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VA Outperforms Wait Times Compared to Community Care


BACKGROUND:
To improve access to care for Veterans, Congress passed the Choice Act in 2014 and the MISSION Act in 2018, both of which allow Veterans enrolled in VA healthcare to seek care in their communities, at VA's expense, if they meet certain access criteria. Thus, VA now relies on community-based healthcare providers to fill millions of appointment requests for hundreds of thousands of Veterans each year. This cross-sectional study sought to describe geographic variation in wait times experienced by Veterans for three categories of care: primary care, mental health, and other specialties. This study is the first national comparison of appointment wait times experienced by Veterans for both VA and non-VA clinicians. Using VA data, investigators identified 4.8 million Veterans who sought VA healthcare between January 1, 2018 and June 30, 2021. The main outcome was total wait time, and was defined for community care as the number of days elapsed from when the consult request was approved to when the appointment was completed. Investigators also ranked VISNs across each of the three appointment categories.

FINDINGS:

  • Mean VISN-level wait times were shorter for VA than for community care: 29 vs 39 days for primary care, 34 vs 44 days for mental health, and 35 vs 42 days for all other specialties.
  • A sizeable proportion of Veterans experienced wait times that exceeded the VA standard (20 days or less): 44% of VA appointments and 50% of community care appointments.
  • There was substantial geographic variation in appointment wait times. For example, the mean wait time for a mental health appointment in VISN 1 was 33 days for community care and 31 days for VA care, while the wait times were 55 days and 42 days for VISN 6.

IMPLICATIONS:

  • VA outperformed community care in terms of wait times for a majority of VISNs, suggesting that increased access to community care under the Choice and MISSION Acts may not result in lower wait times in many areas of the country.

LIMITATIONS:

  • Study data did not allow investigators to distinguish the sources of geographic variation in wait times—or whether the wait times experienced by Veterans were clinically appropriate.
  • Due to the large number of specialties included in the study, investigators were unable to describe their findings for individual specialties. However, these data are available to other researchers.

AUTHOR/FUNDING INFORMATION:
This study was partly funded through HSR&D’s Quality Enhancement Research Initiative (QUERI). All authors are part of HSR&D’s Partnered Evidence-based Policy Resource Center (PEPReC).


Feyman Y, Asfaw D, and Griffith K. Geographic Variation in Appointment Wait Times for US Military Veterans. JAMA Network Open. August 25, 2022;5(8)e2228783.

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HSR&D requires notification by HSR&D-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR&D and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR&D based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR&D published articles. Visit the HSR&D citations database for a complete listing of HSR&D articles and presentations.


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