Patient load, lack of funding among the factors that led to VA scandal

Bonuses tied to wait times for care treatment weren't the only factors leading to the scandal that rocked the Veterans Administration (VA)--government decisions made years ago and a surge of patients helped drive the current mess, according to a USA Today report.

At the root of the problem is the fact that more and more aging veterans seek care for conditions not necessarily related to their military service, the publication found.

Since the Spanish-American War in 1898, Congress has continued to loosen the requirements for veterans seeking VA medical services after subsequent wars, Dennis W. Snook, a retired analyst for the Congressional Research Service, told USA Today. The broadening eligibility requirements, combined with the fact that medical advances allow people to live longer, created a surge in patients. As a result, the VA treated more conditions, which required more facilities.

The problem is Congress didn't support the necessary funding to keep up with the surge in patients and conditions. In fact, as the number of vets increased by 141 percent between 1996 and 2003, funding for VA services increased by less than 60 percent, the newspaper reports.

"That is sort of the genesis of the problem that we're seeing right now," U.S. Rep. Ann Kirkpatrick (D-Ariz.), a member of the House Veterans' Affairs Committee, told USA Today. "It's important to keep that in mind--that we're just seeing the convergence of increased usage and lack of funding."

Meanwhile, to help deal with the longer wait times for eligibility determination and medical appointments, the VA instituted a policy that called for facilities to schedule appointments within 14 days of a request. Bonuses were tied to the shorter wait times. The result: falsified records or secret waitlists to cover up the fact that thousands of veterans had to wait months for an appointment. The FBI plans to conduct a criminal investigation into the allegations.

An internal audit reveals that 57,000 veterans have been waiting for appointments for more than 90 days, FierceHealthcare previously reported. Congress, in a rare bipartisan effort, has approved bills authorizing spending of $35 billion over three years to pay for outside care for veterans.

But the Congressional Budget Office estimates that the bill could end up costing taxpayers $50 billion per year.

Meanwhile, the Associated Press reports that the long wait times confirmed in a VA report have some undisclosed caveats. The average wait times are likely much shorter because the analysis left out information about patients who received timely care.

"[The audit results] are valid numbers," Philip Matkovsky, an assistant deputy undersecretary at the Department of Veterans Affairs, told the AP about the audit results. However, he said, the report excluded information about patients who received quick care, and there were other factors behind the longer wait times.

The disparity is due in part to the audits' focus on future doctor visits, while other VA reports looked at past data systems as a reason for the falsifications.

The Congressional bills provide funding to hire more doctors to work at the VA, but a new survey indicates it won't be easy to convince physicians to work for the government, Forbes reports. Only 2 percent of physicians surveyed by The Medicus Firm, a physician staffing company, expressed interest in practicing in a military or government-employed practice.

 "Due to the national physician shortage, combined with a lack of physicians willing to commit to VA employment on a permanent or long-term basis, many VA facilities are forced to rely on locum tenens (temporary) physician staffing, which further breaks down communication, continuity of care and systemic accountability, Jim Stone, president of The Medicus Firm, told Forbes.

To learn more:
- here's the USA Today report
- read the Congressional Budget Office report
- check out the AP story via The Lynn Item
- read the Forbes article

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