VA Health Care: Restructuring Ambulatory Care System Would Improve Services to Veterans

On March 18, 1994, VA issued VHA Directive 10-94-022. The stated VA policy in this directive is that every VA medical facility will develop and institute a Telephone Liaison Care Program, the goal of which would be to allow patients and families to contact the facility by telephone to discuss any concerns relevant to access of care (eligibility and scheduling), medical concerns (treatment and followup), and questions about medications.

VA issued a directive that established a Telephone Liaison Care Program. The program requires that VA medical facilities allow veterans to schedule appointments at general medicine or primary care clinics. The directive establishes a policy that every VA medical facility will develop and institute, the goal of which will be to allow veterans to contact VA by telephone to discuss concerns such as eligibility for care and scheduling appointments. Each medical facility must have a mechanism for making patients aware of its Telephone Liaison Care Program, including the phone number, services available, and hours of operation. VA believes the program can improve access to care providers, reduce unnecessary clinic visits, and decrease waiting times.

In January 1995, VA published "Sharing Innovations Among VA Clinicians." This document is a collection of innovations in clinical practice, including reducing waiting times, from various VA medical centers. Innovations and their benefits are described along with a contact person from whom more detailed information can be obtained. VA plans to publish additional innovations in the future.

VA has issued a directive that sets goals for timeliness of medical care. The goals state that new patients will be scheduled for an appointment with a primary care provider within 30 days, and established patients will be scheduled for an appointment with a primary care provider within 7 days and with a specialist within 30 days. Patients will be seen within 30 minutes of scheduled appointments. VA assessed the timeliness goals in May 1995. Medical facilities were advised of the findings and have been instructed to improve timeliness where necessary. VA has also disseminated a number of strategies that have proven useful in reducing waiting times. Facilities that have difficulties in meeting the timeliness goals are encouraged to consider implementation of one or more of these strategies.

VA has issued a directive that calls for a review of existing specialty clinics and identifying patients who can be more appropriately treated in primary care clinics. The directive identifies examples of the types of services that could appropriately be managed in a primary care clinic.

VA has issued a directive that provides guidance for the implementation of primary care. VA medical centers are to ensure that veterans are treated in primary clinics instead of specialty clinics, when appropriate.

VA has developed several directives aimed at addressing the potential opportunities to reduce the number of no-shows, thereby reducing the need to overbook. VA plans to advise veterans of the importance of keeping appointments, instruct veterans to contact VA if they are unable to keep an appointment, and contact veterans by mail and computerized telephone calls to remind them of appointments.

VA has issued directives addressing customer service standards and reduction of excessive waiting times including those for specialty clinics. These directives require VA medical centers to meet, by 1998, national standards for timely health care delivery to veterans. Both VA central office and medical facilities are required to review actual experience against the standards and report annually the facilities' performance along with plans for improvements where necessary.