Audit: More than 57,000 await first VA appointment

Report reveals a 72- to 145-day wait time at some VAs, but says those who are already in the system don't wait as long for care
Associated Press
Jun 9, 2014

More than 57,000 U.S. military veterans have been waiting 90 days or more for their first VA medical appointments, and an additional 64,000 appear to have fallen through the cracks, never getting appointments after enrolling and requesting them, the Veterans Affairs Department said Monday.

It's not just a backlog problem, the wide-ranging review indicated. Thirteen percent of schedulers in the facility-by-facility report on 731 hospitals and outpatient clinics reported being told by supervisors to falsify appointment schedules to make patient waits appear shorter.

The audit is the first nationwide look at the VA network in the uproar that began with reports two months ago of patients dying while awaiting appointments and of cover-ups at the Phoenix VA center. A preliminary review last month found that long patient waits and falsified records were "systemic" throughout the VA medical network, the nation's largest single health care provider serving nearly 9 million veterans.

"This behavior runs counter to our core values," the report said. "The overarching environment and culture which allowed this state of practice to take root must be confronted head-on."

Acting VA Secretary Sloan Gibson said Monday that VA officials have contacted 50,000 veterans across the country to get them off waiting lists and into clinics and are in the process of contacting 40,000 more.

The controversy forced VA Secretary Eric Shinseki to resign May 30. Shinseki took the blame for what he decried as a "lack of integrity" through the network. Legislation is being written in both the House and Senate to allow more veterans, including those enrolled in Medicare or the military's TRICARE program, to get treatment from outside providers if they can't get timely VA appointments. The proposals also would make it easier to fire senior VA regional officials and hospital administrators.

House Speaker John Boehner, R-Ohio, said the report demonstrated that Congress must act immediately.

"The fact that more than 57,000 veterans are still waiting for their first doctor appointment from the VA is a national disgrace," Boehner said.

The new audit said a 14-day agency target for waiting times was "not attainable," given poor planning and a growing demand for VA services. It called the 2011 decision by senior VA officials to set the target, and then base bonuses on meeting it, "an organizational leadership failure."

A previous inspector general's investigation into the troubled Phoenix VA Health Care System found that about 1,700 veterans in need of care were "at risk of being lost or forgotten" after being kept off an official, electronic waiting list.

The report issued Monday offers a broader picture of the overall system. The audit includes interviews with more than 3,772 employees nationwide between May 12 and June 3. Respondents at 14 sites reported having been sanctioned or punished over scheduling practices.

Wait times for new patients far exceeded the 14-day goal, the audit said. For example, the wait time for primary care screening appointment at Baltimore's VA health care center was almost 81 days. At Canandaigua, New York, it was 72 days. On the other hand, at Coatesville, Pennsylvania, it was only 17 days and in Bedford, Massachusetts just 12 days. The longest wait was in Honolulu — 145 days.

But for veterans already in the system, waits were much shorter.

For example, established patients at VA facilities in New Jersey, Connecticut and Battle Creek, Michigan, waited an average of only one day to see health care providers. The longest average wait for veterans already in the system was 30 days, in Fayetteville, North Carolina, a military-heavy region with Fort Bragg Army Base and Pope Air Force Base nearby.

Gibson, the acting VA secretary, said the department is hiring new workers at overburdened clinics and other health care facilities across the nation and is deploying mobile medical units to treat additional veterans.

The VA believes it will need $300 million over the next three months to accelerate medical care for veterans who have been waiting for appointments, a senior agency official said in a conference call with reporters. That effort would include expanding clinics' hours and paying for some veterans to see non-VA providers. The official said he could not say how many additional health providers the VA would need to improve its service.

The report said 112 — or 15 percent — of the 731 VA facilities that auditors visited will require additional investigation, because of indications that data on patients' appointment dates may have been falsified, or that workers may have been instructed to falsify lists, or other problems.

Gibson also has ordered a hiring freeze at the Washington headquarters of the Veterans Health Administration, the VA's health care arm, and at 21 regional administrative offices, except for critical positions personally approved by him.

Boehner said the House would act on legislation this week to allow veterans waiting at least a month for VA appointments to see non-VA doctors, and said the Senate should approve it, too. An emerging bipartisan compromise in the Senate is broader than that, but senators have yet to vote on it.

Comments

The Hero Zone's picture
The Hero Zone

What a shame. I seriously hope this ends up being a moment for all of us to stop and think about the direction the ACA is taking us or even what will happen if we skip ahead to a single-payer system.

For example: Medical wait times up to 3 times longer in Canada
""It is not right to force Canadians to wait two or three times longer for necessary medical care than citizens of other countries that also have universal publicly funded health systems," the report’s authors said."
http://www.cbc.ca/news/health/me...

Now the above is about ER wait times. Ok so England must have a superior system than even Canada if they want to emulate them. One universal system lamenting another. So let's look at long-term wait times in superior England:

More NHS hospitals failing to meet targets on treatment waiting times
Figures show 2.9m patients waiting for treatment in January, and 45,000 more not treated within 18 weeks than in January 2013

"2.9m people were waiting for treatment in January, up by 362,000 from the 2.538m seen in the same month in 2013, and 326,000 more than the 2.574m who were on the list for treatment when the coalition took over in May 2010."

Seems rather fair and equal for everyone to me? But it is because of these problems we are having our VA move away from this model is it not? So if it is causing this in countries which have been practicing it for years, and in a system in the U.S. that has done the same, why do we want to give to the populace at large the above?

So let's go back to the long term in "CA vs. US":
"It is true that wait times for physician appointments and non-emergency surgery tend to be longer in Canada, which has a government-funded, universal health care system, than in the United States. A study by the Commonwealth Fund, a nonpartisan research foundation that promotes improved health care access and quality, showed that 57 percent of adults in Canada who needed a specialist said they waited more than four weeks for an appointment, versus only 23 percent who said so in the U.S. For emergency physician visits, 23 percent of Canadians and 30 percent of Americans said they could get in to see the doctor the same day, but 23 percent of Americans and 36 percent of Canadians waited more than six days. Wait times for elective and non-emergency surgery were even more disparate: Thirty-three percent of Canadians reported a wait time of more than four months, but only 8 percent of Americans had to wait that long. In another study, 27 percent of Canadians said that waiting times were their biggest complaint about their health system, versus only 3 percent of Americans. In October 2007, the Fraser Institute, a Canada-based libertarian think tank, reported that Canadians waited an average of 18.3 weeks between seeing a general practitioner and getting surgery or treatment."

http://www.factcheck.org/2007/12...

Ok, ok so that was in 2007. Pre-ACA and seven years of elections, laws, and demographics changes later that we find ourselves here.

Against the backdrop of this report (http://www.gov.nl.ca/HaveYouHear...) we can see that despite all the government promises, charters, and such that many of the same problems are experienced up north that are down here. So why are we wanting to go to a model that isn't doing what those who want us there say it will do?

It would seem according to this chart (http://www.oecd-ilibrary.org/sit...) we have the lowest times of other developed nations for as much as people decry us as being the only one that doesn't have universal care.

It was interesting spending some time doing research on the U.S. side. There's only a smattering of info out there and I saw several articles that could have pointed to why: Wait times are not a public nor policy issue in the U.S. because they tend to be superior overall and not mandated by the government (we must exclude the VA where we have seen this fail). So after looking I rolled my eyes, bit my bottom lip and going into it with my grain of salt read this article: "What the world doesn't know about the health care in America"

http://www.foxnews.com/opinion/2...

Setting prejudice aside I clicked on it and read though. It didn't slam Obama. There is no mention of Democrats nor Republicans. If politics is mentioned it is only as they have been made manifest in the compared countries' health systems. Then I got to the section about the author.

"Scott W. Atlas, MD is the David and Joan Traitel Senior Fellow at the Hoover Institution, Stanford University, and author of "In Excellent Health: Setting the Record Straight on America’s Health Care" (Hoover Press, 2011)."

His book (http://www.amazon.com/In-Excelle...) discusses the much-mysterious and oft-asked question here in our local boards of "If you don't like Obamacare then what would you do?"

"Drawing from research in scientific and medical journals, the author defends both the quality of and access to medical care in the United States compared to numerous countries with nationalized systems often held up as models for health system reforms. He then suggests a logical and complete reform plan designed to maintain choice and access to excellence and facilitate competition. His proposal offers a series of key improvements in the three critical areas of the health care puzzle—tax structure, private insurance markets, and government health insurance programs—that will reduce health costs and maintain essential support for America's most vulnerable citizens, seniors and low-income families, without jeopardizing the exceptional health care quality and access in the United States."

Be as dubious as you want about which entity printed his piece, but look at the author's education and merits.

I think it's time we look at facts in a national and global context so we can actually make good policy that betters the population at large, not subsidizes private insurers with tax money, gives power over your life and decisions to distant people behind desks, etc.

The VA, in my opinion with the recent Senate bill (http://www.sanduskyregister.com/...), is moving it in the proper direction. But it isn't there yet. Hopefully we can shift the conversation to use our own homegrown data about manipulate and the uselessness of promising on paper that people have to do things for you in a certain time frame.

grumpy

(sarcasm on) Please stop using numbers, statistics, studies to prove your contentions. It is not fair to those who just have taliking points gleaned from thir morning emails and blogs that don't used such things and rely on blind acceptance of what the "party" tells them is happening and more important, what they want to happen if only the "right" people are in charge. ( sarcasm off)

I wish more folks would back their contentions up as well.

Contango

VA - A great model for U.S. single-payer health ins.

Even that 'great' Nobel Prize winning, liberal economist Paul Krugman thinks so:

http://dailycaller.com/2014/05/1...

MiddleRight

There is no reason these heros shouldn't be able to just call a local doctor and get it.

Eliminate the VA and give veterans a gov't insurance card so that they can seek care wherever they want. You'd pay for it by eliminating the VA.

grumpy

I would agree for those things that are normal medical problems that affect most folks, cancer and heart problems to name a few. Then keep the VA for those things that affect servicemen more than the general public, PTSD, missing limbs to name a few. That is where the VA is needed the most... for things that mostly affect the servicemen, not for the common medical problems where they should get a voucher to a regular doctor or hospital. Seems to make the most sense to me anyway...

MiddleRight

That was the original intent, to provide the best possible care provided by doctors trained to deal with their unique mental and physical conditions.

Now they are being put on fake waiting lists to die.