The way Veterans Affairs (VA) medical centers in North Carolina and Virginia last year recorded wait times for patients' appointments precluded some eligible patients from seeking care in the private sector, according to a VA Office of Inspector General (OIG) report released Thursday.
OIG from April 2016 through January 2017 reviewed primary and mental health care appointments for new patients, as well as referrals for specialists. The office reviewed "more than 1,400 appointments consisting of 618 new patient appointments, 389 [VA Choice Program] authorizations, 210 discontinued or canceled consults from [fiscal year] 2016, and 210 specialty care consults open more than 30 days as of March 23, 2016."
OIG for the report calculated wait times as the time between when an appointment was requested and when the actual appointment occurred. In contrast, VA calculates wait times by determining the time between the date veterans want to be seen or when their physician says they should be seen and the date their appointments occur.
The investigation included VA medical facilities in North Carolina's Asheville, Charlotte, Durham, Fayetteville, Greenville, Kernersville, Salisbury, and Wilmington, as well as facilities in Virginia's Hampton, Richmond, and Salem.
OIG estimated that 36 percent of appointments for new patients had wait times longer than 30 days. OIG estimated that the average wait time for that 36 percent of appointments was 59 days. According to the report, an estimated 20,600 medical appointments had wait times greater than 30 days.
In contrast, the VA scheduling system, based on VA's method for calculating wait times, showed that only 10 percent of patients had to wait more than 30 days for an appointment.
Further, the report found that VA staff entered inaccurate information "that made it appear as though the wait time was 30 days or less" for about three-quarters of the 20,600 medical appointments that actually had wait times exceeding 30 days. For example, some VA staff inaccurately entered patients' appointment dates as patients' preferred dates for the appointments, which indicated a wait time of zero days.
OIG wrote that the wait time discrepancy "resulted in a significant number of veterans not being eligible for treatment" under the VA Choice Program. The office estimated that up to 13,800 veterans who should have been eligible to seek private-sector care because of their wait times were never added to lists to authorize such care under the Choice Program.
In addition, OIG found that veterans who were added to the appropriate lists still faced long wait times, with 82 percent waiting longer than 30 days for an appointment. According to USA Today, it took VA staff on average 42 days to authorize private sector care and 42 days for veterans to receive such care after they had been approved.
Rep. Richard Hudson (R-N.C.) said the findings "shin[e] a light on a systemic, bureaucratic problem at" VA.
Sen. Richard Burr (R-N.C.) said, "It is absolutely unacceptable that [VA's] scheduling system does not provide accurate information about wait times." He called on Shulkin to "use the power that Congress has given him to hold employees accountable and get the results that our veterans demand."
However, VA Secretary David Shulkin, who was VA's undersecretary for health at the time the investigation was conducted, disagreed with the report's findings about wait times because of the way OIG calculated them. He said VA OIG "ignored the dates patients told us they wanted to be seen, and selected an earlier date to use for calculating wait times." He added that the Veterans Health Administration "believes it is very important to respect veterans' preferences for when they want to be seen."
Ultimately, Shulkin said he "cannot concur with some of the conclusions in this report nor use them for management decisions." He added that VA already has taken steps to improve wait times under the Choice program (Slack, USA Today, 3/3; Dalesio, AP/Sacramento Bee, 3/3, VA OIG report, 3/2).
5 myths physicians believe about patient experience
Excellent patient experience is a critical piece of modern medicine, reflected clearly in outcomes. And more than amenities, clean rooms, or quiet during night, the factors that most inflect patient experience all relate to communication and coordination among the care team—factors that physicians are in a unique position to influence.
Clinician-patient communication, leadership of the care team, and support and empathy for the patient across the unit are the most important factors for success, and they're all driven by the physician as the "Influencer in Chief."