Problem's depth and duration imperil Shinseki
Facts can be twisted, but it’s tougher to do with numbers. These are the key numbers, and the excerpts from which they’re plucked, in Wednesday’s interim report on wait times at the Phoenix VA. The Department of Veterans Affairs inspector general’s findings make it increasingly clear that Secretary Eric Shinseki’s job is in grave danger:
Since 2005, the VA Office of Inspector General has issued 18 reports that identified, at both the national and local levels, deficiencies in scheduling resulting in lengthy waiting times and the negative impact on patient care.
To date, we have ongoing or scheduled work at 42 VA medical facilities and have identified instances of manipulation of VA data that distort the legitimacy of reported waiting times.
To date, our work has substantiated serious conditions at the Phoenix HCS [Health Care System]. We identified about 1,400 veterans who did not have a primary care appointment but were appropriately included on the Phoenix HCS EWLs [Electronic Wait Lists]. However, we identified an additional 1,700 veterans who were waiting for a primary care appointment but were not on the EWL.
VA national data, which was reported by Phoenix HCS, showed these 226 veterans waited on average 24 days for their first primary care appointment and only 43 percent waited more than 14 days. However, our review showed these 226 veterans waited on average 115 days for their first primary care appointment with approximately 84 percent waiting more than 14 days.
As of April 28, 2014, the New Enrollee Appointment Request report listed 1,138 veterans who were waiting for an appointment an average of 200 days. However, only 53 of the 1,138 veterans were on the EWL. The remaining 1,085 patients were not on the EWL. Consequently, their wait time prior to being scheduled or added to the EWL would potentially never be captured in any VA wait time data.
It appears that a significant number of schedulers are manipulating the waiting times of established patients by using the wrong desired date of care. Instead of schedulers using a date based on when the provider wants to see the veteran or when the veteran wants an appointment, the scheduler deviates from VHA’s scheduling policy by going into the system to determine when the next available appointment is and using that as a purported desired date. This results in a false 0-day wait time. We evaluated FY 2013 established patient appointments in primary care and determined that for 66 percent of appointments, Phoenix HCS recorded veterans had no wait time.
Many of these schemes are detailed in the then Deputy Under Secretary for Health for Operations and Management April 2010 Memorandum on Inappropriate Scheduling Practices. The purpose of the memorandum was to call for immediate action to identify and eliminate VHA’s [Veterans Health Administration] use of inappropriate scheduling practices to improve scores on clinical access performance measures. The memorandum discussed many of the same schemes we identified at Phoenix HCS and other medical facilities throughout VHA.
The number of times the word “systemic” appears in the 35-page report to describe the problem, including
We are finding that inappropriate scheduling practices are a systemic problem nationwide.
The VA is a huge institution, its 300,000 employees tending to the needs of 230,000 veterans daily. There are bound to be problems of varying scope and size in any such gargantuan place.
What the report makes plain is that the problem, contrary to statements from VA headquarters, is widespread and deep. At a Senate hearing May 15, Shinseki said he was aware of such malfeasance in “a number of isolated cases” that he downgraded to “a couple of cases” moments later. But worse than the problem itself is the fact that it was formally identified in April 2010, along with a call to stop such cheating.
Following the report’s release, Shinseki declared the “systemic issues with patient scheduling and access” it contained “reprehensible” and ordered changes. But it may be too little, too late.
“If Secretary Shinseki does not step down voluntarily,” Senator John McCain, R-Ariz., “then I call on the President of the United States to relieve him of his duties.” The report triggered additional bipartisan calls by lawmakers for the retired four-star Army general to resign. While the IG said it hasn’t concluded whether or not any of the delays contributed to veterans’ deaths, it seems almost moot. Only the living can suffer.