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VA Accused of Distorting Wait Times
Associated Press | September 12, 2007WASHINGTON - The Department of Veterans Affairs repeatedly understated wait times for injured veterans seeking medical care and in many serious cases forced them to wait more than 30 days, counter to department policy, an internal investigation shows.
The review by the VA inspector general's office, released Monday, examined 700 outpatient appointments for primary and specialty care scheduled in October 2006 at 10 VA medical centers.
It found that the Veterans Health Administration in recent months falsely reported to Congress that nearly all of its appointments - about 95 percent - were scheduled within 30 days of a patient's requested date. In fact, only three in four veterans - 75 percent - received such timely appointments.
Of the veterans kept waiting more than 30 days, 27 percent of them had more serious service-connected disabilities, such as amputees and those with chronic problems including frequent panic attacks. Under VHA policy, such veterans must be scheduled for care within 30 days of their desired appointment date.
In addition, despite warnings by the IG in 2005 to more accurately report wait times, department officials last year also may have understated the number of veterans on their electronic waiting lists by more than 53,000.
"While waiting time inaccuracies and omissions from electronic waiting lists can be caused by a lack of training and data entry errors, we also found that schedulers at some facilities were interpreting the guidance from their managers to reduce waiting times as instruction to never put patients on the electronic waiting list," VA investigators wrote.
"This seems to have resulted in some 'gaming' of the scheduling process," the 34-page report said.
Responding, VA undersecretary for health Michael Kussman partly agreed that the agency should take additional steps to improve scheduling with better training, procedures and better accounting of records. But he insisted the VA in most cases was doing the best it can and challenged the IG report's methodology, citing patient satisfaction surveys showing roughly 85 percent of veterans getting appointments when they needed them.
In April, Kussman testified to Congress that 95 percent of veterans were receiving the timely appointments. The VA's 2006 annual report, issued last November, makes similar claims.
"To obtain a more objective, professional analysis of all components of VHA's scheduling process, including electronic wait lists and waiting times reporting, I plan to obtain the services of a contractor who will thoroughly assess the factors," Kussman wrote in Monday's IG report.
The report comes amid intense political and public scrutiny of the VA and Pentagon following reports of shoddy outpatient care of injured troops and veterans at Walter Reed Army Medical Center and elsewhere.
In recent weeks, injured Iraq war veterans have filed a lawsuit against the VA alleging undue delays in health care. The department also is struggling to reduce a severe backlog of disability payments, with delays of up to 177 days to process an initial claim, and it awaits a new leader to make changes once outgoing VA secretary Jim Nicholson steps down Oct. 1.
"This is simply not acceptable," said Sen. Daniel Akaka, D-Hawaii, who chairs the Senate Veterans Affairs Committee. He said the report showed the VA was "skewing" its performance on veterans' health care and that the VA was not taking responsibility.
"It is disturbing that VA is refusing to concur with all of the findings and recommendations," he said.
The VA medical facilities reviewed in the IG report were for both primary and specialty care in the following cities: Birmingham, Ala.; Atlanta; Columbia, S.C.; San Antonio, Temple and Dallas in Texas; Cincinnati; Detroit; Indianapolis; Chillicothe, Ohio.
-The VA facilities with the worst record of scheduling appointments within 30 days were Columbia (64 percent), Chillicothe (64 percent) and San Antonio (67 percent). The best performance was seen in Detroit (84 percent), Temple (83 percent), Birmingham and Cincinnati (both 80 percent).
-VA monitoring of scheduling procedures was spotty and incomplete.
In one case, a veteran with eye problems visited a VA clinic in December 2005 and was told by his doctor to return in six weeks. However, it wasn't until many months later, in September 2006, that the VA scheduler set an appointment - for October of that year.
The scheduler then reported the veteran had requested an October date, when in fact he had waited 259 days from the six-week target date appointment in January, the report said.
"We saw no documentation to explain the delay and medical facility personnel said it 'fell through the cracks,'" investigators said.
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