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Audit: Many VA facilities altered appointment dates

May. 30, 2014 - 06:00AM   |  
The Phoenix VA Health Care Center in Phoenix.
The Phoenix VA Health Care Center in Phoenix. (Ross D. Franklin/The Associated Press)
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The Phoenix VA Health Care Center in Phoenix. (Ross D. Franklin/The Associated Press)

More than 60 percent of Veterans Affairs health facilities surveyed in an audit directed by senior VA leadership were found to have toyed with appointment dates and, in some cases, schedulers were pressured to game wait times to make them appear more favorable, according to a new VA report.

As President Obama announced the resignation of VA Secretary Eric Shinseki on Friday, the department released the early results of a Veterans Health Administration audit of scheduling practices at VA hospitals — findings that ultimately led to Shinseki’s departure.

Auditors found that VA’s complicated appointment system, pressures placed on schedulers and an unrealistic 14-day target to be seen by a doctor created confusion and “represent an organizational leadership failure” at the department.

“Such practices are sufficiently pervasive to require VA re-examine its entire performance management system and in particular whether current measures and targets for access are realistic or sufficient,” the report noted.

The audit found that 13 percent of scheduling staff at 138 medical centers and associated clinics said they had been told to enter a desired date for an appointment into the system different from what the patient had requested, and this happened at 64 percent of the facilities investigated.

The review also found that between 7 percent and 8 percent of the scheduling staff used alternatives to the electronic wait list system — either paper lists or other databases that would not be traceable by the VA headquarters offices.

In a speech Friday morning at a homeless advocates conference, Shinseki said he would begin the firing process for senior leaders at the Phoenix VA health system and withhold bonuses for all department health leaders this year.

He also promised an overhaul of the department’s wait time record systems.

“We now know that VA has a systemic and totally unacceptable lack of integrity within some of our veterans health facilities,” he told attendees at the National Coalition for Homeless Veterans annual conference. “That breach is irresponsible, indefensible and unacceptable.”

The reviewers did not determine whether the changes were done purposefully to meet VA requirements or if schedulers simply did not understand their instructions.

They did find, however, that at most of the VA facilities surveyed, the biggest challenge to patients getting appointments in a timely manner was lack of available time slots. This was followed by the problems of the 14-day wait list requirement.

In his final speech as VA secretary, Shinseki said the problems can be fixed. The summary report echoes Shinseki’s pledges of the last month — that VA managers and staff “engaging in undesired practices are held accountable.”

Shinseki also said that he had been too trusting of some of his health care managers and couldn’t explain their “lack of integrity.”

Staff writer Leo Shane contributed to this report.

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