VA Faces Systemwide Problems with Patient Scheduling

The Veterans Affairs Department faces systemic problems going back more than a decade when it comes to scheduling timely medical appointments for patients, lawmakers on both sides of the aisle charged at a Senate Veterans Affairs Committee hearing today.

The hearing was spurred by news reports that the Phoenix VA Health Care System maintained a “secret” waitlist of 1,400 to 1,600 veterans forced to wait months for treatment. According to reports, 40 veterans on the list died while awaiting care. Since then VA whistleblowers have charged that personnel at VA facilities in Colorado, Florida, Texas and Wyoming have “gamed” the system and “cooked the books” to hide patient wait times.

Sen. Patty Murray, D-Wash., said the Government Accountability Office reported in 2001 that “long wait times persist” even though VA had set a goal for patients to see a clinician within 30 days. Similar critical reports by GAO or the department’s inspector general followed in 2005 and 2012. Sen. Richard Burr, R-N.C., the committee’s ranking member, said “manipulation of patient wait times” included making appointments in what he called “ghost clinics” without staff.

Sen. Johnny Isakson, R-Ga., cited an August 2010 internal VA memo from William Schoenhard, then undersecretary for health administrative operations, where he said “It has come to my attention that in order to improve scores on assorted access measures, certain facilities have adopted use of inappropriate scheduling practices sometimes referred to as ‘gaming strategies’ . . . This is not patient centered care.”

In the memo, first obtained and published by VA Watchdog.org in 2010, Schoenhard said patient schedulers had crafted dozens of strategies to manipulate the system and “additional new or modified gaming strategies may have emerged, so do not consider this list a full description of all current possibilities of inappropriate scheduling practices that need to be addressed. These practices will not be tolerated.”

VA Secretary Eric Shinseki told lawmakers that since the news broke of problems with long and deadly wait times in Phoenix he had received only “isolated” reports of problems in other VA hospitals and clinics. Shinseki said he was “mad as hell” about the flood of allegations centered around the time patients had to wait to see a clinician, and had ordered a systemwide review this week.

Dr. Robert Petzel, undersecretary for health, said a VA team is looking at all 150 VA hospitals this week and next week will examine over 800 VA clinics. Together, those facilities serve more than 8 million patients.

Sen. Jerry Moran, R-Kan., said the systemwide audit of health facilities, which is to be conducted by 220 VA employees, looks more like more like damage control than the thorough examination needed. Moran told Shinseki, “Mr. Secretary, we have 1,700 VA points of access to care. I don’t see a review that lasts two weeks . . . as capable of providing information.”

Shinseki said a long term review of patient wait times will be aided by the temporary assignment yesterday of White House deputy chief of staff Rob Nabors to the job. President Obama said, “While we get to the bottom of what happened in Phoenix, it's clear the VA needs to do more to ensure quality care for our veterans. I'm grateful that Rob, one of my most trust advisors, has agreed to work with Secretary Shinseki to help the team at this important moment.”

Moran, echoing other members of the committee, said VA needs to engage in swift action to change an institutional culture that systematically plays games with veterans’ lives.