New productivity expectations for Department of Veterans Affairs mental health counselors requiring them to see more patients could be detrimental to the quality of care they deliver, a Government Accountability Office report warns.
The Veterans Health Administration's Readjustment Counseling Service provides care through 300 Vet Centers. In 2017, the agency changed how counselor productivity is assessed, setting expectations for the percentage of time spent with clients and the number of patient visits. For example, counselors are expected to achieve an average of 1.5 visits for each hour they provide direct services.
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However, Readjustment Counseling Service officials told the GAO in the report that they have no plans to evaluate the overall impact of the productivity goals, even though doing so is required by federal standards.
Such an evaluation would monitor the effects of the new productivity expectations and correct any problems, according to the GAO.
Established by Congress in 1979, the Vet Centers help eligible veterans who experience challenges from military-related trauma readjust to civilian life through counseling and other services.
"The vet counselors are employed directly by the VA, and many of them are veterans themselves," said Debra Draper, director of GAO's Health Care team and author of the report.
Readjustment Counseling Service officials said in the report the individual expectations are incorporated into counselors' annual performance reviews, but claimed they are not used punitively. A Vet Center director may choose to create a written plan to help a counselor meet productivity expectations within a specified time period, they added.
But several of the counselors interviewed by the GAO said there is no effective mechanism for reporting concerns about the productivity goals. Although most counselors met the requirements in fiscal 2019, some told the GAO they had to change their work practices in ways that could hurt veterans' care.
The counselors said they had to reduce the length or frequency of appointments and to hold more group counseling sessions to meet productivity requirements -- something they said may be disruptive to veterans' care. For example, counselors at one Vet Center told the GAO that, to meet productivity expectations, they spend less time with each client to fit more patients into their schedules.
The counselors also expressed concern that they might be forced to hold more group counseling sessions to help meet productivity goals. But some clients, such as younger veterans from recent conflicts, may not be clinically ready for group counseling sessions or may not have time due to busy schedules.
Without an evaluation of its productivity expectations, the Readjustment Counseling Service cannot be sure it is identifying any unintended or potentially negative effects of the expectations on counselor practices and client care, the GAO reported.
According to the VA, from fiscal 2006 to 2019 there was a 90% increase in the number of veterans receiving mental health care from the Veterans Health Administration -- more than three times the rate of increase for all VA health care services.
Draper said the increased need for mental health services is not surprising.
"It's been well documented that there has been an increased rate of suicides," she said. "And then there also has been a lot of conflicts during that period of time."
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