Audit of VHA’s Efforts To Improve Veterans’ Access to Outpatient Psychiatrists

OIG conducted this audit to evaluate VHA’s efforts to improve veterans’ access to outpatient psychiatrists. OIG determined that VHA has not been fully effective in its use of hiring opportunities or its use of existing personnel to improve veterans’ access to psychiatrists. From FY 2012 through FY 2014, VHA increased outpatient psychiatrist full time equivalents (FTEs) by almost 15 percent. During that time, the number of veterans’ outpatient encounters with psychiatrists increased by about 10 percent, and the number of individual veterans who received outpatient care from a psychiatrist increased about 9 percent. OIG found that VHA did not have an effective method for establishing psychiatrist staffing needs. Throughout recent hiring initiatives, VHA did not stress a specific need for psychiatrists; instead, facilities determined their own staffing needs. This resulted in 94 of 140 health care facilities that needed additional psychiatrist FTEs to meet demand, as of December 2014. In addition, OIG found that VHA did not ensure facilities used consistent and effective clinic management practices. Because of this, OIG determined that VHA facilities could have better used about 25 percent of psychiatrist FTE clinical time to see veterans in FY 2014, which equated to nearly $113.5 million in psychiatrists’ pay. Over the next 5 years, this would equate to over $567 million if VHA does not strengthen clinic management now. OIG recommended the USH ensure facilities incorporate the Office of Mental Health Operations staffing model to determine the appropriate number of psychiatrists needed, and attain appropriate staffing levels or identify alternative options. OIG also recommended the USH develop clinic management business rules, reassess the appropriateness of VHA’s productivity target for psychiatrists, and develop a mechanism to monitor the variance in which psychiatrists code encounters. The USH concurred with OIG’s findings and recommendations and plans to complete all corrective actions by September 2016.