Key Issues > Managing Risks and Improving VA Health Care
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Managing Risks and Improving VA Health Care

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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The Department of Veterans Affairs’ (VA) Veterans Health Administration (VHA) operates one of the largest health care systems in the nation, with 172 medical centers and more than 1,000 outpatient facilities. But VA also faces a growing demand for its health care services—partly due to the needs of an aging veteran population. Additionally, the total number of veterans enrolled in VA’s health care system rose from 7.9 million to over 9 million from FYs 2006 through 2017—and VHA’s budget more than doubled during that period, from $37.8 billion to $92.3 billion.

VA Health Care Issues 

GAO designated VA health care as a high-risk area in 2015 due to five areas of concern regarding VA’s ability to provide timely access to safe, high-quality health care for veterans: (1) ambiguous policies and inconsistent processes; (2) inadequate oversight and accountability; (3) IT challenges; (4) inadequate staff training; and (5) unclear resource needs and allocation priorities. In 2017, GAO reported that while VA had taken some actions to address these issues, little progress had actually been made.
Since GAO’s 2017 High-Risk Report, VA has worked to address each of these areas, but still has not made sufficient progress to address the concerns. GAO has found, for example:

  • VA medical center officials did not always document or conduct required reviews of providers in a timely manner when allegations were made against them. As a result, VA medical center officials may have lacked the information they needed to ensure that VA providers were competent to provide safe, high-quality care to veterans.
  • VA lacked complete, reliable data to systematically monitor the timeliness of veterans’ access to care through the Veterans Choice Program. For example, veterans that were referred to this program for routine care could potentially wait up to 70 calendar days for care (as allowed by VA’s policies), rather than the 30 days required by law.
  • VA’s data on employee misconduct and disciplinary actions were unreliable and could not be accurately analyzed. VA also did not consistently ensure that allegations of misconduct involving senior officials were reviewed according to VA’s investigative standards, or ensure that these officials were held accountable.
  • VA’s suicide prevention media outreach activities declined in recent years due to leadership turnover and reorganization. Additionally, VHA did not assign key leadership responsibilities or establish clear lines of reporting for its suicide prevention media outreach campaign, which hindered its ability to oversee the campaign. As a result, VA may not be maximizing its reach with suicide media content to veterans, especially those who are at risk.

VA needs to further develop its capacity building initiatives and establish metrics to monitor and measure its progress in addressing high-risk areas of concern. Further, VA needs to continue to implement the health care recommendations GAO has made. As of December 2018, more than 125 recommendations remain open, including 17 older than 3 years.

Looking for our recommendations? Click on any report to find each associated recommendation and its current implementation status.