Key Issues > Managing Risks and Improving VA Health Care - High Risk Issue
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Managing Risks and Improving VA Health Care - High Risk Issue

The Department of Veterans Affairs’ (VA) Veterans Health Administration operates one of the largest health care delivery systems in the nation, with over 160 medical centers and more than 1,000 outpatient facilities. Over the past decade, there have been numerous reports of VA facilities failing to provide timely care. 

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Demand for VA health services has grown over the past decade due, in part, to servicemembers returning from Afghanistan and Iraq and the aging veteran population. During this period of time, total budgetary resources for VA's Veterans Health Administration have increased substantially, from $37.8 billion in fiscal year 2006 to $91.2 billion in fiscal year 2016.

VA health care is a high-risk area because of continued concerns about the department's ability to ensure:

  • veterans' timely access to health care,  
  • resources are being used cost-effectively and efficiently, and
  • the quality and safety of veterans' health care.

Access to health care
There have been numerous reports for more than a decade of VA facilities failing to provide timely health care. In some cases, the delays in care, or VA's failure to provide care at all, reportedly resulted in harm to veterans.

In response to serious and longstanding problems with VA health care, the Veterans Access, Choice, and Accountability Act of 2014 (Pub. L. No. 113-146, 128 Stat. 1754) was enacted. It provided temporary authority and $10 billion in funding through August 2017 (or sooner, if those funds are exhausted) for veterans to obtain health care services from community (non-VA) providers to address long wait times, lengthy travel distances, or other challenges accessing VA health care. Under this authority, VA introduced the Veterans Choice Program in November 2014. VA has purchased care from non-VA community providers through its care in the community programs since as early as 1945. VHA has numerous programs, including the Veterans Choice Program, through which it purchases VA care in the community services.

Management of resources for current and future years
VA faces challenges regarding the reliability, transparency, and consistency of its budget estimates for medical services, as well as weaknesses in tracking obligations for medical services and estimating budgetary needs for future years.

These challenges were evident in June 2015, when VA requested additional funds from Congress because of a projected funding gap in fiscal year 2015 of about $3 billion for medical services. The projected funding gap was largely due to administrative weaknesses that resulted in lower-than-expected utilization of the Veterans Choice Program in fiscal year 2015, and higher-than-expected demand for previously-established VA community care programs.

To address the projected funding gap in fiscal year 2015, the VA Budget and Choice Improvement Act provided VA temporary authority to use up to $3.3 billion from the Veterans Choice Program appropriation for obligations incurred for other specified medical services. VA officials anticipated requesting an additional increase in funding for health care services in the budget request for fiscal year 2018.  

Coordination of health care services to ensure quality and safety
While timely and cost-effective access to needed health care services is essential, care coordination between VA and community providers, and between VA and the Department of Defense (for transitioning servicemembers), is also critical to ensure the quality and safety of veterans health care.

  • Coordination with community providers. With the increased use of community providers, veterans have to navigate multiple complex health care systems to obtain needed health care services. Their quality of care may be adversely affected if VA and community providers do not promptly communicate important clinical information.
  • Coordination with the Department of Defense. Servicemembers transitioning from Department of Defense to VA health care may experience a disruption in the continuity of their prescription medication. For example, VA providers may inappropriately discontinue or change mental health medications for transitioning servicemembers because the Department of Defense and VA formularies are different and VA's related policy is unclear. Specifically, VHA's policy to ensure the continuation of mental health medications lacks clarity on the types of medications considered mental health medications, and, as a result, VHA providers may be inappropriately changing or discontinuing mental health medications due to formulary differences, potentially increasing the risk for adverse health effects.
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2015 High Risk Overview From the Comptroller General


2015 Update to GAO's High Risk ListWednesday, February 11, 2015
Health Care for Women VeteransFriday, December 2, 2016
Veterans Crisis Line ProblemsMonday, June 27, 2016
VA Mental Health Access and Wait TimesWednesday, October 28, 2015