According to study results published in JAMA Network Open, wait times for patients receiving care within the United States Department of Veterans Affairs (VA) health care system improved between 2014 and 2017, while access to care in the private sector remained static.
The investigators of this repeated cross-sectional study sought to compare wait times for new patients in the VA medical centers with wait times in the private sector. Public VA scheduling data were used to determine wait times for primary care, dermatology, cardiology, and orthopedics; private sector wait times were determined using Merritt Hawkins survey methods.
Patients requesting new appointments within VA medical centers were identified, and wait times were measured directly in the VA scheduling system for 2014 and 2017. Wait time data for 5 specialties in the private sector (cardiology, dermatology, family medicine, orthopedics, and OB/GYN) were collected using a secret shopper survey approach in which new-patient appointment requests were analyzed across 15 major metropolitan areas. The primary outcome measure was patient wait time; the VA and the private sector were compared for overall wait time and stratified by specialty and metropolitan area. The investigators performed a secondary analysis on the number of unique patients seen by the VA system between 2014 and 2017, as well as to determine any change in patient satisfaction scores.
In 2014, overall mean VA wait times for new appointments were statistically similar to private sector wait times (mean, 22.5±7.3 vs 18.7±7.9 days; P =.20). Across specialties and regions, VA wait times in 2014 were also similar to those in the private sector. In 2017, however, overall wait times for new appointments at the VA were significantly shorter compared with the private sector (mean, 17.7±5.9 vs 29.8±16.6 days; P <.001). This comparison held true for primary care (mean, 20±10.4 vs 40.7±35 days; P =.005), dermatology (mean, 15.6±12.2 vs 32.6±16.5 days; P <.001), and cardiology (mean, 15.3±12.6 vs 22.8±10.1 days; P =.04) specialties. Wait times for orthopedic centers were longer in the VA system than in the private sector (mean, 20.9±13.3 vs 12.4±5.5 days; P =.01) but improved significantly between 2014 and 2017; wait times for orthopedic centers in the private sector remained the same. Secondary analysis showed that among the VA system, the number of unique patients and unique appointment encounters increased between 2014 and 2017 for all specialties. Additionally, patient satisfaction scores within the VA system showed improvement over time in regards to access to specialty care, urgent care, and routine primary care.
One limitation of the study was the use of different methods for collecting wait times between the VA and the private sector. However, the investigators indicated that the Merritt Hawkins secret shopper survey method may report shorter wait times for the private sector in which the earliest available appointment was recorded as the wait time. VA data, on the other hand, may not reflect the earliest available appointment. Other limitations to the study include not including mental health wait times or a comparison of data from rural and midsized areas.
An increase in unique patients and appointment encounters as well as improvement in patient satisfaction scores further suggest that access to care within the VA has improved since 2014.
“Although this study was a comparative analysis of 30 large metropolitan regions in the United States, follow-up studies are critical to analyze access to the entirety of VA health care,” the researchers concluded.
Penn M, Bhatnagar S, Kuy S, et al. Comparison of wait times for new patients between the private sector and United States Department of Veterans Affairs Medical Centers JAMA Netw Open. 2019;2(1):e187096