Patient-Reported Wait Times for VA Appointments Affect Veterans' Future Use of Primary Care

Objective: Improving access to the Veterans Affairs (VA) Health Care System is a high priority, particularly given statutory mandates of the Veterans Choice Act passed in 2014. Most VA enrollees have access to non-VA health care given 77% have at least one other source of health insurance coverage. We sought to assess whether patient-reported wait times for VA appointments were associated with veterans’ future use of primary care from VA, fee-for-service Medicare or both.

 

Methods: This was an observational study using administrative data from the VA Corporate Data Warehouse, Medicare claims data and patient-reported data from the 2012 Survey of Healthcare Experiences of Patients (SHEP) Patient Centered Medical Home Module. Primary care utilization was defined as the number of face-to-face visits with primary care providers from VA and Medicare in the 12 months following SHEP completion. Patient-reported wait time data were derived from SHEP responses measuring the usual number of days to a VA appointment for veterans seeking immediate care. We defined appointment wait times categorically: same day, 1 day, 2 to 3 days, 4 to 7 days and ≥7 days. We used negative binomial regression with VA clinic fixed effects to examine the relationship between patient-reported wait times and utilization of primary care from VA and Medicare. Regression models adjusted for patient demographics, comorbidity, subjective health status, prior health service use and non-VA health supply.

 

Results: Of the 36,396 veterans in this study, 67.8% did not require immediate care from VA. Among veterans requiring immediate care, 25.4%, 17.2%, 20.3%, 14.6% and 22.4% reported usually receiving an appointment from VA within the same day, 1 day, 2-3 days, 4-7 days and >7 days, respectively. The predicted number of annual VA primary care visits was 4.94 per patient for veterans reporting same day access to immediate VA care. Compared to veterans reporting same day access, veterans waiting 4-7 days or >7 days had 0.31 (p=0.003) or 0.61 (p<0.001) fewer VA visits annually. Differences for the 1-day and 2-3 day wait time categories were not significantly different from the same day access category. The predicted number of annual Medicare primary care visits was 0.84 per patient for veterans reporting same day access to immediate VA care. Compared to veterans with same day VA access, veterans waiting 2-3 days, 4-7 days and >7 days had 0.15 (p=0.057), 0.59 (p<0.001) and 0.66 (p<0.001) more Medicare visits annually.

Conclusion: Veterans reporting longer usual wait times for immediate VA care exhibited lower future use of VA primary care and greater future use of primary care through Medicare. Patients seeking immediate care through VA and experiencing relatively longer wait times appear to be insulated by Medicare. Clinics’ ability to provide timely access to care is important for reinforcing care continuity, which is a key element of the patient-centered medical home model. Improving care coordination between VA and non-VA providers will be important for patients who experience longer VA wait times.