The Tip of the Government Health Care Iceberg


Thursday May 29th, 2014   •   Posted by Craig Eyermann at 6:37am PDT   •  

12082739_S Some excerpts from the Office of the Inspector General’s report on the Department of Veterans Affairs’ bureaucrat-led fraud of the real conditions at Phoenix’s VA hospital and a number of other VA facilities, the first of many we will be hearing in the news. We’ll present the results in a Q&A style format:

How many veterans are on the official wait list at the Phoenix VA, and how many seeking care have not been added to it?

To date, our work has substantiated serious conditions at the Phoenix HCS [Health Care System]. We identifed about 1,400 veterans who did not have a primary care appointment but were appropropriately included on the Phoenxi HCS’ EWLs [Electronic Wait Lists]. However, we identified an additional 1,700 veterans who were waiting for a primary care appointment but were not on the EWL. Untils that happens, the reported wait time for these veterans has not started. More importantly, these veterans were and continue to be at risk of being forgotten or lost in Phoenix HCS’s convoluted scheduling process. As a result, these veterans may never obtain a requested or required clinical appointment.

How long does the Phoenix VA hospital say in official reports it takes a veteran to get a primary care appointment at that facility, and how long does it really take (based on a statistical sample of veterans)?

VA national data, which was reported by Phoenix HCS, showed these 226 veterans waited on average 24 days for their first primary care appointment and only 43 percent waited more than 14 days. Howevere, our review showed these 226 veterans waited on average 115 days for their first primary care appointment with approximately 84 percent waiting more than 14 days.

How did the VA’s administrators manipulate the official wait list for medical care to hide the long waits for veterans seeking medical treatment?

Scheduling Scheme #1: Schedulers go into the scheduling program, find an open appointment, ask the veteran if that appointment would be acceptable, back out of the scheduling program, and enter the open appointment date as the veteran’s desired date of care. This makes the wait time of an established patient 0 days.

Scheduling Scheme #2: Schedulers at several locations described a process using the Clinic Appointment Availability Report (or similar report) to identify individual schedulers whose appointments exceeded the 14-day goal. Scheduling supervisors told schedulers to review these reports and “fix” any appointments greater than 14 days. Schedulers say they were instructed to reschedule the appointments for less than 14 days. At one location, a scheduler told us each supervisor was provided a list of schedulers who exceeded the 14-day goal. To keep their names off the supervisor’s list, schedulers automatically changed the desired date to the next available appointment, thereby, showing no wait time.

Scheduling Scheme #3: Staff at two VA medical facilities deleted consults without full consideration of impact to patients. The first facility deleted pending consults in excess of 90 days without adequate reviews by clinical staff. Schedulers working at the second facility cancelled provider consults without review by clinical staff.

Scheduling Scheme #4: Multiple schedulers described to us a process they use that essentially “overwrites” appointments to reduce the reported waiting times. Schedulers make a new appointment on top of an existing appointment of the same date and time. This cancels the existing appointment but does not record a cancelled appointment. This action allows the scheduler to overwrite the prior Desired Date and appointment Create Date with a new Desired Date. This adjusts the Create Date to the current date of entry and the Desired Date to the date of the appointment, thus reducing the reported wait time.

What benefits did the VA’s administrators receive for adopting these fraudulent schemes?

A direct consequence of not appropriately placing veterans on EWLs is that the Phoenix HCS leadership significantly understated the time new patients waited for their primary care appointment in their FY 2013 performance appraisal accomplishments, which is one of the factors considered for awards and salary increases.

How else did the VA’s administrators enforce these schemes?

At one location, a scheduler told us each supervisor was provided a list of schedulers who exceeded the 14-day goal. To keep their names off the supervisor’s list, schedulers automatically changed the desired date to the next available appointment, thereby, showing no wait time.

Such are the carrot and stick incentives of bureaucrats who always put their own interests ahead of those of regular Americans.




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