VA Scheduling Errors Mislead on Wait Times for Care

Agency lacks sufficient oversight to ensure veterans get appointments on time

A patient at the VA hospital in Hines, Ill., where employees allegedly kept secret waiting lists / AP

The Department of Veterans Affairs still does not provide sufficient oversight to ensure that medical center employees contact newly enrolled patients and accurately log patient wait times.

Two years after VA employees were found keeping secret wait lists to conceal the long periods that veterans waited for appointments, a new report from the Government Accountability Office points to persistent scheduling problems at several VA facilities that kept veterans waiting long periods for primary care. In some cases, the veterans did not receive the care they needed.

Auditors reviewed six VA medical centers across the country between January 2015 and March 2016. They discovered that schedulers at half of the centers made errors when recording veterans’ "preferred dates" for care, which resulted in veterans’ wait times appearing much shorter. Wait times were understated by as many as 20 days on average at one of the medical centers.

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In some cases, when appointments were canceled, schedulers at the medical centers updated the preferred dates for care to reflect the new, later preferred dates, which is inconsistent with VA policy. In other cases, when veterans were placed on the electronic waiting list, schedulers revised the initially preferred dates to later dates when the appointments were eventually scheduled, which is also against agency policy.

"This included revising preferred dates to the same dates of the scheduled appointments," the GAO wrote, meaning that wait times dropped to zero. Auditors found that 54 percent of the 120 veterans who successfully sought care and whose records they reviewed had appointments with a zero-day wait period.

"[Veterans Health Administration] officials indicated that appointments with wait times of zero days are a potential indicator of scheduling errors," the GAO report said, noting that more than a dozen of the records had incorrect zero-day wait times based on the review.

"Officials from one medical center said they audited nearly 1,200 appointments between January and June 2015, and identified 205 appointments for which schedulers incorrectly recorded the veteran’s preferred date," GAO auditors wrote.

Employees at five of the six medical facilities told auditors that they had found evidence of schedulers incorrectly recording preferred dates.

"Ongoing scheduling problems continue to affect the reliability of wait-time data, including for primary care," auditors wrote.

The review examined the records of dozens of veterans newly enrolled in VA care—60 who had requested but not yet received care and 120 who had—at agency medical facilities in Massachusetts, Tennessee, North Carolina, South Carolina, Kansas, and California. Auditors looked at medical records and interviewed staffers to assess veterans’ access to prompt care and the VA’s accompanying oversight.

Specifically, auditors found that about half of the veterans who had requested but not yet received VA care had not received care because of "problems" in the VA scheduling process. For example, some veterans did not appear on a list used by schedulers to contact patients. In other cases, staffers did not abide by VA policy and reach out to veterans three times by phone and then by mail to schedule appointments. For a handful of the records reviewed, schedulers did not attempt to contact veterans who asked for care.

When veterans did book primary care appointments, they faced spotty wait times due to limited appointments and "weaknesses" in VA scheduling practices. The review found that, for veterans who did see primary care providers, the average number of days between their initial requests for care and their appointment dates ranged from 22 days to 71 days at each medical center.

While 67 veterans were seen by VA providers within the agency’s targeted 30-day window, 29 veterans waited between 31 and 60 days, 12 veterans waited between 61 and 90 days, and 12 veterans waited more than 90 days. One veteran, for example, wanted to be seen as soon as possible but waited 63 days for an appointment.

"Although VHA has processes for identifying those veterans who have requested VA contact them to schedule appointments, our review of a sample of newly enrolled veterans revealed that VA medical centers did not always provide that care until several months after veterans initially indicated interest in obtaining it, if at all," the review concluded.

"In the absence of consistent adherence by medical center staff to VHA scheduling processes and policies, veterans may continue to experience delays in accessing care."

The new report highlights problems with VA oversight, which is producing bad results for the nation’s veterans. The problems have persisted despite President Obama’s signing of the Veterans Access, Choice, and Accountability Act into law in 2014 in the wake of that year’s fake wait list scandal.

"This report proves what we’ve long known: wait-time manipulation continues at VA and the department’s wait-time rhetoric doesn’t match up with the reality of veterans’ experiences," Rep. Jeff Miller (R., Fla.), who chairs the House Committee on Veterans’ Affairs, told USA Today in a statement reacting to the report.

"But given the fact that VA has successfully fired just four people for wait-time manipulation while letting the bulk of those behind its nationwide delays-in-care scandal off with no discipline or weak slaps on the wrist, I am not at all surprised these problems persist," Miller said.

While Republicans like Miller and veterans’ advocates have pushed for legislation to boost accountability at the VA, Obama and fellow Democrats have resisted their efforts.

"This report shows that the VA continues to fail in its primary mission: delivering timely care to veterans," John Cooper, press secretary for Concerned Veterans for America, a veterans’ group advocating for VA reform, told the Free Beacon in a statement.

"Worse, the VA refuses to be honest about how long veterans are actually waiting to receive that care. It’s time for the VA to recognize that the status quo is simply unsustainable, and a disservice to our veterans, and embrace reforms that enhance accountability and offer veterans real choice in making the care decisions that are best for them."

Mismanagement at the VA has become an issue in the 2016 presidential race. Hillary Clinton came under fire last October for claiming that Republicans had made problems at VA hospitals appear more "widespread" than they were in reality.

Sen. Bernie Sanders (I., Vt.), her challenger for the Democratic nomination, has made his experience chairing the Senate Committee on Veterans’ Affairs a touchstone of his campaign. However, Sanders, who chaired the committee when the wait list scandal broke, at first dismissed the controversy and suggested it was being fueled by a partisan effort to undermine the VA. At least forty veterans died waiting for care at the Phoenix VA hospital system at the heart of the scandal.

A consistent flow of reports from the VA inspector general has exposed mismanagement and poor care at the agency’s hospitals in recent months. Additionally, an independent assessment commissioned by the VA concluded last September that the agency’s hospital network demanded a "system-wide reworking."