Chapter
VHA Is Generally Meeting Access Policies for Other Types of Mental Health Appointments
VHA Monitors Access to Mental Health Care, but Current Policies Cannot Ensure Reliable Data, Which Precludes Effective Oversight
VHA’s Hiring Initiative Met Goals, but VAMCs Reported Continued Challenges in Hiring Mental Health Staff and Meeting the Growing Demand for Mental Health Care
VHA’s Hiring Initiative Met Its Goals, but VAMCs Reported Continued Challenges Hiring and Placing Mental Health Providers
VHA’s Hiring Initiative Coincided with an Increased Demand for Mental Health Care That VAMCs Reported Being Unable to Meet
VHA’s Community Provider Pilot Program Expanded Access to Mental Health Care for a Limited Number of Veterans; VAMCs Reported Successes and Challenges
VHA’s Community Provider Pilot Program Provided Mental Health Care for a Limited Number of Veterans
Officials Identified Successes and Challenges of the Community Provider Pilot Program
Recommendations for Executive Action
Agency Comments and Our Evaluation
Statement of Dr. Harold Kudler, Chief Consultant for Mental Health Services, Department of Veterans Affairs. Hearing on “VA Mental Health: Ensuring Access to Care”(
Increasing Access and Hiring Practices
Community Provider Pilot Program
VA Response Letter to GAO Report
Management of Open-Access Appointments
Testimony of Nicholas Karnaze, Veteran, U.S. Marines. Hearing on “VA Mental Health: Ensuring Access to Care”(
Veterans Health Administration: Review of Veterans’ Access to Mental Health Care*
Acronyms and Abbreviations
VHA’s Mental Health Performance Data Is Not Accurate or Reliable
VHA’s Measurement of a First-Time Patient’s Access to a Full Mental Health Evaluation Was Not a Meaningful Measure of Waiting Time
VHA Was Not Providing All First-Time Patients a Full Mental Health Evaluation within 14 Days
VHA Overstated Its Success in Providing Veterans New and Follow-up Appointments for Treatment within 14 Days
VHA Schedulers Did Not Consistently Follow Procedures
Mental Health Staff Vacancies May Be Affecting VHA’s Ability to Meet Timeliness Goals
Measuring Access to VHA Mental Health Care
Under Secretary for Health Comments
Issue 1: VHA’s Mental Health Performance Data Is Not Accurate or Reliable
VHA’s Mental Health Performance Data Is Not Accurate or Reliable
VHA’s Measurement of a First-Time Patient’s Access to a Full Mental Health Evaluation Was Not a Meaningful Measure of Waiting Time
OIG’s Assessment of How Long Patients Waited to Receive a Full Mental Health Evaluation
OIG’s Site Visits to Four VHA Medical Centers
VHA Overstated Its Performance Outcomes to Provide Veterans New and Follow-up Appointments for Treatment within 14 Days
OIG’s Assessment of How Long Patients Waited for their Mental Health Care Treatment Appointment
VHA’s National Access List
Next Available Appointment
Scheduling Procedures Were Not Followed
Increasing Workload and Staffing Shortages
Under Secretary for Health Comments
OIG Response to VHA’s Technical Comments
Issue 2: VHA Measures Do Not Fully Reflect Critical Dimensions of Mental Health Care Access
Overview and Definition of VHA Mental Health Access Measures
Points of Access and Flow of Veterans With PTSD and Substance Use Disorder through VHA
Flow of Veterans with PTSD
Measure 1: 14-Day Follow-Up (New Patients)
Measure 2: 7-Day Follow-Up Discharge
Measure 3: OEF/OIF Veterans with Eight Psychotherapy Visits in 14 Weeks
Measure 4: High-Risk Suicide Monitor
Flow of Veterans with Substance Use Disorders through VHA
Bundled and Competing Access Measures
VHA Mental Health Staffing and Productivity Data
OPES Staffing and Productivity Reports
Limitations with Productivity Data
Measuring Access to Mental Health Care in the Private Sector
Continuity of Care and Follow-Up Appointments
Application of Private Sector Measures to VHA
Under Secretary for Health Comments
Appendix A: Scope and Methodology
Appendix B: Statistical Sampling Methodology
Estimates and Margins of Error
Appendix C: Previous OIG Reports Highlighting Need for Improved Appointment Scheduling and Performance Measures
Audit of VHA’s Outpatient Scheduling Procedures, Report No. 04-02887-169, July 8, 2005
Audit of VHA’s Outpatient Waiting Times, Report No. 07-00616-199, September 10, 2007
Audit of Alleged Manipulation of Waiting Times in VISN 3, Report No. 07-03505-129, May 19, 2008
Healthcare Inspection of Access to VA Mental Health Care for Montana Veterans, Report No. 08-00069-102, March 31, 2009
Healthcare Inspection of Electronic Waiting List Management for Mental Health Clinics Atlanta VA Medical Center, Report No. 10-02986-215, July 12, 2011
Review of Select Patient Care Delays and Reusable Medical Equipment Review, Central Texas Veterans Health Care System, Report No. 11-03941-61, January 6, 2012
Appendix D: Detailed Legend for Figures
Appendix E: Under Secretary for Health Comments
Attachment A: Description of Measures
A. Metric: First-Time Patient’s Access to a Full Mental Health Evaluation
B. Metric: New Patient Waiting Time
C. Metric: Follow-up Appointments
Veterans Health Administration: Audit of VHA’s Efforts to Improve Veterans’ Access to Outpatient Psychiatrists(
Report Highlights: Audit of VHA’s Efforts to Improve Veterans’ Access to Outpatient Psychiatrists
Importance of Psychiatrists to Mental Health
Nationwide Pay Exception for Psychiatrists
Office of Mental Health Operations Staffing Model
Results and Recommendations
Finding: VHA Needs to Further Improve Veterans’ Access to Psychiatrists
Veterans’ Access Needs Improvement
No Uniform Staffing Approach
2012 Hiring Initiative Did Not Focus on Psychiatrists
VHA Not Ensuring Facilities Meet Staffing Levels in 2014–2015 Hiring Plans
Clinic Management Practices Allowed for Unused Capacity
Veterans per Psychiatrist
Use of Clinical Time for Patient Care
Inconsistent Procedure Coding
Duplicate Procedure Coding
Appendix A. Scope and Methodology
Appendix B. Potential Monetary Benefits in Accordance With Inspector General Act Amendments
Potential Monetary Benefit Calculation
Appendix C Under Secretary for Health Comments
Veterans Health Administration (VHA) Action Plan
Office of Inspector General’s (OIG) Draft Report
Audit of VHA’s Efforts to Improve Veterans’ Access to Outpatient Psychiatrists
Veterans’ Access to Mental Health Care: Assessments
( Military and Veteran Issues )
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