GAO: VA Should Improve Behavioral Health Medical Record Exchange Oversight

A Government Accountability Office (GAO) report to congressional committees found gaps in oversight of data exchange when veterans are referred outside the Department of Veterans Affairs (VA) for behavioral healthcare. 

The May 2025 report noted that veterans used more than 350,000 referrals to receive behavioral health services (e.g., psychotherapy for depression) from community providers in fiscal years 2021 through 2023. "Many veterans who were cared for by community providers later returned to VA medical centers for further care. To coordinate this care, community providers must send medical documentation (e.g., diagnoses, prescriptions, progress notes) to VA after the veteran’s initial and final visits for each referral,” the GAO said. 

The VA’s Office of Inspector General reported in 2024 that VA providers have raised concerns that the inability with or delay in obtaining medical documentation from community providers contributes to inefficient patient care and can negatively affect patient outcomes. The GAO report included summaries of VHA officials explaining why this care coordination is important, especially when a veteran receives care from a community provider and then returns to the VA medical center to continue receiving appropriate care from a VA provider. “For example, a veteran may experience changes to their diagnoses or may have positive or negative experiences with certain treatments while under a community provider’s care, which can last months or longer. Having this information can help the veteran’s VA provider determine whether the veteran should continue treatment that appears to be going well or avoid duplicating a previously attempted treatment that was deemed ineffective.”

The report added that the VA does not monitor whether these medical record exchanges are completed across all medical centers. But it found that 33 percent of these referrals were missing records for initial visits when it reviewed the data that VA has readily available. “Further, no such data are available for final visits, so the extent to which those exchanges are completed is unknown.”

GAO also noted that VA is not monitoring the extent to which community providers complete any of eight core trainings on opioid safety, suicide prevention, and other veteran-centric topics. “We found that about 2 percent of the community providers with a behavioral health referral from fiscal years 2021 through 2023 had completed one or more of these trainings.”

GAO made five recommendations to VA, including for it to establish goals and performance measures and monitor the extent to which medical documentation exchanges and core community provider trainings have been completed.

VA concurred with one recommendation and concurred in principle with the other four recommendations, as discussed in the report.