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Gerald M. Cross, M.D., FAAFP

Gerald M. Cross, M.D., FAAFP, Veterans Health Administration, Principal Deputy Under Secretary for Health, U.S. Department of Veterans Affairs

Good afternoon Chairman Michaud and Chairman Mitchell and Members of the Subcommittees.  Thank you for inviting me here today to discuss the issue of outpatient waiting times.  Accompanying me today are Mr. William Feeley, Deputy Under Secretary for Health for Operations and Management; Ms. Kathy Frisbee, Deputy Director of the VHA Support Service Center; and Ms. Odette Levesque, Clinical/QA Liaison for the Office of the Deputy Under Secretary for Health for Operations and Management. 

I am pleased to have this opportunity to share with you the current actions the Department of Veterans Affairs (VA) is taking to guarantee that our veteran patients have access to timely medical care at our VA facilities.  We are making good progress in meeting the needs of our veterans and we are committed to providing all necessary care, including preventive care, in a timely manner.  I just want to be clear that we are talking about waiting times for general routine outpatient appointments; veteran patients with urgent or emergent needs are seen immediately.  In a health care system as large as VA, where we provide over one million patient encounters in our clinics each week, we understand there would be opportunities for improvement.  VA is actively seeking solutions to further reduce wait times as we are committed to ensuring the care we provide our veterans is timely as well as high quality.

VA has identified timely access to outpatient care as a top priority.  With national implementation of the Advanced Clinical Access initiative, we have made significant progress in reducing waiting times, but challenges continue.  In the patient satisfaction survey for the third quarter year to date for FY 2007, which is administered by the National Research Corporation (NRC), 85 percent of veterans surveyed reported they received primary care appointments when they wanted them, and 81 percent reported that their specialty care appointments were made at a time that was acceptable to them.

In FY 2007, 96 percent of our 40 million appointments were seen within 30 days of the desired appointment date.  This percentage represents waits for outpatient primary and specialty care appointments.  It does not, however, reflect waits for outpatient or inpatient procedures such as colonoscopies or joint replacements.  VHA is also building upon existing measures by actively moving forward with enhancements to the current scheduling package.  For example, an enhancement to the current surgery case scheduler is expected to be released nationally during the middle of this fiscal year and will better enable us to manage and measure wait times for outpatient and inpatient procedures. 

We are improving access for new veterans as well as improving waiting times for mental health services and medical procedures.  The percent of new primary care patients who were seen within 30 days of their desired date has improved from 75 percent in FY 2005 to 83 percent in FY 2007—and the percent of new primary care patients seen within 30 days of their desired date for the month of September 2007, was 90 percent.   Our statistics are even better for patients seen for follow-up appointments.  Finally, we are focusing on mental health access by setting a new standard this fiscal year that requires all new mental health patients be seen and their needs for care evaluated within 24 hours and that these veterans have a follow-up evaluation within 14 days.  With the assistance of Congress, we have increased by 3,600, the number of mental health professionals within our system since 2005.  This includes physicians, psychologists and social workers. 

The conclusions made by VA’s Office of the Inspector General (OIG) in the recent September 10, 2007 report on outpatient waiting times differs from the 85 percent patient satisfaction score with respect to access and VA’s metric on the 96 percent of appointments seen within 30 days of the desired date.  VA has several concerns about the OIG’s audit methodology that was used in this particular audit.  VA takes OIG reports seriously.  Non-concurrences are infrequent with the last major non-concurrence occurring in the early 1990’s.  For this report on wait times, specifically, the methodology used by OIG and VHA to calculate waiting times do not match.  VA’s waiting times data reflects a “real time” approach to measure patient access using an old scheduling system not designed for this purpose.  While differences in methodology exist, the overriding focus for both sets of measurements is the veteran patient.  VA has a driving interest to accurately monitor and continually improve access for our veterans.   

VA has worked diligently to develop an objective, reliable process to measure waiting times.  I am not aware of any other large system in the public or private sector that has attempted to duplicate the efforts of VA to measure the waiting times for each appointment.  There are an estimated 40 million appointments each year in the VA system.  There are multiple variables involved in this measurement tracking, which includes patient preferences and differences in the organization of individual facility services and clinics, including scheduling practices.  VA has identified that ongoing training of our scheduling clerks is critical for success.  For this reason, we require our scheduling clerks to be trained using our scheduling education modules and to pass a competency exam for certification.  We also began requiring annual refresher training. 

VA is proactively taking steps to review the total scheduling process, including the way VA measures waiting times.  We will continue to improve our processes, educate scheduling staff, and strive to improve clinic access to further reduce waiting times.  To this end, VA has contracted with an independent third party to conduct an evaluation of VA’s scheduling practices and waiting time metrics.  The contractor is beginning the pilot program phase of its assessment, and VA anticipates receiving the final report in Spring of 2008. 

In conclusion, we are taking the following substantive actions to aggressively address the issues of veteran access and wait times—we are developing a new scheduling software package as well as developing shorter term software solutions for our current scheduling package; we are continually improving our training programs, and we are contracting with an outside consulting firm for an independent review of our scheduling process and metrics. 

Thank you, again, for having me here today.  I would be pleased to answer any questions you or any of the members of the Committee may have.