[Federal Register Volume 87, Number 141 (Monday, July 25, 2022)]
[Notices]
[Pages 44191-44192]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2022-15790]


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DEPARTMENT OF VETERANS AFFAIRS


Calculation of Average Wait Time for New and Established Patients

AGENCY: Department of Veterans Affairs.

ACTION: Notice and request for comment.

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SUMMARY: Providing veterans with meaningful information to make 
informed decisions about their health care is a top priority for the 
Department of Veterans Affairs (VA). VA has published average wait 
times for primary care, mental health, and specialty care appointments 
at each of its medical centers since 2014. Since that time, VA has 
received feedback from veterans, caregivers, veterans service 
organizations, oversight authorities, and Congress, which led VA to 
revise the wait time metrics presented on the Access to Care website to 
better reflect veterans' experience. This notice describes this revised 
methodology. Additionally, VA is requesting public comment on the 
revised wait time metrics presented on the Access to Care website.

DATES: Comments must be received on or before 60 days after date of 
publication in the Federal Register.

ADDRESSES: Comments may be submitted through www.Regulations.gov. 
Comments received will be available at regulations.gov for public 
viewing, inspection, or copies.

FOR FURTHER INFORMATION CONTACT: Joseph Duran, Director, Policy and 
Planning, Office of Integrated Veteran Care (OIVC), Veterans Health 
Administration, Department of Veterans Affairs, 810 Vermont Avenue NW, 
Washington, DC 20420. [email protected] or 303-370-1637 (This 
is not a toll-free number).

SUPPLEMENTARY INFORMATION: Section 206 of the Veterans Access, Choice, 
and Accountability Act of 2014 (Pub. L. 113-146) requires the 
Department of Veterans Affairs (VA) to publish in the Federal Register, 
and on a publicly accessible internet website of each medical center of 
the Department, the wait-times for the scheduling of an

[[Page 44192]]

appointment in each Department facility by a veteran for the receipt of 
primary care, specialty care, and hospital care and medical services 
based on the general severity of the condition of the veteran. Whenever 
the wait-times for the scheduling of such an appointment changes, VA is 
required to publish the revised wait-times on a publicly accessible 
internet website of each VA medical center by not later than 30 days 
after such change and in the Federal Register by not later than 90 days 
after such change. This notice announces VA's updates to the definition 
and calculation methodology for average wait times and publication of 
information on the use of Third Next Available Appointment (TNAA) for 
those VA medical centers that have implemented the new electronic 
health record.
    To further improve user experience, VA has also upgraded the way 
average wait times are calculated and displayed on the website. 
Importantly, average wait times are never used to determine a veteran's 
eligibility for community care, and none of the changes on the website, 
as explained in this notice, affect a veteran's eligibility for 
community care. Rather, the average wait times that VA displays on its 
website represents a guide that can assist veterans in making informed 
health care decisions.
    Average wait times for all VA medical centers and clinics (except 
those that have transitioned to VA's new Electronic Health Record 
(EHR)) are now calculated to include additional steps in the 
appointment process that had not been captured in the past. As of the 
date of the publication of this notice, the VA medical centers and 
clinics that have adopted the new EHR include: Spokane, WA; Walla 
Walla, WA; Columbus, OH and White City, OR. Averages are representative 
of general performance and may not represent individual experience, but 
the upgraded calculation makes the average wait times that VA displays 
on its website more reflective of the complete process of requesting 
and receiving care.
    For purposes of the discussion below, veterans are considered new 
patients if they have not been seen by a provider or a clinical service 
at the same medical center for the same, or a related, health care need 
in the past three years. If they had an appointment in a clinical 
service at the same medical center for the same or similar health care 
need in the past three years (either in person or via phone/video), 
they are considered an established patient.
    The revised calculation includes the following changes:
     For new patient appointments, the average wait time is 
calculated from the earliest recorded date in the scheduling system, to 
the date the appointment is completed, or the date it is scheduled to 
occur if it is not yet completed.
    [cir] For example in many cases, veterans who need a new type of 
care will have a referral entered by their provider into the medical 
record during a visit, and this starts the care coordination process. 
For appointments with a referral, this referral date is the starting 
point used for measuring average wait times, and the end point is the 
date care is received or the date it is scheduled to occur if not yet 
completed.
    [cir] For appointments without a referral, the average wait time 
starts with the earliest recorded date in the process of receiving 
care, typically the date a scheduler works with a veteran to coordinate 
a future appointment, and it ends on the date care is received or the 
date it is scheduled to occur if not yet completed.
     For established patient appointments, average wait times 
are measured from the date agreed upon between a veteran and provider 
for future care and ends on the date care is received, or the date that 
care is scheduled to occur if it has not yet occurred.
    VA sites that have implemented the new EHR will display information 
known as Third Next Available Appointment (TNAA).\1\ Other major health 
systems also use this measure, and it reflects availability for 
upcoming appointments so veterans can anticipate what their experience 
will be when they request care.
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    \1\ Brar, Sumeet & Hopkins, Michael & Margolius, David. (2019). 
Time to Next Available Appointment as an Access to Care Metric. The 
Joint Commission Journal on Quality and Patient Safety. 45. 10.1016/
j.jcjq.2019.07.007.
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    TNAA is a measure of appointment availability that displays the 
number of days between today's date and the date of the third-next 
appointment available in VA's scheduling system. The technology in our 
new EHR system allows us to use this more modern, industry standard 
measure at these sites. This measure is considered a more accurate 
measure of elective service availability than the next available 
appointment or second-next available appointment.
    VA is transitioning to use of TNAA for several reasons, including 
that this measure informs veterans of their likely experience when 
seeking care. This will also ensure consistency in measuring 
appointment availability across VA medical centers as the enterprise 
transitions to a new EHR.

    Note: As described above, averages that reflect a small number 
of appointments--for example, in a geographic area where only a few 
veterans seek a certain type of subspecialty care in any given 
month--may show average wait times that are skewed high or low due 
to the small number. The best way for veterans to find out when they 
can be seen is always to contact the local facility or use the 
online ``Make an Appointment'' button on www.accesstocare.va.gov.

Signing Authority

    Denis McDonough, Secretary of Veterans Affairs, approved this 
document on July 19, 2022, and authorized the undersigned to sign and 
submit the document to the Office of the Federal Register for 
publication electronically as an official document of the Department of 
Veterans Affairs.

Jeffrey M. Martin,
Assistant Director, Office of Regulation Policy & Management, Office of 
General Counsel, Department of Veterans Affairs.
[FR Doc. 2022-15790 Filed 7-22-22; 8:45 am]
BILLING CODE 8320-01-P