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The Department of Veterans Affairs has said it will change the way it determines wait times for veterans making appointments to meet with VA healthcare providers.
The decision follows a report released in December that faulted the Veterans Health Administration’s system for tracking wait times for veteran patients to see a doctor for initial or follow-up visits. The Government Accountability Office found that VA reports on wait times are unreliable because neither the policy nor training materials used by schedulers setting appointments are clear.
The result has been inconsistent practices and misleading data, according to GAO, Congress’ investigatory arm.
The VA agreed that it had problems and said it would work to resolve them and come up with a reliable measurement of wait times. The VA has been criticized by Congress for years over the time it takes for veterans to see a doctor.
The VA’s goal in 2011, the year the GAO studied, was to have patients see a healthcare provider within 14 days of the patient’s or provider’s “desired” appointment date. VA data, based on the recorded dates and wait times the GAO reviewed, shows the department met its goal in primary care medical appointments 94 percent of the time and in specialty care appointments 95 percent of the time.
“However, patient complaints and media reports about long wait times have persisted, prompting renewed concerns about excessive medical appointment wait times,” the GAO said, explaining why it conducted the review.
The 51-page GAO report said VA employees are not consistent in recording the veteran patient’s “desired” appointment date.
“While the policy defines desired date as ‘the date on which the patient or provider wants the patient to be seen,’ it also instructs that the ‘the desired date needs to be defined by the patient’,” according to the General Accountability Office report. The policy applies to new patient medical appointments, appointments made in response to consult requests, and follow-up appointments by established patients.
The GAO drafted its report after visiting 23 clinics at four VA Medical Centers, reviewing Veterans Health Administration policies and data, and interviewing VHA officials.
The GAO found that 12 schedulers they interviewed said they would enter the “desired” date as the one selected by the patient; four said they would use the provider’s date and three others said they would use the next available medical appointment date.
If there is a conflict between a date the patient wants and when the provider is available, the VA scheduler is supposed to contact the provider. But neither policy nor training documents spell out when the provider’s appointment date should be entered as the “desired” one. Some schedulers would use the patient-requested date, others the provider’s date, the agency found.
“The variation in schedulers’ interpretation of the desired date suggests confusion about its correct use in different scheduling scenarios,” the GAO wrote.
In some cases, schedulers altered the desired date because of appointment availability, resulting in inaccurate recording of patient wait times.
The VA, in response to the criticisms, said it is considering new ways to measure the wait times, including recording new patient wait times as the period between the appointment create date and the completed date. For established patients, the time may be measured from the patient’s desired date to the future scheduled appointment, the VA said in a Dec. 11, 2012 reply to GAO.
The VA also agreed it would standardize the training of employees making appointments for veterans to avoid inconsistencies.
The GAO report did not address allegations made in congressional testimony last year indicting that at least some of the faulty data may have been deliberate. A former official with the VA Medical Center in New Hampshire told Congress last April that some senior executives at VA hospitals were “gaming the system” on appointment numbers because they were tied to bonuses.
Following the testimony the Department of Veterans Affairs cancelled more than half of all bonuses targeted to senior executives.