Five years after the Department of Veterans Affairs was rocked by a scandal over appointment delays linked to veterans' deaths, it still struggles with scheduling issues and tracking wait times, a government oversight official told Congress.

During a hearing July 24 before the House Veterans Affairs Committee, Debra Draper, health care director at the Government Accountability Office (GAO), said that, while the VA has "taken action to ensure its facilities provide timely access to medical care," it must do more.

Draper said the VA has made progress since the GAO first warned in 2012 of shortcomings in its appointment scheduling and tracking system, as well as lengthy delays in patient care. But she added that the VA's data on wait times remains unreliable and appointment delays continue to be long.

"At this time, we continue to be concerned that VA has not sufficiently addressed the reliability of its wait time data," Draper said. "For example, we have found that VA's wait times do not capture the time it takes the department to enroll veterans in VA health care benefits, which we found could be quite lengthy."

The issue is not restricted to appointments at VA health facilities, she said, adding that wait time data for the VA Choice program, a community care program that let veterans seek care at a private facility, was incomplete or inaccurate. VA Choice has been replaced by the Mission Act, which consolidated all VA programs for community care.

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"Since implementing our recommendation, VA has taken a number of actions. One is by annual audits of schedulers -- and the most recent, in 2018, they audited about 667,000 appointments, and they found the 8 percent error rate, so that affected about 53,000 appointments," Draper said. "There is improvement. [But] there's more work to be done, definitely."

In a separate report released July 24, the GAO found that since the VA's tracking system captures only part of the appointment scheduling process, the department may show it is meeting its average wait time goal of 30 days. But when considering all factors, veterans potentially are waiting up to 70 days for an appointment.

Speaking at the hearing, Teresa Boyd, Veterans Health Administration assistant deputy secretary for clinical operations, acknowledged that the VA still has challenges but added it also has "undergone tremendous transformation" since 2014.

Boyd said that, for established patients, the VA's average wait times for primary care and mental health are less than five days, and seven days for specialty care.

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"We recognize that there are still challenges ahead of us, but it is important to keep in mind that veterans continue to receive the highest quality care, often with shorter wait times than in the private sector," she told the committee.

The GAO recommended that the VA implement its previous recommendations on improving scheduling at both VA facilities and community care programs. The VA will implement a new system to support appointment scheduling, authorizations and referrals in fiscal 2021, which VA officials have said will address some of the issues. But Draper said clear policies, oversight and effective training also are needed.

In his opening statement, committee chairman Rep. Mark Takano, D-California, cited recent media reports about ongoing private waitlists and an apparent lack of transparency on wait times within the VA and in the private sector -- obfuscation that limits a veteran's ability to choose health services, he said.

"The lack of accurate information on wait times at VA hospitals, and with community providers, should cause us all to question whether the policy to send more veterans to community care providers is sound or even if it's working," he said.

He added that the VA has an opportunity to lead the nation in crafting wait time standards and accessibility to data that allows patients to make "informed choices."

"If VA can get that right, make it simple for veterans to understand, I believe we will do not only veterans a great service, but we'll do the American people a great service by setting the standards that the private sector will have to match," he said.

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Rep. Phil Roe, R-Tennessee, the committee's ranking Republican, said he'd be remiss not to "acknowledge the many ways in which access to care for veterans has improved" since 2014, with the VA completing 1 million more appointments in 2018 than the previous year.

But, he added, there is "no doubt VA has farther still to go."

"The VA Inspector released an alarming report about delays in care for veterans seeking mental health appointments at the Albuquerque VA Medical Center. That report paints a heartbreaking picture of why we must continue to focus on access to care," he said.

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