What are the Predictors of Wait Times for Veterans Seeking Care in the VA and the Community through VA‐Purchased Care?

Abstract

Research ObjectiveThe Veterans Choice Program (VCP) was passed in August 2014 in direct response to the VA wait time crisis of that year. It expanded the availability of community care (CC) by allowing VA enrollees who have to wait longer than 30 days or live more than 40 miles from a VA clinic to use community providers paid for by VA. While a few studies have evaluated whether VCP improved access to care, little attention has focused on whether VCP differentially affects Veteran subgroups that have historically experienced greater barriers to care (eg, rural Veterans, non‐white Veterans). To examine this, we compared wait times in CC and VA for the five most commonly authorized outpatient specialty services in CC (cardiology, physical therapy, optometry, ophthalmology, and dental) among Veterans since the inception of VCP.Study DesignRetrospective observational study conducted from Fiscal Year (FY) 2015 to FY18 (10/1/14‐9/31/18) using data from the VA’s Corporate Data Warehouse. Our outcome variable was “wait time,” defined as days from consult request to consult completion date. Independent variables included setting of care (VA vs CC), rural/urban status, demographic characteristics (eg, race), and comorbidities. Bivariate and multivariate analyses were used to determine predictors of mean wait times and to assess the probability of waiting >45 days for care.Population StudiedAll Veterans receiving >1 of selected outpatient services in VA and/or CC during the study time period.Principal FindingsIn FY15, black Veterans’ mean wait times were consistently longer than those for white Veterans (eg, mean wait times for PT services among blacks and whites were 28 and 25 days, respectively). Linear regression models, which adjusted for sociodemographic variables and comorbidities, found similar results: black race was associated with 2‐5 days longer wait times across services than white race in FY15. Wait times declined during the study period, but more so for blacks than whites. This eliminated the wait time disparity in FY18 for cardiology and optometry services but not for PT, ophthalmology, and dental (eg, in FY18, black mean wait times for PT were 28 days compared to 25 days for whites). In FY18, the percentage of blacks waiting >45 days for care remained consistently higher than for whites for PT, ophthalmology, and dental, regardless of rurality and setting of care (eg, 31% of blacks compared to 25% of whites waited >45 days for orthopedic services in rural CC). No other independent variables were meaningful predictors of wait times.ConclusionsAlthough we expected that rural Veterans would be at higher risk for delays in care compared to urban Veterans, their mean wait times were relatively comparable. Despite decreases in wait times since VCP implementation, black Veterans continued to have longer wait times than whites for most services.Implications for Policy or PracticeWhile VCP appears to have improved access to timely care for many Veterans, not all Veterans benefited equally from the policy change. Further study is needed to investigate whether the disparities we found in wait times are also present in other outcomes impacted by VCP.Primary Funding SourceDepartment of Veterans Affairs.