The VA Office of Inspector General (OIG) assessed aspects of community care and VA direct care programs at the Montana VA Healthcare System (system) for fiscal year 2022.
Among patients who received VA primary care and VA mental health care, 98.8 and 77.5 percent, respectively, did so exclusively through VA direct care. The utilization of specialty care services through only VA direct care or only community care depended on the type of specialty care sought. Most community care referrals were requested due to patients’ associated drive times to access needed care.
The OIG found that:
• VA staff acted on most direct and community care referrals within two days.
• Approximately 65 percent of VA direct care referrals reviewed (not canceled or discontinued) had an associated appointment set within seven days, and approximately 56 percent of community care referrals reviewed had an associated appointment set within 21 days.
• VA staff completed approximately 95 and 48 percent of direct and community care referrals, respectively, within 90 days of the requested date.
• Approximately 39 percent of patients with community care referrals for primary care obtained an appointment within 20 days of the requested date, and about 64 percent of patients received an appointment for mental health care within 20 days of the requested date.
• Approximately 97 percent of all community referrals were for specialty care; 54 percent of patients received an appointment within 28 days of the requested date.
Finally, the OIG identified two potentially disqualified former VA providers associated with community care claims paid by the system.
The OIG made five recommendations to the Montana VA Healthcare System Director related to timely appointment setting, timely completion of community care appointments, consult management, appointment wait times, and utilization of eligible community care providers.
