Veterans newly enrolling for health care from the Department of Veterans Affairs and requesting an appointment can endure a months-long wait before they first see a medical provider, according to an audit issued Monday.
The Government Accountability Office also said that the department’s method of measuring wait times understates the delay a veteran experiences.
The average waiting time — as measured from the time veterans requested that VA contact them to schedule appointments to when they were seen — at the six medical centers GAO studied ranged from 22 to 71 days. Of the 180 veterans GAO tracked, 60 still hadn’t been seen by the time the auditors ended their review last month, in several cases because VA never followed up on their requests to be contacted or because of other administrative errors.
In addition, wait times “varied widely, even within the same medical center,” and 12 of those who were seen had waited more than 90 days.
“These time frames were impacted by limited appointment availability and weaknesses in medical center scheduling practices, which contributed to unnecessary delays,” the report said.
The report was issued ahead of a House Veterans Affairs’ Committeehearing on Tuesday, two years after a hearing there helped trigger a flood of revelations that veterans had been enduring long waits for care and that some patient records had been fudged to hide it.
“This report proves what we’ve long known: wait-time manipulation continues at VA and the department’s wait-time rhetoric doesn’t match up with the reality of veterans’ experiences,” Rep. Jeff Miller (R-Fla.), the committee chairman, said in a statement. “But given the fact that VA has successfully fired just four people for wait-time manipulation while letting the bulk of those behind its nationwide delays-in-care scandal off with no discipline or weak slaps on the wrist, I am not at all surprised these problems persist.”
GAO noted that the department calculates appointment wait times from the day that veterans request an appointment date, rather than from when they first ask VA to contact them to schedule one. “Therefore, these data do not capture the time these veterans wait prior to being contacted by schedulers, making it difficult for officials to identify and remedy scheduling problems that arise prior to making contact with veterans,” it said.
It gave as an example a veteran who applies for health-care benefits on the first of a month and requests that VA contact him to schedule an appointment; on the seventh, VA determines he is eligible; on the 12th, a scheduler contacts him and learns that the preferred appointment date is the 17th; on that date, VA reschedules the appointment for the 21st because no appointment is available for the preferred date; and on the 21st the veteran is seen.
Although 20 days have passed since the veteran set the appointment ball rolling, by VA’s reckoning, the wait time was only four days — from the date the appointment was finally set until the veteran was seen.
In addition, GAO found that “scheduling errors, such as incorrectly revising preferred dates when rescheduling appointments, understated the amount of time veterans waited to see providers.”
In comments to the report, VA agreed with recommendations to ensure that newly enrolling veterans requesting appointments are contacted promptly; that it begin measuring wait time from the first request to be contacted until the patient is seen; and that it clarify scheduling processes and assure that staff members are trained on them.
In response to the disclosures in 2014, VA revised many of its scheduling practices and Congress passed the Veterans Access, Choice and Accountability Act. That law allows veterans facing long waits or lengthy travel distances the opportunity to obtain health-care services — including primary care — from community providers.
The 2014 law also restricted the appeal rights for VA’s senior executives, shortening the time they have to respond to proposed discipline and to appeal once the department does take action. Also, the department wins by default if a Merit Systems Protection Board (MSPB) hearing officer does not overturn the discipline within three weeks and there is no further right of appeal.
Despite those limits, hearing officers recently overturned the department in three high-profile cases. VA then proposed to revise the 2014 law by allowing most executives to appeal only to internal review boards and by requiring the MSPB to give more deference to the department’s decisions for the rest.
Such language may be incorporated into a bill the Senate Veterans’ Affairs Committee is drafting as an update to the 2014 law. Sen. Johnny Isakson (R-Ga.), chairman of that committee, recently said that the measure will be designed to improve care and “hold all VA employees accountable for mismanagement and misconduct.”
The House last year passed with bipartisan support a bill to extend across the VA workforce many of the 2014 law’s provisions now applying only to executives. It would give VA authority to more swiftly fire or demote any employee for poor performance or misconduct while adding protections for whistleblowers and limiting the agency’s ability to place employees on paid leave pending disciplinary action.
The full Senate has not acted on a counterpart that passed its committee late last year, however.
“Veterans need better access to private care. Unaccountable bureaucrats need to be fired. The VA needs a radical transformation if it is ever going to adequately care for our veterans,” House Majority Leader Kevin McCarthy (R-Calif.) said in a statement. “Congress has already given the VA the power to do all of this. If the VA wanted to, it could change. What is keeping veterans from getting improved care they deserve? Bureaucratic inertia.”
Senior VA medical officials are scheduled to testify at Tuesday’s hearing, as are representatives of the GAO and VA’s inspector-general office, which has investigated so many allegations of manipulated wait times that it recently began bunching its findings by state.
The independent Office of Special Counsel also has launched numerous investigations of wait-time manipulation, in some cases finding that VA management had retaliated against whistleblowing employees.