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VA News

Veterans Win with Trump Administration's MISSION Act Reforms

Vets Win with Trump

 

According to early headlines in the media, the Department of Veterans Affairs' implementation of the MISSION Act was going to be something of a mess.

One story said to "expect glitches." Another said it was "confusing." Some lawmakers who supported the bipartisan bill suddenly warned about the possibility of "overreach" by the Trump Administration, while others warned of a "tech nightmare."

But thanks to thousands of dedicated VA workers around the country and President Donald J. Trump's support for this historic reform, elements of the MISSION Act took effect on June 6, and Veterans immediately began benefitting from the largest transformation in Veterans' health care since the end of World War II.

This achievement was met mostly by silence in the media -- which is as close as the press ever gets to saying, "good job." But because this revolution is likely to affect the health care decisions of millions of Veterans for years to come, it's worth explaining how the MISSION Act has changed the lives of America's heroes for the better.

At its core, the MISSION Act reflects the president's vision that Veterans need to be at the center of their health care decisions. If it's too long a drive to the VA, if wait times are too long, if we can't offer the services a Veteran needs, or if it's simply in the best medical interest of a Veteran to use non-VA services, they can now seek care in their community.

That change was a long time coming for our rural Veterans, many of whom live nowhere close to a VA hospital or clinic. And it's much more than just an "extension" of the Choice program enacted under President Obama. That program was temporary, narrow and incomplete, while the MISSION Act is permanent and will put a much broader group of Veterans in the driver's seat when it comes to their health.

The response from those who wore the uniform to defend this great Nation was immediate and sustained. A tool we developed to decide whether Veterans are eligible for community care is being used tens of thousands of times each day.

The MISSION Act also created an urgent care benefit that finally gives Veterans what others have in their neighborhood -- access to nearby care to treat ailments that need immediate attention, like the flu or a sprained ankle. One Veteran in Texas said this change is a "godsend" because under the old system, getting a sore throat treated meant a 45-minute ride each way to the VA.

And he's not alone. Thousands of urgent care visits have been scheduled for Veterans under the MISSION Act. By mid-July, we were starting to exceed 500 visits each day, and that number has been growing each week as Veterans learn more about this important new benefit.

In the end, the MISSION Act simply gives the VA what all other major healthcare systems have -- a way of referring patients to outside care when needed. Community care is one piece of that, as is the new urgent care benefit. We have nearly 5,000 urgent care providers in our network so far, and that number is expanding as we continue to provide Veterans with more options to get care when and where they need it.

Washington, D.C., has a history of bungling the implementation of major new programs and forgetting that it has the power to positively affect the lives of millions of Americans. The MISSION Act is a welcome shock to that system that shows the Trump Administration is willing and able to buckle down and deliver real reform.

Our Veterans, who answered the call and fought for our freedom and our interests around the world, deserve nothing less.

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Flanders rallies health IT professionals to be 'cost warriors'

Pat Flanders

 

Serving as "cost warriors" while the DHA's IT infrastructure is modernized, standardized, and streamlined continues to be a top priority, said Pat Flanders, deputy assistant director for Information Operations, and Military Health System chief information officer. Flanders gave the opening remarks on Tuesday, July 30, at the 2019 Defense Health Information Technology Symposium, or DHITS. The theme of this year's DHA-sponsored event is "One Team, One Mission – Enabling MHS Transformation."

Flanders explained some of the structural changes his team is undergoing to respond to innovations. "We know where we're going," he said, adding that with all military treatment facilities coming under the DHA on Oct. 1, utilizing Ektropy is key.

Ektropy is a customized web-based program and portfolio management solution that helps the MHS run like a business, Flanders said. It provides unprecedented relational view among cost, contracts, personnel, and programs across the MHS.

The name is meant to be the antonym of the word entropy, which means lack of order. Flanders says Ektropy was built to make it as easy to use as possible, so that "we're exposing the people at the MTFs who are responsible for the IT financials to the bare minimum of financial complexity."

Ektropy captures data across the entire MHS, Flanders noted, providing an enterprise-wide view of IT spending. This enhanced visibility enables data-driven decisions in support of the delivery of a more secure, efficient, and effective IT infrastructure. Funding is aligned with defined priorities, he said, and supports the effective management and administration of MHS IT.

"The reason this is so important is, it allows me to fight for money," Flanders said. "It allows me to show where we're taking savings. And it allows me to see what's out there so that I can ponder strategic sourcing and get better deals."

Flanders said a quality single standard will be enforced "where it makes sense. Where things are more alike than different, I want standardization. Where they're more different than alike, I just want to baseline that so that we know we've consciously said to let them be different for that aspect of what they do."

Ektropy marks the first time all enterprise health IT financial data has been made available in a centralized repository, Flanders noted. "DHA is committed to creating and maintaining a performance-based culture focused on results and accountability," he said. "We're going to run IT like a business."

Other issues Flanders touched on during his remarks included cybersecurity and Desktop to Datacenter, the program to streamline infrastructure service lines across the MHS.

After Flanders spoke, Navy Vice Adm. Raquel Bono, the DHA director, assisted with presenting the 2019 DHITS awards. Awards and recipients are as follows:

  • U.S. Army Medical Department Mercury Award for Health Information Technology:
  • Civilian of the Year: Joseph Lowe, Regional Health Command Atlantic
  • Officer of the Year: Army Capt. Michael A. Kellenbenz, Office of the Surgeon General, G-6 Health Information Technology Directorate, Operation Medicine Section
  • Team of the Year: Regional Health Command – Central, Virtual MEDCEN
  • Captain Joan Dooling Award for Information Professional Excellence (Navy):
  • Information Professional Officer of the Year: Navy Lt. Rachel Knight
  • Information Professional Enlisted Member of the Year: Navy Petty Officer 3rd Class Miguel Velasquez
  • Information Professional Civilian Member of the Year: David Tran
  • Information Professional Team of the Year: Naval Health Clinic Lemoore’s Information Technology Department
  • Information Professional Clinical Informaticist of the Year: Navy Lt. Cmdr. “Robert” Park
  • Air Force Surgeon General's Medical Information Services Team Award: 374th Medical Support Squadron, Information Services Flight, Yokota Air Base, Japan
  • Deputy Assistant Director Information Operations Awards, J-6:
  • Field Grade Officer of the Year: Air Force Lt. Col. William Lunsford
  • Company Grade Officer of the Year: Air Force Capt. Joseph Donahue
  • Senior Non-Commissioned Officer of the Year: Air Force Master Sgt. Katrina Rollins
  • Non-Commissioned Officer of the Year Air Force Staff Sgt. Steven Edgar
  • Category II Civilian of the Year: Shaundra Knight
  • Category I Civilian of the Year: Ying Gomez

DHITS brings together government, military, and industry information technology professional to share knowledge, ideas, new developments, and lessons learned. The symposium continues through Aug. 1 at the Caribe Royale in Orlando, Florida.

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Medical devices, MHS GENESIS: DHITS session focuses on ties that bind

Medical Devices 001

 

The opportunities and challenges of integrating medical devices with MHS GENESIS was the focus of a breakout session Wednesday, July 31, at the 2019 Defense Health Information Technology Symposium, or DHITS. The theme of this year's event, sponsored by the Defense Health Agency, is "One Team, One Mission – Enabling MHS Transformation."

"Integrating medical devices in real time with the electronic health record allows seamless work flow, data flow to happen instantaneously," said Saad Khan, the DHA's chief of biomedical devices integration.

Khan explained that across five clinical capabilities – anesthesia, laboratory, PACS (picture archiving and communications system), pharmacy, and physiological monitoring – 17,359 individual medical devices are currently connected to legacy electronic health records. They include heart, blood pressure, and anesthesia monitors in operating rooms.

Khan is lead of the Medical Device Integration Task Force. Among the group's duties was developing a list of devices that should be connected at the go-live stage of implementing MHS GENESIS. The task force is also working to ensure that devices connected to legacy systems will work with the new electronic health record.

"In order to maintain current interoperability of medical devices within the five clinical capabilities, these medical devices must not lose connectivity at the MHS GENESIS go-live stage," Khan said. "It's critically important that patient safety is never compromised during the implementation of MHS GENESIS."

Khan said the task force has identified medical devices that may require specialized hardware and/or interface and driver development to share data with MHS GENESIS. For some devices, he said, support for MHS GENESIS may not be validated.

Khan emphasized that across the enterprise there will be "massive standardization, not only on the device but what you're doing with it and the recording on the electronic health record. Your current workflow may not work in this new environment."

Other activities include conducting site assessment and validation 18 months to two years prior to the go-live stage, assisting with the business case analysis process for replacing vs. interfacing, and reviewing and validating all remedy tickets for new interface requirements in sustainment.

Khan said it's vital for MTFs to provide a point of contact for the task force during the preparation and execution of onsite validation; ensure equipment data records are complete and accurate; confirm all existing interfaces and use of middleware, gateways, and servers; and ensure personnel and vendors are trained and aligned to support testing and sustainment requests.

The session also covered issues related to equipment purchases and contract modifications.

"We want to get ahead of this and get you educated on what that process will look like, because it's going to be a little different than how you got it connected initially," Khan told the attendees. "Just because you can connect it, doesn't mean you should. There's a process for how you go about it."

Khan's co-presenters were Air Force Lt. Col. Richard Keller, the chief of Medical Logistics Enterprise Information; and Air Force Lt. Col. Christina Sheets, the assistant program manager for MHS GENESIS Baseline.

DHITS brings together government, military, and industry information technology professionals to share knowledge, ideas, new developments, and lessons learned. The symposium began Tuesday, July 30, and continues through Thursday, Aug. 1, at the Caribe Royale in Orlando, Florida.

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Better together: DoD, VA collaboration focus of DHITS session

DHITS Session

 

The Departments of Defense and Veterans Affairs "are committed to collaborating on health IT wherever it is appropriate for both organizations," said Chris Harrington, deputy assistant director of the Defense Health Agency's Information Operations Solution Delivery Division.

He noted that joint health IT adoption doesn't occur at the expense of one organization over the other. "It accentuates and accelerates both departments' desire for transformational change," he said.

Harrington spoke about DoD-VA collaboration on Wednesday, July 31, during a breakout session at the 2019 Defense Health Information Technology Symposium, or DHITS. The theme of this year's DHA-sponsored event is "One Team, One Mission – Enabling MHS Transformation."

Harrington said the two federal departments "can count on each other to be valued, trusted, and committed partners in overall transformation activities. All health IT processes that we adopt will be true joint, interagency processes."

He noted that the transition DHA is experiencing is mirrored in the VA, and that the VA recently adopted the same electronic health record as the DoD's. The EHR will be deployed in coordination with DoD, and "the result will be a single health IT system experience that improves quality of care, access, and satisfaction for beneficiaries as well as users."

Collaboration "creates the opportunity to have longitudinal and very seamless treatment between the two organizations," Harrington added. "The EHR follows someone from accession through active duty and then after retirement."

Additionally, Harrington noted, collaboration enables data collection and mining, "which optimizes outcomes management and maximizes decisions related to purchasing and other activities."

"Standardizing the process creates a tremendous analytical engine behind that data-generation capability," he said. "It allows optimization on a business level, and also on a clinical level."

Surrounding the EHR deployment is the adoption of numerous IT applications, Harrington said. Examples include the Joint Patient Safety Reporting System, a web-based application to report events across the Military Health System and the VA; and the medical logistics IT platform known as Defense Medical Logistics Standards Support, or DMLSS. Combined with the successor system, LogiCole, this platform enhances pharmacy, medical, and surgical purchases for facilities and the combat theater.

"Enterprise visibility – let's call it an Amazon effect of price-product comparison," Harrington said. "LogiCole allows that to happen. We won't adjudicate as a function of the IT what people purchase. But we will show them the different items that are being purchased throughout the enterprise and the relative prices, to let them make the best decisions for their respective organizations."

Harrington also said standardization of communication across the network allows reciprocity. "You won't have to do the same things over and over and over again, in different places, because you've got everyone on the same network," he said. "The standards of that network demand a certain criteria, and you meet that criteria in the cybersecurity certification of a device or IT application. With true reciprocity, you proliferate that across the enterprise."

John Short, chief technology integration officer for the VA's Office of Electronic Health Record Modernization, joined Harrington in the presentation.

"Sometimes you have a functional champion; sometimes you have an IT champion," Short said. But for successful transition and collaboration, Short said, "You must have both."

DHITS brings together government, military, and industry information technology professional to share knowledge, ideas, new developments, and lessons learned. The symposium began Tuesday, July 30, and continues through Thursday, Aug. 1, at the Caribe Royale in Orlando, Florida.

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VA Doesn’t Really Know What It Costs To Run VistA

VistA

 

Lowball estimates for operating the current electronic health records system through the transition to Cerner cast doubt that overall projections are accurate.

As the Veterans Affairs Department makes its 10-year, $10 billion transition to the Cerner Millennium electronic health records system, the agency will have to maintain its proprietary VistA system at a cost of $4.89 billion. However, as with VA’s past EHR programs, that estimate is likely well below what the actual cost will be.

In order to arrive at the estimate, VA officials looked at the costs of maintaining and updating VistA over the last three years, a figure they pegged at $2.3 billion. But a Government Accountability Office analysis of VistA costs casts that figure in doubt.

By GAO’s accounting, only $1 billion of that figure is reliable.

“The source data for the remaining $1.3 billion—which largely accounted for VistA’s infrastructure, related software and personnel costs—were not well documented,” Carol Harris, director of GAO’s IT and cybersecurity division, told the House Veterans Affairs Subcommittee on Technology Modernization. “As a result, VA’s subject matter experts were unclear on how to account for VistA versus non-VistA costs. Furthermore, the department omitted costs related to additional hosting and data standardization in testing from the total spend.”

Based on GAO’s analysis, spending on VistA over those three years was likely much higher, Harris said.

For example, in June, VA officials told GAO the agency spent $238 million on additional hosting services each year. Shortly thereafter, VA officials came back to GAO with a new number: $950 million. Ultimately, officials ended up leaving the line item blank.

“When we talked with VA subject matter experts, they agreed that the $950 million was off base, but the fact that that additional hosting line item was not included in the $2.3 billion estimate suggests that the number is higher,” Harris said.

The central issue is VistA’s decentralized nature, she explained. As the system has developed over the decades, each facility and office has customized it to their own needs, resulting in at least 130 distinct versions across 1,500 locations. That reality coupled with poor inventory management has led to an unreliable accounting of costs.

“As a result of that decentralization—which began in the ‘80s—VA is not in a position to be able to effectively draw that circle—that perimeter—around what is and isn’t VistA,” Harris said. “The inability to draw that perimeter is why they don’t have accurate costs and they don’t have an accurate basis for an ROI for moving to the Cerner system.”

Furthermore, the record of poor accounting casts doubt that VA’s $10 billion estimate for the Cerner rollout, lawmakers said.

“We don’t have any confidence a) in what VistA actually entails, so I don’t think we have any confidence in that $4.8 billion; but then, more importantly, that makes me have less confidence in the $10 billion estimate for Cerner, as well,” Subcommittee Chair Rep. Susie Lee, D-Nev., said. “Money does not grow on trees. At what point do we lay out exactly what the costs are?”

Early into the planning phases of the Cerner deployment, the agency increased the cost estimate by $350 million to cover government salaries that previously weren’t included.

One way VA plans to address gaps in the VistA cost estimate is through use of the Technology Business Management framework—a set of accounting standards designed to link IT investments to specific outcomes. Agencies are under mandate to use TBM in their IT reporting, which Paul Tibbits, executive director of the Office of Technical Integration, said VA is implementing in this year’s upcoming budget requests.

Using that framework, Tibbits said VA will begin to properly report personnel and infrastructure costs that were previously wrapped in with other areas.

But TBM itself won’t be enough, according to Harris.

“Until VA can fully define VistA, they will not be in a position to accurately report the costs. The two go hand-in-hand and the definition of VistA is foundational,” she said. “Whether they use TBM or another methodology, the core issue remains that the definition of VistA is not fully defined, and that’s the problem.”

“TBM is only part of the answer,” Tibbits agreed. “The definitional boundary of [the collocated hosting services] is clearly an important part of the answer, as well. The two of those combined together is what’s going to end up being our methodology.”

Tibbits added that VA expects to have that methodology finalized in the transition plan update coming this fall.

“There are many unknowns in this transition,” Lee said during her opening remarks. “The fact that this plan is still being formulated is concerning.”

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VA Migrates 23.5 Million Veteran Patient Records To Cerner Data Center

Cerner Data Center

 

All new patient data will go into the shared Veterans Affairs-Defense Department data center as the two agencies move forward with the massive electronic health records overhaul.

The Veterans Affairs Department is getting ready to pilot the first instances of its new electronic health records system next spring but took the first major step this week, migrating millions of Veterans’ health records to a third-party data center.

The department announced reaching a “critical milestone” Monday with the transfer of 23.5 million records to a shared data center managed by Cerner Corp., the health IT company awarded the 10-year, $10 billion contract to overhaul VA’s electronic health records system and integrate it with the Defense Department’s MHS GENESIS system.

The migrated records account for some 78 billion data points compiled from across the VA, totaling about 50 terabytes of information. The data includes “lab results; pharmacy prescriptions; inpatient and outpatient diagnoses and procedures; and other medical data of both living and deceased Veterans,” according to the release.

Going forward, all new patient data will be automatically transferred from the existing VistA platform to the Cerner system, which will then be integrated into the Cerner Millennium EHR platform. The VistA system—developed internally by VA over decades—will be phased out over 10 years, at which point all data will be processed in the Cerner Millennium system.

“For decades, VA and DoD have been struggling to achieve interoperability and seamlessly share patient records between our health systems—placing an unfair burden on our Veterans and their families,” VA Secretary Robert Wilkie said of the announcement. “No Veteran, family member or caregiver should have to carry boxes of paper, medical and service records around. This data migration is the first step to solving that problem for good.”

The move to a data center shared by both the VA and Defense departments is key to ensuring the systems are interoperable, one of the central missions for both agencies’ EHR efforts.

“This is the foundation of interoperability—the ability for VA, DoD and community providers to access the right data, at the right place, at the right time⁠—ensuring a lifetime of seamless care for Veterans, service members and their families,” Travis Dalton, president of Cerner Government Services, told Nextgov in a statement. “Not only is migrating four decades worth of patient information a historic accomplishment for VA, but it's also the most comprehensive health data migration ever.”

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VA releases Benefits Administration’s 3rd quarter benefits performance results

DVA Logo 014

 

WASHINGTON — U.S. Department of Veterans Affairs’ (VA) Undersecretary for Benefits, Dr. Paul R. Lawrence, reported on his organization’s performance for the third quarter of fiscal year 2019 in a livestream broadcast today. 

The Veterans Benefits Administration (VBA) provides disability, education, and other forms of benefits earned through military service.

“Being open and transparent about how VBA measures up against its quarterly targets continues to build trust between VA and those we are dedicated to serving,” said VA Secretary Robert Wilke. “VA’s Benefits Administration lays it all on the table, highlighting the organization’s accomplishments, opportunities for improvement and plans for ongoing initiatives.”

VBA met or exceeded this quarter’s targets in the majority of its business lines. In the last eight weeks of the quarter, VBA completed more than 261,000 disability compensation claims, which is above the eight-week cumulative target of 255,000. For the entire quarter, VBA completed nearly 351,000 of these claims exceeding their target of 335,000. This was done in an average of 105 days, which is above the longstanding goal of 125 days to complete these claims.

VBA also exceeded targets for completing claims in Veterans Pension, the number of field examinations conducted in the Fiduciary Program and the timeliness of processing original education claims. Additionally, the Insurance Program exceeded its goal to locate beneficiaries upon an insured Veteran’s passing.

Dr. Lawrence recognized that some quarterly results did not make the targets. Although VBA completed 57% more Dependency and Indemnity Compensation claims this quarter than last, it did not meet its target for number of claims processed or average days to process claims. Lawrence assured viewers that VBA is actively looking for opportunities to streamline its processes to meet these targets.

Dr. Lawrence also addressed the Blue Water Navy Vietnam Veterans Act of 2019, touching on key aspects of the law and outlining what VA is doing to speed claims from Vietnam Veterans. Later in the webcast Willie Clark, deputy under secretary for Field Operations, reported on a performance challenge posed this summer to VBA’s claims processing teams. Jeffrey London, executive director of Loan Guaranty Service, described VBA’s Home Loan Funding Fee Refund Initiative. Dr. Lawrence concluded the broadcast by fielding questions from representatives of two key Veterans Service Organizations; The American Legion and Paralyzed Veterans of America.

To watch the entire webcast, visit https://www.benefits.va.gov/benefits/stakeholder.asp.

For more information regarding VA’s benefit programs, visit https://www.benefits.va.gov/benefits/

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VA updates the disability rating schedule for infectious diseases, immune disorders and nutritional deficiencies

DVA Logo 24

 

As of Aug. 11, the U.S. Department of Veterans Affairs (VA) updated portions of the VA Schedule for Rating Disabilities (VASRD, or Rating Schedule) that evaluate infectious diseases, immune disorders and nutritional deficiencies.

The collection of federal regulations used by the Veterans Benefits Administration helps claims processors evaluate the severity of disabilities and assign disability ratings.

“VA is in the process of updating all 15 body systems of the VASRD to more accurately reflect modern medicine and provide Veterans with clearer rating decisions,” said VA Secretary Robert Wilkie. “By updating the rating schedule, Veterans receive decisions based on the most current medical knowledge of their condition.”

The complete list of updates to the rating schedule is available online. Claims pending prior to Aug. 11, will be considered under both the old and new rating criteria, and whichever criteria is more favorable to a Veteran will be applied. Claims filed on or after Aug. 11, will be rated under the new rating schedule.

Updating the rating schedule for conditions related to infectious diseases, immune disorders and nutritional deficiencies, enables VA claims processors to make more consistent decisions with greater ease and ensure Veterans understand these decisions. VA remains committed to improving its service to Veterans continuously and staying at the forefront of modern medicine as it has for decades.

Since Sept. 2017, VA has updated the schedules for dental and oral conditions, conditions related to the endocrine system, gynecological conditions and disorders of the breast, the general rating formula for diseases of the eye, skin conditions and the hematologic and lymphatic systems.

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VA secretary to visit American Samoa next week

America Samoa

 

Pago Pago, AMERICAN SAMOA — Speaking at Thursday’s cabinet meeting, under a tent at the Su’igaula o le Atuvasa Beach Park in Utulei, Gov. Lolo Matalasi Moliga informed cabinet directors, that the Governor’s Office is preparing for a visit by the US Secretary of Veterans Affairs, Robert Wilkie, who is arriving next week.

He said the Office of Samoan Affairs is charged with setting the program for the Secretary’s visit, including the usual airport arrival and traditional welcoming protocol.

Lolo’s remarks came after LBJ Medical Center chief executive officer, Faumuina John Faumuina informed cabinet members that the hospital has been informed that Wilkie will be visiting LBJ next week.

Faumuina said the scheduled visit is for 10:40a.m on July 31st and LBJ will share with the VA secretary the programs and services the Hospital is able to provide for Veterans.

Two ASG officials told Samoa News yesterday that after the LBJ meeting, there will be public forums to provide the opportunity for Veterans to address their needs to the VA Secretary.

As of yesterday afternoon, LBJ was the only ASG entity that will meet with Wilkie, who has been serving as VA Secretary since last year, according to the officials, who noted that the agenda and program for the visit is being firmed up.

It’s unclear at this point if the ASG Department of Health will be involved in the discussions with LBJ.

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5 Years After Nationwide Scandal, VA Still Struggles to Track Wait Times

Wait Time Scandal

 

Five years after the Department of Veterans Affairs was rocked by a scandal over appointment delays linked to Veterans' deaths, it still struggles with scheduling issues and tracking wait times, a government oversight official told Congress this week.

During a hearing Wednesday before the House Veterans Affairs Committee, Debra Draper, health care director at the Government Accountability Office (GAO), said that, while the VA has "taken action to ensure its facilities provide timely access to medical care," it must do more.

Draper said the VA has made progress since the GAO first warned in 2012 of shortcomings in its appointment scheduling and tracking system, as well as lengthy delays in patient care. But she added that the VA's data on wait times remains unreliable and appointment delays continue to be long.

"At this time, we continue to be concerned that VA has not sufficiently addressed the reliability of its wait time data," Draper said. "For example, we have found that VA's wait times do not capture the time it takes the department to enroll Veterans in VA health care benefits, which we found could be quite lengthy."

The issue is not restricted to appointments at VA health facilities, she said, adding that wait time data for the VA Choice program, a community care program that let Veterans seek care at a private facility, was incomplete or inaccurate. VA Choice has been replaced by the Mission Act, which consolidated all VA programs for community care.

"Since implementing our recommendation, VA has taken a number of actions. One is by annual audits of schedulers -- and the most recent, in 2018, they audited about 667,000 appointments, and they found the 8 percent error rate, so that affected about 53,000 appointments," Draper said. "There is improvement. [But] there's more work to be done, definitely."

In a separate report released Wednesday, the GAO found that since the VA's tracking system captures only part of the appointment scheduling process, the department may show it is meeting its average wait time goal of 30 days. But when considering all factors, Veterans potentially are waiting up to 70 days for an appointment.

Speaking at the hearing, Teresa Boyd, Veterans Health Administration assistant deputy secretary for clinical operations, acknowledged that the VA still has challenges but added it also has "undergone tremendous transformation" since 2014.

Boyd said that, for established patients, the VA's average wait times for primary care and mental health are less than five days, and seven days for specialty care

"We recognize that there are still challenges ahead of us, but it is important to keep in mind that Veterans continue to receive the highest quality care, often with shorter wait times than in the private sector," she told the committee.

The GAO recommended that the VA implement its previous recommendations on improving scheduling at both VA facilities and community care programs. The VA will implement a new system to support appointment scheduling, authorizations and referrals in fiscal 2021, which VA officials have said will address some of the issues. But Draper said clear policies, oversight and effective training also are needed.

In his opening statement, committee chairman Rep. Mark Takano, D-California, cited recent media reports about ongoing private waitlists and an apparent lack of transparency on wait times within the VA and in the private sector -- obfuscation that limits a Veteran's ability to choose health services, he said.

"The lack of accurate information on wait times at VA hospitals, and with community providers, should cause us all to question whether the policy to send more Veterans to community care providers is sound or even if it's working," he said.

He added that the VA has an opportunity to lead the nation in crafting wait time standards and accessibility to data that allows patients to make "informed choices."

"If VA can get that right, make it simple for Veterans to understand, I believe we will do not only Veterans a great service, but we'll do the American people a great service by setting the standards that the private sector will have to match," he said.

Rep. Phil Roe, R-Tennessee, the committee's ranking Republican, said he'd be remiss not to "acknowledge the many ways in which access to care for Veterans has improved" since 2014, with the VA completing 1 million more appointments in 2018 than the previous year.

But, he added, there is "no doubt VA has farther still to go."

"The VA Inspector released an alarming report about delays in care for Veterans seeking mental health appointments at the Albuquerque VA Medical Center. That report paints a heartbreaking picture of why we must continue to focus on access to care," he said.

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