VA should track canceled appointments more closely, watchdog days

The Department of Veterans Affairs should examine cancellations by type of care and examine if follow-up efforts are effective, according to the Office of Inspector General.

The Department of Veterans Affairs is making progress in following up on appointments that were canceled in the COVID-19 pandemic, but the agency must continue reaching out to patients that have yet to be seen, according to a federal watchdog.

The VA’s Office of Inspector General issued a report Nov. 3 outlining areas of improvement in following up canceled appointments. The VA should look more closely at following up canceled appointments for preventive care, the inspector general said.

The office examined the department’s handling of canceled appointments from January through July 2021.

The inspector general found that the Veterans Health Administration had evidence on following up on 87% of the canceled appointments (7.6 million out of 8.7 million canceled appointments). That represents an improvement over an earlier report, which found that the VHA needed to follow up on about 32% of canceled appointments in 2020.

Nonetheless, the inspector general’s office report stated, “VHA’s monitoring of canceled appointments has weaknesses that could lead to lack of follow-up and patients not receiving necessary care.”

While VHA met the target of circling back on at least 80% of appointments that were canceled, the inspector general said the agency should work to follow up on the 1.1 million appointments.

The inspector general’s office also suggested the VHA should improve its monitoring of activities after appointments are canceled, including taking a closer look at the types of care involved in those appointments. The VHA should also look at canceled appointments on a monthly basis to identify trends, as well as reviewing cancellations at individual facilities to see if some need to improve.

More than one-third of the types of care (92 of 243) had a follow-up rate of less than 80%, the inspector general’s office found. And all facilities had at least one type of care with a follow-up rate of less than 80%.

The inspector general cited the importance of following up canceled appointments by the type of care, pointing to a VA-funded study that found that “disruptions due to the COVID-19 pandemic have led to substantial reductions in new cancers being diagnosed.”

Some canceled appointments for preventive or diagnostic care had follow-up rates of under 80%, including mammograms (64% follow-up rate), ultrasound (70%) and women’s preventive care (75%).

Some VA facilities also didn’t fare as well as others when it came to checking in on patients who had canceled appointments. The VA looked at facilities and examined how many types of care had a follow-up rate of under 80% for canceled appointments.

Some facilities had dozens of types of care where the follow-up rate fell short of 80%. Ten facilities had at least 55 types of care with a follow-up rate of under 80%.

In addition, seven facilities had a follow-up rate below 80% for two consecutive months.

The VHA uses several criteria to determine if canceled appointments need follow-up, but the agency hasn’t reviewed those activities to see if they are working, the report stated.

“VHA can better ensure that all patients receive necessary care after appointments are canceled by adding metrics to specifically monitor by types of care and by monthly facility performance,” the inspector general said in the report.

The inspector general recommended that the VA more closely watch followup rates at individual facilities, examine the type of care involved in canceled appointments, and track on a monthly basis.

The VHA concurred with the inspector general’s recommendations, and the inspector general indicated it would continue to assess if the agency is making progress.