VA Health Care

Restructuring Ambulatory Care System Would Improve Services to Veterans Gao ID: HRD-94-4 October 15, 1993

Veterans are experiencing lengthy delays when receiving medical care at the approximately 200 outpatient facilities run by the Department of Veterans Affairs (VA). Veterans often wait up to 3 hours before being examined by a doctor in VA's emergency/screening clinics. In addition, veterans wait an average of 8 to 9 weeks for an appointment in specialty clinics, such as those for cardiology or orthopedics. Inefficient operating procedures are the main cause of these delays. President Clinton has called for VA to compete with other providers in meeting the health care needs of veterans. To be a viable competitor, VA needs to quickly restructure its outpatient care delivery system to provide more timely ambulatory services. The establishment of telephone assistance networks and appointment scheduling systems, for example, would help in the case of veterans with nonurgent conditions. GAO summarized this report in testimony before Congress; see: Veterans Affairs: Service Delays at VA Outpatient Facilities, by David P. Baine, Director of Federal Health Care Delivery Issues, before the Subcommittee on Oversight and Investigations, House Committee on Veterans Affairs. GAO/T-HRD-94-5, Oct. 27, 1993 (eight pages).

GAO found that: (1) the VA ambulatory care system forces veterans with nonurgent conditions to use VA emergency screening clinics regardless of their medical needs; (2) veterans with nonurgent conditions are treated on a first-come, first-served basis; (3) most VA facilities have taken some steps to reduce veterans' waiting times; (4) long delays frequently occur in specialty clinics because many veterans receive routine follow-up care in these clinics after their conditions are stabilized; (5) VA headquarters has not provided guidance on how veterans' waiting times should be measured; (6) VA headquarters has not established performance goals to evaluate the timeliness of services; and (7) facilities have no benchmarks to compare performance, since systemwide goals have not been set.

Recommendations

Our recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.

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