57,000 waiting 90 days at VA

64,000 veterans never got appointments, report shows

People stand outside the Spark M. Matsunaga VA Medical Center in Honolulu. Hawaii had the longest wait time in the nation for veterans to get their first appointment with a primary care physician, according to data released by the U.S. Department of Veterans Affairs.
People stand outside the Spark M. Matsunaga VA Medical Center in Honolulu. Hawaii had the longest wait time in the nation for veterans to get their first appointment with a primary care physician, according to data released by the U.S. Department of Veterans Affairs.

WASHINGTON — More than 57,000 U.S. veterans have been waiting at least 90 days for a first appointment at government hospitals, according to a report released Monday that broadens the scope of failings in the federal agency.

photo

VA hospitals wait times

A government review of 731 medical facilities for veterans showed that almost 64,000 other veterans who enrolled in the U.S. Department of Veterans Affairs health system during the past 10 years never received appointments.

It was not clear whether the 64,000 veterans who did not get appointments remained interested in being seen by the VA.

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

Richard Griffin, the VA’s acting inspector general, said investigations of medical facilities nationwide could result in criminal charges, which Griffin said might be needed to curb fraudulent scheduling practices often referred to as “gaming” the system.

“Once someone loses his job or gets criminally charged for doing this, it will no longer be a game. And that will be the shot heard around the system,” Griffin said Monday night at a hearing of the House Veterans Affairs Committee.

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.

“This data shows the extent of the systemic problems we face, problems that demand immediate actions,” Gibson said Monday in a statement.

Gibson has ordered a hiring freeze at the Washington headquarters of the Veterans Health Administration and at 21 regional administrative offices, except for critical positions. Such hiring decisions are subject to his approval.

Medical care for the nation’s 22.1 million veterans has become a top priority for Congress after reports that the Veterans Health Administration, the country’s largest integrated health system, hid long waits for veterans trying to see a doctor. About half of the 1.9 million troops discharged after serving in Iraq or Afghanistan have returned to the U.S. in need of medical care, agency data show.

The 57,000 patients who waited more than 90 days for appointments accounted for 1 percent of the 6 million appointments that were scheduled — excluding surgeries and other procedures — as of May 15.

At least 18 veterans died while awaiting medical care in Phoenix, Gibson has said. House Veterans Affairs Committee Chairman Jeff Miller, R-Fla., has said there were as many as 40 deaths.

Miller and other lawmakers have blamed agency performance goals for motivating hospital workers to falsify official waiting lists. Gibson said last week that the department would remove the 14-day scheduling goal as a measure for bonuses.

The report released Monday states a 14-day agency target was “not attainable,” given poor planning and a growing demand for services as Vietnam veterans age and younger veterans from the Iraq and Afghanistan wars enter the system. The 2011 decision by senior agency officials to set the target — and tie it to bonuses — was “an organizational leadership failure,” the report states.

Gibson’s predecessor, Eric Shinseki, resigned May 30 after an earlier review found systemic mismanagement, treatment delays and falsified records throughout the health system. The internal audit showed workers were instructed to manipulate appointments at 64 percent of facilities.

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 last Tuesday. Respondents at 14 sites reported having been sanctioned or punished over scheduling practices.

The report states 13 percent of the schedulers interviewed said they had been instructed by “supervisors or others” to enter false information related to how long veterans had to wait for appointments.

Wait times for new patients far exceeded the 14-day goal, the audit states. For example, the wait time for a primary-care screening appointment at Baltimore’s VA health-care center was almost 81 days. At Canandaigua, N.Y., it was 72 days. On the other hand, the average wait was 17 days in Coatesville, Pa., and 12 days in Bedford, Mass. The longest wait was in Honolulu — 145 days.

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

For example, established patients at facilities in New Jersey; Connecticut; and Battle Creek, Mich., waited an average of only one day to see health-care providers.

New patients at Arkansas’ only VA hospitals, in Fayetteville and Little Rock, average 52- and 60-day waits, respectively, for appointments with primary-care doctors, according to the study.

Established patients fare far better — waiting less than three days for primary-care visits in Fayetteville and about four days in Little Rock, the study found.

Overall, veterans seeking appointments at VA hospitals in Arkansas fared about the same as the national average, according to the report.

About 96 percent of patients at the Veterans Health Care System of the Ozarks in Fayetteville got appointments within 30 days of requesting them, the study found. The Little Rock facility — the Central Arkansas Veterans Healthcare System — scheduled 97 percent of patient’s appointments within 30 days.

The national average was 96 percent within the 30-day period.

The report didn’t list national averages for new-patient waits versus established patients.

“I think we’re running close to the national averages,” VA spokesman Miles Brown of Little Rock said Monday.

Waits were a little shorter for patients seeking appointments with specialists, according to the study. New Arkansas patients needing mental-health care also have shorter waits: about 35 days on average in Fayetteville for an appointment and 39 days in Little Rock. Established patients get mental-health appointments, on average, in about four days in Fayetteville and six days in Little Rock.

Brown said new patients need longer appointments — 45 minutes to an hour.

“There are only so many new-patient appointments available in a week,” he said. Therefore, new patients have to wait longer for appointments. He also cited a growing number of veterans in more rural areas.

The report lists 31 smaller veterans health-care facilities nationwide that need further review, including the Hot Springs community clinic in Arkansas.

The report doesn’t enumerate problems with those clinics. Brown said inspectors also didn’t reveal to administrators any special problems at Hot Springs.

“During their informal out-brief, the [VA] team identified no major red flags,” Brown said.

When Arkansas VA administrators learned Monday that the Hot Springs clinic would get a follow-up check, “we were a little taken aback, but we’ll comply with whatever the VA requires of us,” Brown said.

Congressional measures

The Senate might act as soon as this week on a proposal that would expand access to health care for veterans. The $2 billion measure would provide money to lease 26 new medical facilities and hire doctors and nurses.

It also would set up a two-year pilot program requiring the agency to reimburse some non-VA facilities that provide medical care for veterans who live at least 40 miles from a facility or can’t schedule an appointment within about two weeks.

“The release of today’s data is an indication of the president’s commitment to be transparent about this process,” said Josh Earnest, a White House spokesman. “This continues to be a priority.”

President Barack Obama’s administration is taking steps to “ensure timely action” to schedule appointments, including hiring more workers and making use of mobile medical centers, Earnest said.

“This is a large task,” he said.

The agency 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 agency would need to improve its service.

The main negotiators on the Senate measure are Bernie Sanders, I-Vt. and chairman of the Veterans Affairs Committee, and John McCain, R-Ariz. The agency’s $160 billion budget is the fourth-largest of any federal agency.

House Republicans are promoting nine veteran-related bills that passed in recent months and await Senate action. Those include a proposal to make it easier to dismiss agency officials for misconduct and another that would freeze bonuses for senior agency officials through the 2018 fiscal year.

House Speaker John Boehner, R-Ohio, said Monday’s 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.

Information for this article was contributed by Michael C. Bender and Roger Runningen of Bloomberg News; by Matthew Daly, Donna Cassata and Alan Fram of The Associated Press; Richard A. Oppel Jr. of The New York Times; and by Lisa Hammersly of the Arkansas Democrat-Gazette.

A Section on 06/10/2014

Upcoming Events