Review of Perceived Barriers in Coordinating Veteran Maternity Care

To better understand the coordination of Veterans Health Administration (VHA) maternity care services for women veterans, the VA Office of Inspector General (OIG) conducted a national survey of VHA Maternity Care Coordinators’ (MCCs) reported staffing, duties, and challenges. While the OIG found that all VHA facilities had a designated MCC, the MCCs at 40 percent of VHA facilities reported having insufficient time for their duties. MCCs reported that time designated for MCC duties, patient caseloads, and collateral duties were barriers to sufficient time. MCCs who reported patient caseloads within or below the Office of Women’s Health recommended guideline were more likely to report sufficient time for care coordination duties than those who reported caseloads higher than the recommended guideline.

Timely access to maternity care was a common concern reported by facility MCCs. The OIG was concerned that 50 percent of MCCs surveyed reported challenges for scheduling routine prenatal visits within the first trimester, and more than a third (38 percent) cited difficulties expediting appointments for high-risk patients or those seeking care in later pregnancy. Barriers to timely access were primarily attributed to community maternity care provider availability and delays related to facility community care processes.

Billing was the top area for improvement in VA maternity care as identified by approximately 80 percent of the MCCs surveyed. Additionally, approximately one in five MCCs identified need for additional patient education resources, including childbirth preparation, lactation support, and parenting classes.

The OIG made two recommendations to the Under Secretary for Health regarding review of designated time, caseload, and collateral duties for MCCs to determine if additional staffing resources are needed; and facility community care referrals to ensure timely access to maternity care.