The Department of Veterans Affairs is opening new community outpatient clinics with the aim of serving existing patients rather than trying to expand its market share, according to a congressional watchdog agency.
The report from the General Accounting Office was much more complimentary of the VA's process for opening and operating community-based outpatient clinics than was a 1996 GAO report.
Before that report, the GAO said, the VA had not made clear its policies about whom the new clinics should serve. As a result, the new VA clinics were threatening to steal patients from private providers by luring them to the clinics and signing them up for VA primary-care plans, the GAO charged.
The report congratulating the VA for keeping an eye on its main customers comes at a time when one veterans organization is calling on the VA to open up its inpatient hospitals to family and dependents of military veterans (See story, p. 40).
The VA since has clarified its instructions to its 22 network directors to say that new clinics should be established to provide convenient access for existing patients who live more than 30 minutes from a VA clinic.
The VA has approved 198 clinics, and its networks plan on opening 402 additional facilities between now and 2002. Of the 178 approved since October 1996, 104 will be operated by the VA and 74 will be operated under contract.
Despite the VA's instructions to clinics about drawing new patients, the GAO's report said at least 13.6% of the veterans to be served at those 178 clinics will be new VA patients.
Although the report includes many accolades, it also criticizes the VA for not addressing how it will use its clinics to equalize differences in access. The GAO is concerned about veterans who have the same disability status but have inequitable access to healthcare facilities because of where they live.
Because of limited resources, the VA should focus on using the authority to open clinics as a way to make sure that a roughly equivalent percentage of current VA patients live within a 30-minute drive of a clinic, the GAO said.
The GAO recommended the VA set a national goal that by 2002 the clinics would be located in places where the highest percentage of veterans live within 30 minutes of the facilities.
It also recommended that networks, in developing business plans for new clinics, should indicate what percentage of patients would meet that 30-minute standard in 2002 because of the new clinics.