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"Ensuring Timely Access: Challenges in VA Scheduling"

House Veterans Affairs Committee, Technology Modernization Subcommittee Hearing

September 26, 2024 (recording here)

HEARING INFORMATION

Witnesses & Written Testimony (linked):

• Ms. Hillary Peabody: Acting Assistant Under Secretary for Health for Integrated Veteran Care, U.S. Department of Veterans Affairs, Veterans Health Administration

• Mr. Mark Hausman, M.D.: Executive Director for Integrated Access, U.S. Department of Veterans Affairs, Veterans Health Administration

• Ms. Cherri Waters: Executive Director, Health Portfolio, U.S. Department of Veterans Affairs, Office of Information and Technology

Keywords mentioned:

• Appointment scheduling, Integrated Scheduling Solution (ISS), Clinical Capacity Search Tool (CCST), External Provider Scheduling (EPS), Medical Appointment Scheduling System (MASS), Centralized Scheduling Solution (CSS), provider enrollment, community care, IT modernization

IN THEIR WORDS

OPENING STATEMENTS FROM THE SUBCOMMITTEE

• Chairman Matt Rosendale opened the hearing by discussing the persisting difficulties veterans face when trying to access care through the Veterans Health Administration (VHA) or community care. He expressed concern over bureaucratic complexities and outdated IT systems that make it difficult for both veterans and VA employees to manage appointments. He praised the utility of community care, particularly in states like Montana, and criticized the VA for abandoning promising solutions like the Medical Appointment Scheduling System (MASS) in favor of inferior alternatives, such as the Oracle-Cerner Electronic Health Record (EHR) system, which he claimed has not met expectations.

• Ranking Member Sheila Cherfilus-McCormick pointed out that while much attention has been placed on the VA’s transition to Oracle-Cerner’s EHR, the need for a new appointment scheduling solution is just as critical. She explained that the current scheduling system adds unnecessary delays to veterans' access to care. She also criticized the VA for its decades-long failure to modernize its scheduling systems and recounted multiple failed attempts over the years. Ranking Member Cherfilus-McCormick stressed the importance of creating a system that allows for comparisons between VA and community care and urged the VA to provide veterans with timely and high-quality care.

SUMMARY OF KEY POINTS

• Ms. Cherri Waters described the VA's efforts to modernize its scheduling system. She mentioned the Integrated Scheduling Solution (ISS), which is being developed to replace the legacy system and streamline appointment scheduling across multiple sites of care. Ms. Waters discussed the implementation of tools like the Clinic Capacity Search Tool (CCST) and Clinic Configuration Manager (CCM), which are designed to improve scheduling efficiency and access to care. She noted the collaboration between the VHA and the Office of Information and Technology (OIT) in this modernization effort and reaffirmed the VA’s commitment to improving veterans’ access to care.

• Chairman Rosendale asked Ms. Waters how the CCST would improve the appointment scheduling process. Ms. Waters explained that the tool would allow staff to view available appointments across multiple sites in a unified manner, initially for telehealth and, starting in January 2025, for in-person appointments as well. When asked about the system's full functionality, she stated that incremental improvements are always expected, though not all features will be functional by January 2025. She added that ISS is designed to streamline the process, improve scheduler efficiency, and integrate various scheduling tools like CCST and External Provider Scheduling (EPS).

• Ranking Member Cherfilus-McCormick asked why the VA chose to develop another ISS instead of deploying the Cerner CSS, which had already been purchased. Dr. Mark Hausman explained that after evaluating CSS in 2020, the decision was made to halt its implementation due to high costs, disruptions in clinical operations, and the need to rebuild thousands of clinics. ISS, in contrast, integrates seamlessly with VISTA clinics and requires less disruption. The Ranking Member also inquired about the cost difference between ISS and CSS, which Dr. Hausman did not have on hand.

• Chairman Rosendale asked about the current process for scheduling community care appointments without WellHive. Dr. Hausman explained that it involves multiple steps, including collecting patient preferences, manually contacting providers, and coordinating appointments. Chairman Rosendale noted the complexity and inefficiency of this system, comparing it to WellHive, which reduces the scheduling time from 26 days to 17 days. Dr. Hausman confirmed that schedulers using WellHive can handle up to 25 appointments per day compared to only eight in the traditional system.

• The Ranking Member asked Ms. Waters if the VA had learned from previous IT failures and how the current approach to ISS differed. Ms. Waters again emphasized the collaborative approach between the VA and OIT, stating that they are working shoulder-to-shoulder to develop the solution incrementally. When pressed on the issue of past failures, Ms. Waters acknowledged that while she personally was not aware of all past failures, the VA team is working diligently to ensure that the ISS project avoids repeating past mistakes.

• Chairman Rosendale questioned the VA's recent decision to extend the goal for community care appointment scheduling from 7 to 14 days. Ms. Hillary Peabody acknowledged the change but clarified that the metric applies to internal scheduling timeliness, not overall wait times. She explained that the change was made to provide more realistic timelines for schedulers while stating that urgent consultations are still being scheduled within two days. The Chairman criticized the decision as counterintuitive, arguing that setting lower performance goals would not lead to improvements.

• Ranking Member Cherfilus-McCormick asked Ms. Peabody about the factors limiting provider enrollment in the EPS system. Ms. Peabody explained that the technical integration required for providers to share their appointment availability with the VA is lengthy and a significant investment for providers. She mentioned that the VA has not yet offered incentives for enrollment but is considering ways to incentivize providers based on market research. The Ranking Member also pointed out discrepancies in enrollment success, noting that South Carolina was more successful than Orlando, and Ms. Peabody acknowledged that better involvement from staff and providers played a key role in successful enrollments.

• Dr. Hausman underscored that EPS is seen as the enterprise solution for community care scheduling and that by the end of fiscal year 2025, EPS will be active in approximately one-third of VA medical centers. He projected a significant increase in provider participation and appointment bookings and noted that the VA plans to continue rolling EPS out to the rest of the enterprise in subsequent years. The Ranking Member then asked why EPS tools are being pulled from some facilities, and Dr. Hausman explained that this decision was based on the need to focus resources in areas with the highest potential for success.

• The Chairman inquired about the process for recruiting providers into EPS and confirmed that the VA was shifting its strategy from a nationwide rollout to focusing efforts in key regions. Ms. Peabody said that the new approach was designed to attract larger hospital systems and more providers in urban areas, whereas rural areas like Montana might be more challenging. Chairman Rosendale voiced his concern about relying too heavily on large providers, warning that bigger healthcare systems tend to deliver lower-quality care at higher costs. He advocated to ensure that veterans, particularly in rural areas, have access to the providers they prefer.

• Ranking Member Cherfilus-McCormick expressed concerns about the high cost of community care and the lack of an integrated scheduling solution that allows for comparisons between VA and community care access. She asked what the VA is doing to address this issue. Ms. Peabody explained that her office is working on ensuring veterans receive high-value care, both from the VA and community providers. This includes a focus on building a high-performing provider network and enhancing utilization management.

• Chairman Rosendale questioned why the VA was planning to shut down WellHive in certain facilities when the system had proven effective in reducing scheduling times. Dr. Hausman explained that the decision was based on the inability to fully utilize the system due to a lack of community care providers participating in certain areas. Chairman Rosendale disapproved of shutting down WellHive in places like Hudson Valley, which had many participating providers, as it could send a negative message to providers and make future recruitment efforts more difficult. Dr. Hausman acknowledged the potential for frustration but reiterated that the VA intends to resume the program in those areas in the future.

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