Evaluation of the Department of Veterans Affairs Mental Health Services (2018) / Chapter Skim
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9 Timely Access to Mental Health Care
9 Timely Access to Mental Health Care
Pages 199-220
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From page 199... ...
It summarizes the published research regarding wait times, wait-time data collected within the VA, the qualitative site interview data obtained as part of this study, appointment scheduling practices, cancellation and missed appointment practices and policies, the VA's efforts to improve timely access, and suggestions for improvement from site visit interviews. The survey results from this study regarding timely access are noted in this chapter but reported in detail in Chapter 6 under the heading Barriers and Facilitators to Service Use.
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From page 200... ...
. The VA publishes monthly wait-time data showing the average wait time from the veteran's preferred date for new mental health appointments for every facility across the system (VA, 2016a)
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From page 201... ...
The ultimate goal of the MyVA Mental Health Access Initiative is to ensure that all facilities provide access to same-day services for urgent mental health appointments. Medical center directors have committed to making them available in all medical centers by the end of FY 2016 (VA, 2017b)
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From page 202... ...
They said that it was because they were so busy. Efforts to Improve Timely Access The committee's findings also suggest that some of the access successes cited by the VA staff reflect some of the strategies intended to meet the 30-day benchmark for getting the veterans connected with the system, but not necessarily connected with care.
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From page 203... ...
Because the VA uses the veterans' preferred appointment date -- not the date of the initial request for services or referral to services -- actual wait times are in most cases several days longer than what is reported. For example, when a veteran requests mental health services, the VA scheduler may take several days to contact the veteran to schedule the appointment.
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From page 204... ...
the 13th. Day Day Day Day Day Day Day Day Day Day Day Day Day Day Day Day Day Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 VHA calculated wait time is 5 days Veteran's overall wait time is 17 days FIGURE 9-1 Actual versus VA calculated wait time for mental health appointments.
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From page 205... ...
The VA's Veterans Satisfaction Survey (VSS) , an annual survey of veterans served by the VA, also asks veterans about mental health care appointments.
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From page 206... ...
The issue of missed mental health appointments or "no shows" is complex, with differing interpretations of how they occur. From many staff members' perspectives, veterans' failure to show up for appointments not only shows a lack of personal responsibility, but contributes to access challenges for other veterans: Veterans are only going to get better if they take a little bit of ownership for identifying their needs, driving to the VA and getting their ID card, calling the 800 number and making an appointment, canceling their appointment if they can't go so it doesn't jam the system for everyone else to try to get an appointment.
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From page 207... ...
. Shorter Appointments, Longer Intervals Between Them Another strategy to meet the demand and shorten wait times is to shorten the actual appointment time.
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From page 208... ...
[Iowa City, Iowa] Interestingly, several veterans interviewed during the site visits said that they preferred getting counseling services at the vet centers because the centers regularly offer evening and weekend hours during which time they can receive individual counseling or attend a group session.
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From page 209... ...
which allows veterans to schedule appointments from their smartphones, tablets, or through the Web on a home computer. The app allows users who are receiving care from either a VAMC or CBOC to schedule and request primary care appointments and request mental health appointments (VA, 2016b)
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From page 210... ...
There is some evidence, however, that VCL has had problems providing timely access to its service. In 2015 the GAO reviewed how well the VA was meeting its response-time goals for the VCL, how the VA was monitoring VCL call center operations, and how the VA was working with VCL service partners to ensure that veterans received high-quality service (GAO, 2016b)
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From page 211... ...
In FY 2016, community care accounted for about 16 percent of VA's medical care obligations.5 Recent legislative action -- most notably the Veterans Access, Choice, and Accountability Act6 -- has allowed the VA to greatly expand the use of community care to improve access to services -- including mental health services -- for veterans. In 2014, 20 percent of all VA users utilized some community care.
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From page 212... ...
For example, in FY 2016, there were only 511 mental health authorizations for PC3, compared to 47,109 for VCP.8 The Veterans Choice Program In response to the health care access issues facing the VA, including excessive wait times for appointments, Congress passed the Veterans Access, Choice, and Accountability Act of 20149 (Choice Act) .10 The Choice Act provided new authorities, funding, and other tools to help improve access to care for veterans using the VA system, and it expanded the services provided under PC3.
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From page 213... ...
This is a dramatic increase from FY 2015, during which the VA issued 7,597 authorizations for mental health to 6,307 unique veterans.13 Other elements of the Choice Act designed to improve access to care for veterans include an extension of Project Access Received Closer to Home and the Assisted Living Pilot Program, an expansion of mobile vet centers and mobile medical centers, and outreach to the Indian Health Service. All of these efforts were designed to improve access to populations with limited access to VA services, such as rural populations, veterans with traumatic brain injury, or Native American veterans (VA, 2014c)
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From page 214... ...
For example, coordinating and managing the care veterans receive via community care providers poses a challenge, especially since the requirement for providers to submit patient records with their claims was abandoned in 2016 (Kime, 2016b)
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From page 215... ...
Third-Party Administrators Since 2013, VA community care programs have been managed by two third-party administrators -- TriWest and Health Net. The two entities are responsible for developing regional networks of providers, verifying that providers are appropriately credentialed, licensed to practice in their states, and eligible to participate in federally funded health care programs.
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From page 216... ...
Furthermore, veterans who present with acute mental health needs are also, understandably, given priority. Navigators and Case Managers Facilitate Timely Access Veterans and VA staff alike described the challenges working through a massive organization like the VA, which can frustrate even the most seasoned case manager, let alone a veteran with cognitive challenges from PTSD or traumatic brain injury.
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From page 217... ...
Managing Acute Distress A second category of veterans who appear to gain timely access to VA services are those who present at a VA facility in acute distress, that is, those whose conditions indicate the potential for imminent harm to themselves or others (for example, in the case of psychiatric crisis or homelessness)
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From page 218... ...
• While the Veterans Access, Choice, and Accountability Act of 2014 allows eligible veterans who meet certain conditions to seek care outside of the VA, non-VA community mental health providers are in short supply in many areas and may lack the training and expertise to deliver high-quality care for conditions such as PTSD. • The network of mental health providers providing care under the Veteran's Choice Program is expanding; however, sharing medical records between the VA and community providers and the coordination of care for veterans who are using the Veteran's Choice Program continues to be a challenge for the VA to manage.
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From page 219... ...
2016c. Improved oversight of community care physicians' credentials needed.
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From page 220... ...
2015a. Veterans Health Administration review of Patient-Centered Community Care (PC3)
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