VA overstates record on wait times for medical appointments

VA overstates record on wait times for appointments, report finds
By Stella M. Hopkins and Chris Adams
McClatchy Newspapers
(Hopkins reports for The Charlotte Observer.)

WASHINGTON - The Department of Veterans Affairs continues to significantly overstate its success in getting patients to see doctors for timely appointments, undercutting one of its key claims of success, according to a draft report obtained by McClatchy Newspapers.

While top VA officials told Congress earlier this year that 95 percent of appointments are scheduled within 30 days of a patient's requested date, the true number is about 75 percent, according to the analysis by the department's inspector general.

The report hasn't been released and is stamped "Draft - For Discussion Only." It's in the final stages of preparation and could be revised.

In a statement, VA spokesman Matt Smith said the department was reviewing the report and remains "committed to ensuring our veterans are seen in a timely manner." The VA said it will visit facilities in need of improvement and will hire a contractor to review the department's scheduling procedures.

Some medical centers performed far worse than average. In Columbia, S.C., and Chillicothe, Ohio, only 64 percent of VA appointments were within 30 days of a patient's request, the report said. The high score among centers studied was Detroit at 84 percent.

The inspector general's report is an update of a similar report from 2005. It's based on an analysis of 700 medical appointments and 300 referrals at 10 VA medical centers, as well as interviews with 113 VA schedulers.

Waiting times for veterans to get in to see doctors are closely watched by Congress and veterans' advocates. In February, the VA's top health official, Michael Kussman, told a congressional committee that the VA provides 39 million appointments a year - and 95 percent of them are done within 30 days of the patient's request.

"We want to make it 100 percent," he said. "We are going to work hard to do that. But all told, I think we are providing pretty good service for people when they need it."

In its annual report, the VA broke those numbers down further, saying that 96 percent of primary-care appointments were within 30 days, as were 95 percent of specialty-care appointments.

The inspector general's assessment was far different.

Looking at appointments that the VA said took place within 30 days, the inspector general found that only 78 percent of primary-care appointments and only 73 percent of specialist visits were within 30 days.

As it did in 2005, the inspector general found that VA schedulers weren't following department procedures when making appointments.

The VA calculates waiting time as the difference between the appointment date and the patient's "desired date." But the report said schedulers often mistakenly recorded the first available appointment as the desired date, thus understating waiting time.

In another type of error, the inspector general found that at one hospital, a veteran was referred for a specialty appointment in April 2006. On Sept. 20, the scheduler set an appointment for Oct. 20 - 185 days after the requested date of April 18. But the scheduler recorded Sept. 20 as the desired date, which gave a reported waiting time of 30 days.

Schedulers used the wrong desired dates 72 percent of the time for the bulk of visits analyzed, according to the report.

Beyond that, schedulers failed to follow VA rules and keep up-to-date waiting lists for patients needing appointments. Such electronic waiting lists are "instrumental in making sure no veterans go untreated," but none of the 10 medical centers investigators looked at properly maintained the lists, the report said.

Another continuing problem: lack of proper training. Schedulers told the inspector general that they didn't have time to take available training. "Their managers agreed, saying that medical facilities were short of staff and training was not a high priority," the report said.

In a May 18 meeting between VA officials and the inspector general's office to discuss the findings, a deputy undersecretary for health, William Feeley, said he was concerned about the inspector general's conclusion that the VA "overstated" the number of veterans seen within 30 days.

According to an internal report summarizing the May 18 meeting, Feeley said that "such a statement could easily be misconstrued by readers of the report to imply that VA was being deliberately deceptive, when there was no evidence to that effect," the report said. "He went on to say that this is a situation where honest people are trying to do the right thing, but that processes are breaking down."

Last month, McClatchy reported on the VA's tendency to exaggerate its accomplishments; among the examples was that VA Secretary Jim Nicholson told Congress about the VA's "exceptional performance" in getting veterans in to see doctors.

The VA told McClatchy it had largely fixed its prior scheduling problems, although this latest report shows that the department has yet to make all the improvements it promised after the 2005 inspector general's report.