specialty Care in Veterans Health Administration Facilities vs Community Medical Centers. JAMA Network Open. Research Letter. August 26, 2020. Epub ahead of print.