VA report assails ‘systemic’ delays in veterans care

In an interim report, internal investigators at the VA say scheduling delays for veterans were not limited to medical facilities in Phoenix, as the Inspector General “confirmed that inappropriate scheduling practices are systemic” throughout the VA health care system, leading to new calls for a major shakeup at the VA.

“Today the inspector general confirmed beyond a shadow of a doubt what was becoming more obvious by the day: wait time schemes and data manipulation are systemic throughout VA and are putting veterans at risk in Phoenix and across the country,” said Rep. Jeff Miller (R-FL), the Chairman of the House Veterans Committee.

Miller, who had refused to join calls for the resignation of the VA Secretary, ended that as soon as this report became public.

“VA Secretary Eric Shinseki should resign immediately. Shinseki is a good man who has served his country honorably, but he has failed to get VA’s health care system in order,” Miller said in a statement.

The report found that vets waited an average of 115 days for a first appointment in the Phoenix VA system, as the Inspector General detailed four different “scheduling schemes” that were used to make it look like veterans were not encountering health care delays.

+ Scheduling Scheme #1 – Schedulers go into the scheduling program, find an open appointment, ask the veteran if that appointment would be acceptable, back out of the scheduling program, and enter the open appointment date as the veteran’s desired date of care. This makes the wait time of an established patient 0 days.

+Scheduling Scheme #2 – Schedulers at several locations described a process using the Clinic Appointment Availability Report (or similar report) to identify individual schedulers whose appointments exceeded the 14-day goal. Scheduling supervisors told schedulers to review these reports and “fix” any appointments greater than 14 days. Schedulers say they were instructed to reschedule the appointments for less than 14 days. At one location, a scheduler told us each supervisor was provided a list of schedulers who exceeded the 14-day goal. To keep their names off the supervisor’s list, schedulers automatically changed the desired date to the next available appointment, thereby, showing no wait time.

Scheduling Scheme #3 – Staff at two VA medical facilities deleted consults without full consideration of impact to patients. The first facility deleted pending consults in excess of 90 days without adequate reviews by clinical staff. Schedulers working at the second facility cancelled provider consults without review by clinical staff.

Scheduling Scheme #4 – Multiple schedulers described to us a process they use that essentially “overwrites” appointments to reduce the reported waiting times. Schedulers make a new appointment on top of an existing appointment of the same date and time. This cancels the existing appointment but does not record a cancelled appointment. This action allows the scheduler to overwrite the prior Desired Date and appointment Create Date with a new Desired Date. This adjusts the Create Date to the current date of entry and the Desired Date to the date of the appointment, thus reducing the reported wait time.

The full report is available on the VA OIG website.

The details of the report also brought about new calls from Democrats for change at the top at the VA – Sen. Mark Udall (D-CO) became the first Senator to demand the resignation of Secretary Shinseki, even as the VA chief said he would move quickly to address the details of this report, including immediate efforts to deal with the estimated 1700 veterans who were never put on VA waiting lists.