WASHINGTON — A review of a dozen Veterans Affairs medical facilities in North Carolina and Virginia identified widespread inaccuracies that vastly understated veteran wait times for appointments last year, leading the VA inspector general to conclude that VA scheduling data is still unreliable and a “high-risk” area for the agency.
The miscalculations, outlined in an inspector general report issued Thursday, masked actual demand for care and precluded veterans from getting private sector treatment, which they are supposed to be able to get if they have to wait longer than a month for a VA appointment.
The inspector general looked at primary and mental health care appointments for new patients and referrals for specialists and found that overall, 36% had to wait longer than a month for an appointment, but the VA scheduling system said only 10% had waited that long.
The report estimated that as many as 13,800 veterans should have been able to get VA-sponsored care in the private sector because of their long waits, but the VA never added them to lists authorizing them to receive outside care under the so-called Choice program.
VA staffers entered the wrong dates in the scheduling system in some cases and didn’t follow up on appointment requests in a timely way in others. In a few cases, medical center directors or other supervisory staff disagreed with national guidelines designed to ensure veterans see specialists within a time frame dictated by their referring doctor. So they just didn’t require staff to follow them.
The inspector general also reviewed records of veteran patients who were added to Choice lists and managed to get appointments outside the VA. Auditors found that 82% of them waited longer than 30 days, and on average, they waited nearly three months.
“Choice did not reduce wait times to receive necessary medical care for many veterans,” Larry Reinkemeyer, assistant inspector general for audits, wrote in the report.
The investigation is the largest on wait-time manipulation at the VA since 2014, when at least 40 veterans died waiting to be seen at the Phoenix VA while schedulers there kept secret wait lists hiding how long they were waiting. The inspector general has looked at more than 100 medical centers individually since then and found widespread problems, but the most recent investigation is the first to assess the reliability of wait-time data in an entire region, the mid-Atlantic in this case. And it identified flaws in the scheduling system still used by VA facilities nationwide.
VA Secretary David Shulkin, whom the Senate confirmed unanimously a few weeks ago, was undersecretary for health at the time of the audit, which stretched from April 2016 to last month. He said the agency has already taken action to improve wait times for the Choice program, and he disputed the findings about inaccurate wait times because he disagrees with the way the inspector general calculated them, according to his response included with the report.
“I cannot concur with some of the conclusions in this report nor use them for management decisions,” Shulkin wrote.
He said they are also based on outdated rules for scheduling appointments. Shulkin issued new rules in July.
Understating wait times
But the inspector general said that even after taking those rules into account, schedulers entered dates that understated how long veterans were waiting in nearly 60% of appointments.
“Thus even if we calculate wait times using VHA’s updated policy, which was not in effect during the scope of our audit, there were still significant inaccuracies,” Reinkemeyer wrote.
“VA data reliability continues to be a high-risk are,” he said, adding that the findings are consistent with others by the Government Accountability Office as recently as last month.
His office reviewed a sampling of more than 1,400 appointment records from the last quarter of 2015 and found veterans waited an average of 27 days for primary care appointments — the VA scheduling system said the average was only eight days.
For mental health, the inspector general found the average wait was 26 days, but the VA system showed 6 days. And for referrals to specialists, the audit found veterans waited an average of 36 days, while the VA system said the wait was 10 days.
The inspector general tracked the time between appointment requests and the actual appointments.
The VA system, on the other hand, tracks the time between dates that veterans say they want to be seen or when a doctor says they should be seen and their actual appointments. For example, if a veteran asks for an appointment in two weeks or if a doctor says come back in two weeks, the wait time clock starts in two weeks instead of at the time of the request.
“VHA believes it is very important to respect veterans’ preferences for when they want to be seen,” Shulkin wrote in his response to the report.
But depending on schedulers to enter the right dates can lead to inaccurate results.
For example, the inspector general found a new veteran patient asked in August 2015 for a primary care appointment and didn’t get one until nearly two months later, but the VA system showed zero wait time because the scheduler entered the appointment date as the preferred date.
In another case, a veteran seeking a mental health appointment in July 2015 couldn’t get one until the end of September that year. Four days before the appointment, the VA canceled it along with others that day. A scheduler rebooked it two months later in November 2015 and entered that date as the one preferred by the veteran. The system showed zero wait time even though the wait was actually four months.
Republican Rep. Richard Hudson of North Carolina, home to nine of the 12 medical facilities audited, said the resulting report “shines a light on a systemic, bureaucratic problem at the VA.”
“It is an absolute fiasco and our veterans deserve better,” he said in a statement Friday. “I am alarmed and outraged that employees weren’t following proper reporting protocol, preventing veterans from accessing timely, quality care through the Choice Program.”
(© 2017 USA TODAY)