VISN 12 Needs to Improve How It Administers the Veterans Community Care Program

This review examines whether medical facilities in VISN 12 (the VA Great Lakes Health Care System covering parts of Illinois, Indiana, Michigan, and Wisconsin) correctly identified veterans eligible for community care, informed them of their care options, and delivered timely care.

The OIG found that during the first quarter of fiscal year 2024, VISN 12 did not consistently offer veterans required information about care options for direct VA or community care. Schedulers also did not always accurately determine a veteran’s eligibility for community care, inform veterans of their eligibility, or correctly process requests for care and appointments. These deficiencies occurred primarily because schedulers lacked the means to identify all available appointments within or outside VISN 12. Another factor was uneven VHA guidance, requiring schedulers to check all eligibility criteria for new patients but only wait times for established patients.

VISN 12 did not reliably provide timely care to veterans during the review period. From scheduling to appointment took on average 44 days for community care (the goal is 30 days) and 35 days for care within VA (with goals of 20 or 28 days depending on the type of care). VISN 12 also had about 250 consults, including both types of care, that had not been completed for a year. These delays risked some veterans not receiving care when needed.

The VISN 12 director concurred with the OIG’s four recommendations to improve the community care program. The OIG is also conducting two national follow-up reviews: the first examines how VISNs determine eligibility and inform veterans of care options and the second compares the timeliness of care received at VA with community care. Because these national audits will include recommendations beyond VISN 12, no national recommendations related to these concerns are offered in this report.