VA Community Clinics

In 1995, the Veterans Health Administration (VHA) announced plans to switch from a hospital-based system of care to a health-care system rooted in primary and ambulatory care. VHA has restructured its facilities into 22 service delivery networks. VHA has strengthened the process that these networks are to use when establishing new community-based clinics, thereby addressing several of GAO's earlier recommendations. VHA has provided more detailed guidance and it has developed a more structured planning process. VHA's long-range goal is to increase the number of community-based clinics. To that end, VHA has approved 198 clinics, and network business plans show that 402 additional clinics are to be established by 2002. The plans, however, do not address the percentage of current users who have reasonable access, or what percentage of those without reasonable access are targeted to received enhanced access through the establishment of new clinics. As a result, VHA's network business plans cannot be used to determine on a systemwide basis how well networks are using clinics to equalize veterans' access to primary care.

GAO noted that: (1) VHA has strengthened the process that networks are to use when establishing new community-based clinics, thereby addressing several of GAO's recommendations; (2) VHA provided more detailed guidance, including a 30-minute travel standard and an expectation that clinics be established primarily to benefit current users rather than attract new users; (3) VHA developed a more structured planning process, including the development of network business plans covering a 5-year period, and established a task force in accordance with VHA's guidelines; (4) VHA's long-range goal is to increase the number of community-based clinics; (5) to that end, VHA has approved 198 clinics, and network business plans show that 402 additional clinics are to be established between 1998 and 2002; (6) the plans, however, do not address the percentage of current users who have reasonable access, or what percentage of those without reasonable access are targeted to receive enhanced access through the establishment of new clinics; (7) as a result, VHA's network business plans cannot be used to determine on a systemwide basis how well networks are using clinics to equalize veterans' access to primary care; (8) based on the limited information that networks can provide, it appears that the geographic accessibility of VHA primary care currently varies widely among networks and that while networks' efforts should reduce this variation, thousands of the VHA's 3.4 million current users will likely continue to have inequitable access for many years; (9) moreover, it appears that networks are planning to improve access for thousands of lower priority new users over the next two years, while thousands of higher priority current users are waiting considerably longer periods of time for reasonable access; (10) networks, which have primary responsibility for monitoring community-based clinic performance, have developed evaluation plans for proposed clinics, as VHA requires; (11) to date, few clinics have operated for more than 12 months; (12) as a result, most evaluation plans have not been implemented; and (13) network evaluation plans, however, vary widely, with few containing a common set of criteria or indicators that appear necessary to effectively assess clinic evaluations to monitor performance within or among networks.

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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