As the case for the Department of Veterans Affairs (VA) administrators being the number one problem continues, I wanted to revisit a topic that has been mentioned several times, but not been covered in-depth recently, the scheduling issues at the VA for veterans to obtain an appointment. Back in 2012, the news media went ballistic over veterans dying while waiting to be seen, due to paper wait-lists, cherry-picking veterans to be seen, and employees being encouraged to practice discrimination. I was a patient in the Phoenix VA during the first scandal, and the second scandal, and between these two scandals, nothing changed, but the medical center director.
The Department of Veterans Affairs – Office of Inspector General (VA-OIG) 02 May 2017, released a VISN wide inspection report on the topic of scheduling and VA Scheduling Wait Times. Please note the date of the report, as this is a crucial data point, five (5) years after the Phoenix VA Wait Time Scandal, an entire Veterans Integrated Service Network (VISN) was inspected for compliance with the memos and recommendations after the two VA Wait Scandals at the Carl T. Hayden VA Medical Center, Phoenix, AZ. The results of this inspection are staggering, detestable, and the practice remains unchanged in VISN 22 which includes the Carl T. Hayden VAMC.
VISN 6 was selected for the inspection, and includes the following VAMC’s:
- Charles George VAMC (Asheville, NC)
- Charlotte Health Care Center (Charlotte, NC)
- Durham VAMC (Durham, NC)
- Fayetteville Health Care Center (Fayetteville, NC)
- Fayetteville VAMC (Fayetteville, NC)
- Greenville Health Care Center (Greenville, NC)
- Hampton VAMC (Hampton, VA)
- Hunter Holmes McGuire VAMC (Richmond, VA)
- Kernersville Health Care Center (Kernersville, NC)
- Salem VAMC (Salem, VA)
- G. (Bill) Hefner VAMC (Salisbury, NC)
- Wilmington Health Care Center (Wilmington, NC)
The VA-OIG claims they interviewed more than 300 staff and referred 84 patients from the sample to the VA-OIG’s Office of Healthcare Inspections (OHI) for review “We referred the medical records for these veterans to OHI to determine whether inappropriate or untimely care resulted in any harm to the veteran.” Please keep the following in mind, the findings are reported across the entire VISN, not just one single VAMC or care center.
Finding 1: “… 36 percent of the appointments for new patients at facilities within VISN 6 during the relevant time period had wait times longer than 30 days. We estimated that the average wait time for this 36 percent was 59 days. These numbers are significantly higher than the wait time data that VHA’s electronic scheduling system showed.” The result, “The inaccurate wait time data resulted in a significant number of veterans not being eligible for treatment through Choice.”
Finding 2: The “veterans in VISN 6 who received their care through Choice, our audit estimated that 82 percent of the appointments had wait times longer than 30 days. We estimated that the average wait time for those who received their care through Choice was 84 days.”
Finding 3: “For veterans who did not receive care through Choice within 30 days, they waited an average of 98 days to receive their care, which ranged in our sample from 31 to 389 days.”
Finding 4: “VISN 6 Medical Facilities Did Not Consistently Provide Timely Access to Health Care Needs for New Patient Appointments and Did Not Have Accurate Wait Time Data.” This is the section header for a finding so egregious, heads should have rolled. Understand the basis for scheduling appointments, “We used 30 days from a veteran’s supported preferred appointment date, a referring provider’s clinically indicated date, or the appointment “create date” to determine whether an appointment was timely.”
“The VA-OIG statistical sample of 618 new patient appointments completed at VISN 6 medical facilities in the first quarter of FY 2016. We reviewed these appointments to determine whether medical facilities provided timely access for new patient appointments, as well as to assess the accuracy of VISN 6 wait time data. Based on this review, we estimated about 20,600 of 57,000 appointments (36 percent) had wait times greater than 30 days. For those 20,600 appointments, we estimated veterans waited an average of 59 days. This was notably higher than the 5,500 appointments (10 percent) that VHA’s electronic scheduling system showed were scheduled greater than 30 days” [emphasis mine].
Is the problem clear, the VA is cooking their own books to reflect lower numbers of appointments waiting to be seen, than they are willing to admit? Hence, can any statistical data reported from the VA be trusted for veracity? Here’s the rub, VISN 22, has the exact same problem in both Phoenix and the Albuquerque VAMC’s. I know this from being an employee and listening to the appointment schedulers discuss how they “schedule” appointments. I know from experiencing being cherry-picked, e.g., being told the provider needs to see me within 72-hours of a visit to the Emergency Room, but not being able to be scheduled, and placed on a waiting list or the best excuse I have been told, “I double book the appointments to ensure we keep the provider busy all day.”
I understand there is a provider shortage; but how much of that shortage is being exacerbated by the policies and procedures of the administration, the leadership of the VA? Will someone please explain to me, how the pernicious veteran killing scandal of wait lists is still being allowed, fed, and supported by the VISN leadership across the entire country?
Finding 5: The VA-OIG broke down 57,000 appointments, per the policies and directives governing scheduling appointments and found:
- Of 10,700 primary care appointments, 3,500 (33 percent) had wait times greater than 30 days, with an average wait time of 51 days for those 3,500 appointments. This compared to an estimated 1,900 of 10,700 primary care appointments (17 percent) VHA’s electronic scheduling system showed were scheduled greater than 30 days.
- Of 4,800 mental health care appointments, 780 (16 percent) had wait times greater than 30 days with an average wait time of 59 days for those 780 appointments. This compared to an estimated 260 of 4,800 mental health care appointments (5 percent) VHA’s electronic scheduling system showed were scheduled greater than 30 days.
- Of 41,500 specialty care appointments, 16,300 (39 percent) had wait times greater than 30 days with an average wait time of 60 days for those 16,300 appointments. This compared to an estimated 3,400 of 41,500 specialty care appointments (8 percent) VHA’s electronic scheduling system showed were scheduled greater than 30 days.
- We found that VISN 6 did not capture accurate wait time data primarily because medical facility staff did not consistently enter correct clinically indicated or supported preferred appointment dates when scheduling new patient appointments. Requiring schedulers to document those occasions where a veteran has a preferred appointment date is an internal control that mitigates the opportunities for schedulers to routinely and inappropriately designate all scheduled appointments as preferred appointment dates in order to show substantially reduced wait times.
- Of the estimated 20,600 appointments with wait times greater than 30 days, staff entered incorrect clinically indicated or unsupported preferred appointment dates for 15,300 appointments (74 percent) that made it appear as though the wait time was 30 days or less” [emphasis mine].
- Root Cause analysis showed, “Because the medical facility did not consistently enter correct clinically indicated or supported preferred appointment dates when scheduling appointments, we estimated staff did not identify about 13,800 of these 15,3004 appointments (90 percent) where veterans should have been added to the Veterans Choice List (VCL)” [emphasis mine].
The administration did not “consistently conduct scheduler audits, which have been required since January 2008.” Memos, policies, guidelines, procedures, none of these are making any difference as the VISN and VAMC leadership simply refuse to do their jobs! Where were the politicians from 2000 to 2010 when the policies and guidelines were changed to protect veterans from scheduling abuse and improve access to the VA/Choice? Will someone please ask Speaker Pelosi where she has been as minority and majority speaker of the house since 2000 on protecting veterans from abuses at the hands of the VA! Will someone grab speakers Boehner and Ryan and demand they return some of their “Titanium Parachutes” because they actively refused to protect veterans from abuse by the VA! If this is the “VA Healthcare Defining Excellence in the 21st Century,” I would hate to see how the VA defines failure and ineptitude!
I have said this before and beg your forbearance as I repeat myself for emphasis. VISN 22, and the Albuquerque and Phoenix VAMC’s are but one dead veteran from another major scandal for the Department of Veterans Affairs. The administrators will be the 100% responsible, but they will weasel out of accountability, all because of designed incompetence. I am sick of this abuse towards myself, and any veteran, it is shameful, detestable, and reprehensible. There are no acceptable excuses for these managerial failures! There are no justifiable reasons to have schedulers acting in this manner and not being held accountable by supervisors, who are directly held accountable to directors, who have to report to VISN leaders for accountability. The leadership has failed the veteran and deserves full and complete replacement, as soon as possible!
I believe in the little rocks that start landslides. I know the power of tiny snowflakes that create an avalanche. I know that if enough veterans, their families, friends, and communities rise up, the elected politicians responsible for scrutinizing the government will be forced to make veteran safety and health at the VA a priority and blessed change will finally arrive in the VA Administration and administrators. Imagine how you would feel to learn a close friend or family member died waiting for treatment at the VA. Please respond accordingly!
© 2021 M. Dave Salisbury
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