VA Community Clinics: Networks' Efforts to Improve Veterans' Access to Primary Care Vary
HEHS-98-116
Published: Jun 15, 1998. Publicly Released: Jun 15, 1998.
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Highlights
Pursuant to a congressional request, GAO provided information on the Veterans Health Administration's (VHA) use of community-based clinics to improve veterans' access to primary care, focusing on: (1) VHA's planning process for new community-based clinics; (2) networks' implementation of VHA's planning guidelines; and (3) VHA and network oversight of clinic operations.
Recommendations
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Department of Veterans Affairs | The Secretary of Veterans Affairs should direct the Under Secretary for Health to set a national target level of performance that focuses each network on a goal of providing reasonable geographic access to VHA primary care for the highest percentage of current users practical by 2002. |
Closed – Not Implemented
VA believes that its current efforts to improve access have proven successful because new community clinics have provided more veterans than ever before reasonable access to VHA primary care. VHA asserts that a national target is unnecessary and unwarranted because of this success.
|
| Department of Veterans Affairs | The Secretary of Veterans Affairs should direct the Under Secretary for Health to require networks to include in their business plans the percentage of: (1) current users, by priority status, who have reasonable access; (2) the remaining current users (without reasonable access), by priority status, who are targeted to receive improved access through the establishment of community clinics by 2002; and (3) current users, by priority status, who will not have reasonable access by 2002. |
Closed – Not Implemented
The VHA policy for Planning and Activating Community Based Outpatient Clinics (CBOCs) requires that a detailed description of the target market analysis and proposed workload projections for the CBOCs be included in each new CBOC proposal from the VISN. VA has also prepared a report which analyzes veterans access to care by priority status. However, VA has not projected the number of veterans who will receive improved access by establishment of community clinics through 2002, nor the number of veterans who will not have reasonable access by 2002. Nor has VA required these projections to be included in network business plans.
|
| Department of Veterans Affairs | The Secretary of Veterans Affairs should direct the Under Secretary for Health to require networks to plan and propose new community-based clinics in a manner that ensures that veterans with highest statutory priorities achieve reasonable access as quickly as possible, consistent with the requirements of the Veteran Health Care Reform Act of 1996. |
Closed – Implemented
VA has taken one of two steps necessary to assure that veterans have reasonable access. VA has done an analysis that shows areas where high priority veterans could benefit. However, VA has not directed the networks to use the information to locate clinics and instead allows networks wide latitude in deciding where to locate clinics.
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| Department of Veterans Affairs | The Secretary of Veterans Affairs should direct the Under Secretary for Health to establish minimum criteria that all networks are to use annually for evaluating new clinics' performance. |
Closed – Implemented
A VA workgroup has recommended performance measures for monitoring CBOC performance. Networks, however, are not required to use them annually.
|
| Department of Veterans Affairs | The Secretary of Veterans Affairs should direct the Under Secretary for Health to require networks to annually report their evaluation results to the Capital Budgeting and Oversight Service, a unit within VA, and others for their use in reviewing proposals for new clinics and other purposes. |
Closed – Implemented
A VA workgroup has completed a CBOC evaluation which has been shared with all networks and facilities to assist in their evaluation of local CBOC operations. In addition, networks assess CBOCs on a continuing basis to make changes such as expanding clinic staff, hours of operation or contract provisions. However, VA has not provided guidance on using the workgroup evaluation to evaluate proposals for new clinics.
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Community health servicesHealth care cost controlHealth care planningHealth centersHealth services administrationPatient care servicesPerformance measuresStrategic planningVeteransVeterans benefitsVeterans hospitals