Veterans Health Care: Referral Coordination Initiative for Specialty Care Needs Improved Program Direction and Guidance

What GAO Found

In 2019, the Veterans Health Administration (VHA) updated its process for scheduling specialty care appointments. Under this process, called the Referral Coordination Initiative, referral coordination teams at VHA medical facilities review referrals for specialty care, such as cardiology, and discuss care options with veterans. The implementation of the initiative marked a significant change to the process previously followed for management of specialty care referrals.

GAO's survey found that, as of March 2024, officials from nearly all VHA medical facilities reported using the new process to manage referrals for some specialties. Officials reported using the new process for 30 specialty services, on average. About a fourth reported implementing all planned services.

Referral Coordination Initiative Use at VHA Facilities and in Common Specialties

GAO's survey of 133 VHA medical facility officials and VHA's own studies found medical facilities experienced mixed results in implementing the initiative. For example, GAO found facilities experienced difficulties and inconsistencies in implementation. However, facilities also cited potential benefits such as reducing appointment scheduling time. In May 2024, VHA began a “refresh” of the initiative to improve consistency by increasing regional networks' leadership and oversight of VHA medical facilities' implementation of the initiative.

As of October 2024, VHA had not documented in policy key elements needed to guide the initiative's implementation. These elements include strategic goals, standards for consistent implementation, roles and responsibilities, and oversight and accountability. Further, GAO found that VHA regional networks and medical facilities did not have evidence-based, timely, and consistent guidance that aligned with policy. Without national policy that defines program direction and quality guidance that aligns with policy, VHA networks and medical facilities may continue to experience inconsistencies in the initiative's implementation and struggle to achieve its objectives, such as improving scheduling timeliness.

Why GAO Did This Study

VHA operates the largest health care delivery system in the U.S., providing health care to more than 6 million veterans. In the last decade, Congress has taken steps to expand the ability of eligible veterans to receive care from community health care providers. In fiscal year 2023, 2.9 million veterans received community care. GAO and others have identified challenges veterans have had in scheduling appointments both with VHA facility providers and community care providers.

GAO was asked to examine issues related to VHA appointment scheduling. This report 1) describes the status of the Referral Coordination Initiative's implementation, and 2) assesses the initiative's policy and guidance, among other objectives.

GAO reviewed VHA documentation for the Referral Coordination Initiative and surveyed 139 VHA medical facility officials responsible for implementing it, of which 133 responded. GAO also interviewed VHA central office officials and officials from four regional networks and conducted site visits to six VHA medical facilities.