Title page
Contents
Highlights 2
Letter 6
Background 10
Veterans Community Care Program 10
Isakson-Roe Act Statutory Requirements for VA on Administration and Scheduling of Community Care 12
VA's Data Used to Inform the Statutorily Required Measurements 13
VA Reviewed and Reported Community Care Staffing and Training Needs as Required in Law 14
VA's Measurement of Community Care Timeliness Is Not Compliant with Statutory Requirements 16
Most of the Metrics VA Uses to Inform the Statutorily Required Timeliness Measurements Are Reliable, but Some Are Not, Due to Incomplete Data 20
Conclusions 22
Recommendations for Executive Action 23
Agency Comments 23
Appendix I: VA's Method of Calculating Measurements for Section 3103(b) 25
Appendix II: GAO Replication of VA's Isakson-Roe Act Section 3103(b) 28
Appendix III: Comments from the Department of Veterans Affairs 40
Appendix IV: GAO Contact and Staff Acknowledgments 42
Related GAO Products 43
Table 1. Percentage of VA Community Care Referrals Where Certain Timeliness Data Were Used in Calculations at Nine Selected Facilities (August 16-31, 2023) 21
Table 2. VA Data Elements and Sources Used to Calculate Isakson-Roe Act Required Community Care Scheduling Timeliness Measurements 26
Table 3. GAO Determination of Reliability of Metric Calculations at Nine VA Medical Facility Locations 29
Table 4. Comparison of VA and GAO Calculations-Average Days from VA Determines Care is Required to First Scheduled in CPRS 30
Table 5. Comparison of VA and GAO Calculations-Average Days from VA Determines Care is Required to Referral Sent to a Community Provider or Third-Party Administrator 31
Table 6. Comparison of VA and GAO Calculations-Average Days from VA Determines Care is Required to Referral Sent to a Third-Party Administrator for Scheduling 31
Table 7. Comparison of VA and GAO Calculations-Average Days from VA Determines Care is Required to Referral Sent to a Community Provider 32
Table 8. Comparison of VA and GAO Calculation-Average Days from Referral Sent to a Third-Party Administrator to Referral Accepted by a Third-Party Administrator 33
Table 9. Comparison of VA and GAO Calculations-Average Days from VA Sends Referral to a Community Provider to Community Provider Accepts the Referral 33
Table 10. Comparison of VA and GAO Calculations-Average Days from Referral Sent to a Third-Party Administrator to Referral Marked Scheduled in HSRM 34
Table 11. Comparison of VA and GAO Calculations-Average Days from VA Sends Referral to a Community provider to Referral Marked Scheduled in HSRM 35
Table 12. Comparison of VA and GAO Calculations-Average Days from Referral Sent to a Third-Party Administrator to Referral Marked Scheduled in CPRS 35
Table 13. Comparison of VA and GAO Calculations-Average Days from VA Sends Referral to Referral Marked Scheduled in CPRS 36
Table 14. Comparison of VA and GAO Calculations-Average Days from Referral Accepted by a Third-Party Administrator in HSRM to Referral Completed in CPRS 37
Table 15. Comparison of VA and GAO Calculations-Average Days from Community Care Provider Accepts Referral to Referral Completed in CPRS 37
Table 16. Comparison of VA and GAO Calculations - Average Days from Appointment is Scheduled to Occur in CPRS to Appointment is Scheduled to Occur in HSRM 38
Table 17. Comparison of VA and GAO Calculations-Average Days from Referral Sent to a Third-Party Administrator to the Appointment Date 39
Table 18. Comparison of VA and GAO Calculations-Average Days from Referral Managed by a Third-Party Administrator is Approved for Scheduling in HSRM... 39
Figure 1. Isakson-Roe Act Section 3103 Required Community Care Scheduling Timeliness Measurements 17
Figure 2. Isakson-Roe Act Section 3103(b) Required Community Care Scheduling Timeliness Measurements 25