4/7/16, "VA bosses in 7 states falsified vets' wait times for care," USA Today, Donovan Slack
"Supervisors instructed employees to falsify patient wait times at
Veterans Affairs' medical facilities in at least seven states, according
to a USA TODAY analysis of more than 70 investigation reports released
in recent weeks.
Overall, those reports — released after multiple
inquiries and a Freedom of Information Act request — reveal for the
first time specifics of widespread scheduling manipulation.
Employees at 40 VA medical facilities in 19 states and Puerto Rico regularly “zeroed out” veteran wait times, the analysis shows. In some
cases, investigators found manipulation had been going on for as long as
a decade. In others, it had been just a few years....
The manipulation masked growing demand
as new waves of veterans returned from wars in Iraq and Afghanistan and
as Vietnam veterans aged and needed more health care.
In 2014, The Arizona Republic, part of the USA TODAY NETWORK, and other media revealed scheduling manipulation at Phoenix VA Medical Center
and that dozens of veterans died while waiting for care. Subsequent
reporting that year showed that similar problems extended nationwide.
Investigators had said manipulation was “systemic,” but they did not
identify which facilities had problems and how serious they were. The
inspector general soon launched investigations of more than 100
facilities.
The newly released findings of those probes show that supervisors
instructed schedulers to manipulate wait times in Arkansas, California,
Delaware, Illinois, New York, Texas and Vermont, giving the false impression facilities there were meeting VA performance measures for shorter wait times.
In some cases, the system encouraged manipulation even without explicit instruction from supervisors. A manager in West Palm Beach, Fla., sent out laudatory emails touting the shorter wait times the system showed. Schedulers in Harlingen, Texas,
reported being berated by supervisors when they booked appointments
showing longer wait times for veterans. (It was “not pretty,” one
employee said.)
In some cases — in Gainesville, Fla., White River Junction,
Vt., and Philadelphia, for example — they found VA employees improperly
kept lists of veterans needing care outside the scheduling system, a
violation that also hid actual wait times.
Roughly half of the 70 newly released reports are from investigations
completed more than a year ago, and the VA says it already initiated
discipline against 29 people — three of whom left the agency — because
of the findings.
The agency said it has retrained thousands of
schedulers and is updating software to make it easier for them to book
appointments properly. A pilot program at 10 facilities allows veterans
to book their own appointments, and the VA expects to roll that out
nationwide, according to David Shulkin, a physician who took over as undersecretary for health at the VA in June.
Shulkin
told USA TODAY he also initiated two massive, same-day efforts to try
to provide care sooner for more than 100,000 veterans, and he said the
agency also has increased capacity to get wait times down.
“We’ve
expanded appointments, we have added evening hours and weekend hours,
we’ve added 3 million square feet of space, we’ve hired 14,000 new
providers,” he said.
But VA whistle-blowers say schedulers still are manipulating wait
times. Shea Wilkes, co-director of a group of more than 40
whistle-blowers from VA medical facilities in more than a dozen states,
said the group continues to hear about it from employees across the
country who are scared to come forward.
“Until the VA decides it
truly wants to change its corrupt and poor culture, those who work on
the front lines and possess the true knowledge relating to the VA's
continued data manipulation will remain quiet and in hiding because of
fear of workplace harassment and retaliation,” said Wilkes, a social
worker at the VA Medical Center in Shreveport, La.
This
is not the first time the VA has said it would fix problems with
scheduling. When the inspector general found in 2005 that VA schedulers
were improperly booking appointments — and wait lists were therefore
underestimated by as many as 10,000 veterans — the agency initiated a
“national education plan” to retrain schedulers and supervisors. In
2010, VA officials discovered schedulers were using “gaming strategies”
to falsify wait times to meet agency performance targets, and they
required all schedulers to undergo new training, once again.
In
the newly released reports, investigators found schedulers were using
the same strategies. Most commonly, schedulers would start the wait
clock on the day of the appointment they were booking rather than when
the veteran wanted to be seen. The system then showed there was no wait
time even if the veteran had to wait weeks or months for an appointment.
As recently as October, the Government Accountability Office said the VA’s wait-time system still is prone to scheduler error and produces unreliable data....
More than 480,000 veterans were waiting more than 30 days for an appointment as of March 15, public VA data show."
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