VA Primary Care: Improved Oversight Needed to Better Ensure Timely Access and Efficient Delivery of Care

What GAO Found

GAO found that the Department of Veterans Affairs’ (VA) data on primary care panel sizes—that is, the number of patients VA providers and support staff are assigned as part of their patient portfolio—are unreliable across VA’s 150 medical facilities and cannot be used to monitor facilities’ management of primary care. Specifically, as part of its review, GAO found missing values and other inaccuracies in VA’s data. Officials from VA’s Primary Care Operations Office confirmed that facilities sometimes record and self-report these data inaccurately or in a manner that does not follow VA’s policy and noted that this could result in the data reliability concerns GAO identified. GAO obtained updated data from six of seven selected facilities, corrected these data for inaccuracies, and then calculated the actual panel sizes for the six facilities. GAO found that for these six facilities the actual panel size varied from 23 percent below to 11 percent above the modeled panel size, which is the number of patients for whom a provider and support staff can reasonably deliver primary care as projected by VA. Such wide variation raises questions about whether veterans are receiving access to timely care and the appropriateness of the size of provider workload at these facilities.

Moreover, GAO found that while VA’s primary care panel management policy requires facilities to ensure the reliability of their panel size data, it does not assign responsibility to VA Central Office or networks for verifying the reliability of facilities’ data or require them to use the data for monitoring purposes. Federal internal control standards call for agencies to clearly define key areas of authority and responsibility, ensure that reliable information is available, and use this information to assess the quality of performance over time. Because VA’s panel management policy is inconsistent with federal internal control standards, VA lacks assurance that its facilities’ data are reliable and that the facilities are managing primary care panels in a manner that meets VA’s goals of providing efficient, timely, and quality care to veterans.

In contrast to VA’s panel data, GAO found that primary care encounter and expenditure data reported by all VA medical facilities are reliable, although the data show wide variations across facilities. For example, in fiscal year 2014, expenditures per primary care encounter—that is, a professional contact between a patient and a primary care provider—ranged from a low of $150 to a high of $396 after adjusting to account for geographic differences in labor costs across facilities. Such wide variations may indicate that services are being delivered inefficiently at some facilities with relatively higher per encounter costs compared to other facilities. However, while VA verifies and uses these data for financial purposes, VA’s policies governing primary care do not require the use of the data to monitor facilities’ management of primary care. Federal internal control standards state that agencies need both operational and financial data to determine whether they are meeting strategic goals and should use such data to assess the quality of performance over time. Using panel size data in conjunction with encounter and expenditure data would allow VA to assess facilities’ capacity to provide primary care services and the efficiency of their care delivery. By not using available encounter and expenditure data in this manner, VA is missing an opportunity to potentially improve the efficiency of primary care service delivery.

Why GAO Did This Study

This testimony summarizes the information contained in GAO's October 2015 report, entitled VA Primary Care: Improved Oversight Needed to Better Ensure Timely Access and Efficient Delivery of Care, GAO-16-83.

For more information, contact Randy Williamson at (202) 512-7114 or williamsonr@gao.gov.