OIG: VA hospitals in North Carolina, Virginia underreported wait times; entered incorrect scheduling data

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Veterans seeking care in the VA system may still face long wait times and barriers to access, according to a new report.

Many veterans still face significantly long wait times for care and staff members frequently enter incorrect scheduling data, according to the Department of Veterans Affairs Office of Inspector General.

The agency conducted an audit of an entire Veterans Integrated Service Network (VISN) in response to ongoing concerns about wait times between April 2016 and January 2017 at VISN 6, a network that includes 12 VA hospitals—11 in North Carolina and one located in Richmond, Virginia. It estimated that 36% of appointments for new patients within the network had waits of more than 30 days, with an average wait time in that group of 59 days.

The OIG estimated that 82% of veterans that access care at VISN 6 through the Choice program faced wait times of more than 30 days for new patients, with an average wait time of 84 days. For veterans that did not participate in Choice, the wait times were even longer, averaging 98 days, with wait times as long as 389 days recorded.

The estimates are notably higher than figures recorded in the electronic health records, and this led to a number of veterans losing eligibility for care through Choice, which allows veterans who face long wait times in the VA system to get private care, according to the audit. Staff at the medical facilities consistently failed to enter correct clinically indicated or preferred appointment dates when registering new patients. The report estimates that as many as 13,800 veterans were eligible for Choice benefits, but they were never added to lists that allow them to use it.

“This audit demonstrates that many of the same access to care conditions reported over the last decade continued to exist within VISN 6 medical facilities in 2016,” the OIG concluded.

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In response to the findings, the OIG offered 10 recommendations, four that were sent to then-VA Under Secretary for Health David Shulkin on scheduling requirements and the Choice program. The other six were sent directly VISN 6 to help it address the scheduling problems, including recommendations that they better manage consults and consistently enter correct appointment data.

In a response attached to the report, Shulkin, who is now VA secretary, wrote that the VA has already made adjustments to the Choice program, and that he took issue with the way the OIG calculated the wait times in its audit. He said their methodology was “incongruent” with Veterans Health Administration policy, as it was based on outdated rules for scheduling appointments.

“I am primarily concerned that OIG used a criterion for determining whether schedulers had appropriately recorded a Veteran’s preferred date for their appointment that is not required by our policies,” he wrote. “As a result, the wait times OIG calculates are longer than what VHA reports, simply because the OIG has discounted Veterans’ preferred dates for appointments.”

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Democratic leaders in Virginia, where one of the hospitals in the audit was located, expressed concern at the OIG’s results. Sen. Tim Kaine, D-Va., called the findings “intolerable” in a statement, and Sen. Mark Warner, D-Va., said in a statement issued to the Augusta Free Press that he was "deeply concerned" about the findings. Both senators note they have been highly involved in VA issues since 2014.

“Though the report does not find intentional misreporting, it does find that actual wait times are drastically longer than what is being reported,” Kaine said. “The VA’s own standard on appointment wait times is not being met, either due to a lack of understanding or a lack of training. The bottom line is our veterans are not getting the timely care they deserve.”

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