Notice2022-15790
Calculation of Average Wait Time for New and Established Patients
Primary source
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Published
July 25, 2022
Issuing agencies
Veterans Affairs Department
Abstract
Providing veterans with meaningful information to make informed decisions about their health care is a top priority for the Department of Veterans Affairs (VA). VA has published average wait times for primary care, mental health, and specialty care appointments at each of its medical centers since 2014. Since that time, VA has received feedback from veterans, caregivers, veterans service organizations, oversight authorities, and Congress, which led VA to revise the wait time metrics presented on the Access to Care website to better reflect veterans' experience. This notice describes this revised methodology. Additionally, VA is requesting public comment on the revised wait time metrics presented on the Access to Care website.
Full Text
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<title>Federal Register, Volume 87 Issue 141 (Monday, July 25, 2022)</title>
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[Federal Register Volume 87, Number 141 (Monday, July 25, 2022)]
[Notices]
[Pages 44191-44192]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2022-15790]
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DEPARTMENT OF VETERANS AFFAIRS
Calculation of Average Wait Time for New and Established Patients
AGENCY: Department of Veterans Affairs.
ACTION: Notice and request for comment.
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SUMMARY: Providing veterans with meaningful information to make
informed decisions about their health care is a top priority for the
Department of Veterans Affairs (VA). VA has published average wait
times for primary care, mental health, and specialty care appointments
at each of its medical centers since 2014. Since that time, VA has
received feedback from veterans, caregivers, veterans service
organizations, oversight authorities, and Congress, which led VA to
revise the wait time metrics presented on the Access to Care website to
better reflect veterans' experience. This notice describes this revised
methodology. Additionally, VA is requesting public comment on the
revised wait time metrics presented on the Access to Care website.
DATES: Comments must be received on or before 60 days after date of
publication in the Federal Register.
ADDRESSES: Comments may be submitted through <a href="http://www.Regulations.gov">www.Regulations.gov</a>.
Comments received will be available at <a href="http://regulations.gov">regulations.gov</a> for public
viewing, inspection, or copies.
FOR FURTHER INFORMATION CONTACT: Joseph Duran, Director, Policy and
Planning, Office of Integrated Veteran Care (OIVC), Veterans Health
Administration, Department of Veterans Affairs, 810 Vermont Avenue NW,
Washington, DC 20420. <a href="/cdn-cgi/l/email-protection#cb9d838afafd829d888aa8a8aeb8b88aa8bfa2a4a58bbdaae5aca4bd"><span class="__cf_email__" data-cfemail="8cdac4cdbdbac5dacfcdefefe9ffffcdeff8e5e3e2ccfaeda2ebe3fa">[email protected]</span></a> or 303-370-1637 (This
is not a toll-free number).
SUPPLEMENTARY INFORMATION: Section 206 of the Veterans Access, Choice,
and Accountability Act of 2014 (Pub. L. 113-146) requires the
Department of Veterans Affairs (VA) to publish in the Federal Register,
and on a publicly accessible internet website of each medical center of
the Department, the wait-times for the scheduling of an
[[Page 44192]]
appointment in each Department facility by a veteran for the receipt of
primary care, specialty care, and hospital care and medical services
based on the general severity of the condition of the veteran. Whenever
the wait-times for the scheduling of such an appointment changes, VA is
required to publish the revised wait-times on a publicly accessible
internet website of each VA medical center by not later than 30 days
after such change and in the Federal Register by not later than 90 days
after such change. This notice announces VA's updates to the definition
and calculation methodology for average wait times and publication of
information on the use of Third Next Available Appointment (TNAA) for
those VA medical centers that have implemented the new electronic
health record.
To further improve user experience, VA has also upgraded the way
average wait times are calculated and displayed on the website.
Importantly, average wait times are never used to determine a veteran's
eligibility for community care, and none of the changes on the website,
as explained in this notice, affect a veteran's eligibility for
community care. Rather, the average wait times that VA displays on its
website represents a guide that can assist veterans in making informed
health care decisions.
Average wait times for all VA medical centers and clinics (except
those that have transitioned to VA's new Electronic Health Record
(EHR)) are now calculated to include additional steps in the
appointment process that had not been captured in the past. As of the
date of the publication of this notice, the VA medical centers and
clinics that have adopted the new EHR include: Spokane, WA; Walla
Walla, WA; Columbus, OH and White City, OR. Averages are representative
of general performance and may not represent individual experience, but
the upgraded calculation makes the average wait times that VA displays
on its website more reflective of the complete process of requesting
and receiving care.
For purposes of the discussion below, veterans are considered new
patients if they have not been seen by a provider or a clinical service
at the same medical center for the same, or a related, health care need
in the past three years. If they had an appointment in a clinical
service at the same medical center for the same or similar health care
need in the past three years (either in person or via phone/video),
they are considered an established patient.
The revised calculation includes the following changes:
<bullet> For new patient appointments, the average wait time is
calculated from the earliest recorded date in the scheduling system, to
the date the appointment is completed, or the date it is scheduled to
occur if it is not yet completed.
[cir] For example in many cases, veterans who need a new type of
care will have a referral entered by their provider into the medical
record during a visit, and this starts the care coordination process.
For appointments with a referral, this referral date is the starting
point used for measuring average wait times, and the end point is the
date care is received or the date it is scheduled to occur if not yet
completed.
[cir] For appointments without a referral, the average wait time
starts with the earliest recorded date in the process of receiving
care, typically the date a scheduler works with a veteran to coordinate
a future appointment, and it ends on the date care is received or the
date it is scheduled to occur if not yet completed.
<bullet> For established patient appointments, average wait times
are measured from the date agreed upon between a veteran and provider
for future care and ends on the date care is received, or the date that
care is scheduled to occur if it has not yet occurred.
VA sites that have implemented the new EHR will display information
known as Third Next Available Appointment (TNAA).\1\ Other major health
systems also use this measure, and it reflects availability for
upcoming appointments so veterans can anticipate what their experience
will be when they request care.
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\1\ Brar, Sumeet & Hopkins, Michael & Margolius, David. (2019).
Time to Next Available Appointment as an Access to Care Metric. The
Joint Commission Journal on Quality and Patient Safety. 45. 10.1016/
j.jcjq.2019.07.007.
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TNAA is a measure of appointment availability that displays the
number of days between today's date and the date of the third-next
appointment available in VA's scheduling system. The technology in our
new EHR system allows us to use this more modern, industry standard
measure at these sites. This measure is considered a more accurate
measure of elective service availability than the next available
appointment or second-next available appointment.
VA is transitioning to use of TNAA for several reasons, including
that this measure informs veterans of their likely experience when
seeking care. This will also ensure consistency in measuring
appointment availability across VA medical centers as the enterprise
transitions to a new EHR.
Note: As described above, averages that reflect a small number
of appointments--for example, in a geographic area where only a few
veterans seek a certain type of subspecialty care in any given
month--may show average wait times that are skewed high or low due
to the small number. The best way for veterans to find out when they
can be seen is always to contact the local facility or use the
online ``Make an Appointment'' button on <a href="http://www.accesstocare.va.gov">www.accesstocare.va.gov</a>.
Signing Authority
Denis McDonough, Secretary of Veterans Affairs, approved this
document on July 19, 2022, and authorized the undersigned to sign and
submit the document to the Office of the Federal Register for
publication electronically as an official document of the Department of
Veterans Affairs.
Jeffrey M. Martin,
Assistant Director, Office of Regulation Policy & Management, Office of
General Counsel, Department of Veterans Affairs.
[FR Doc. 2022-15790 Filed 7-22-22; 8:45 am]
BILLING CODE 8320-01-P
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