In a snapshot of an overwhelmed Veterans Health Administration system, auditors found more than 57,000 veterans waiting at least 90 days to be scheduled for care and nearly 64,000 others enrolled in the system in the past decade who have yet to be seen for an appointment.
In Florida, more than 8,500 new patients were on the electronic wait list and unable to get scheduled within 90 days or less, according to the results of a report released Monday on an audit ordered by former VA Secretary Eric Shinseki before he resigned last month. More than 5,200 veterans requested appointments from Florida facilities over the past decade but never got them, according to the report.
VA officials visited more than 700 sites and interviewed more than 3,700 clinical and administrative staff members, according to the report.
Gainesville had the most new patients waiting for 90 days or more, with 4,006, according to the report. Orlando had 2,115; Miami, 1,159; the C.W. Bill Young VA Medical Center (formerly known as Bay Pines VA Medical Center), 712; the James A. Haley Veterans’ Hospital in Tampa, 565 and West Palm Beach with 28.
Gainesville also led the way with 3,051 patients who signed up for appointments in the past decade only to never get them, followed by the Young center with 1,193, West Palm Beach with 426, Miami with 265 and Haley with 238.
The Young center was also among more than 110 across the nation flagged for further review, according to the audit.
The report does not specifically say why the Young center, or any of the others, was identified for further review.
“The initial assessments of sites requiring further review is based on a review of qualitative responses by front-line staff to questions contained in site audit reports,” according to the report. “The listing of these sites should be understood as a preliminary step, and further actions will be taken after the determination of the extent of the issues related to scheduling and other management practices.”
Jason Dangel, spokesman for the Young center, said hospital officials do not know why the facility has been flagged, but said that it is “welcomed.
“No facility knows what the review means,” he said. “But it is welcomed and something we use to improve processes and the system.”
Patients waiting 90 days or more for an appointment may actually be seen sooner and are notified of open appointments when they become available, said Dangel. Under the VA’s new Accelerated Care Initiative, those patients may also be given the option of non-VA care if available, he said. Karen Collins, a spokeswoman for Haley, said that none of those patients is waiting to see a primary care physician, but are seeking high volume speciality care like dental, gastroenterology, ophthalmology, neurology, orthopedics, podiatry and urology. VISN 8 has already taken steps, first reported by the Tribune last week, to address that backlog, including contacting all veterans who have wait times extending beyond 90 days in these specialties to ask if they would like to keep their current appointments, offer an appointment sooner where capacity is available or determine if they need to speak to a provider for any immediate need. Officials at Haley set up a call center for veterans as well.
As for those who requested appointments over the past decade but never got them, Dangel said that list, generated when veterans use the online benefits application system, is one of several ways patients are notified about appointments. He and Collins also say that not all the veterans on that list are eligible for benefits and some may have applied more than once. The list is being monitored daily and constantly updated, said Dangel.
Systemwide, auditors found a host of concerns:
♦ A complicated scheduling process resulted in confusion among scheduling clerks and front-line supervisors.
♦ A 14-day wait-time performance target for new appointments was not only inconsistently deployed but was not attainable giving growing demand and lack of planning.
♦ 13 percent of scheduling staff interviewed indicated they received instruction from supervisors or others to enter a date different than what the veteran had requested in the appointment scheduling system.
♦ 8 percent of scheduling staff said they used alternatives to the official electronic wait list.
♦ In some cases, pressures were placed on schedulers to use unofficial lists or engage in inappropriate practices to make wait times seem shorter, according to the report.
“Where the OIG chooses not to immediately investigate,” the report says, “VHA leadership will launch either a fact finding or formal administrative investigation. Where misconduct is confirmed, appropriate personnel actions will promptly be pursued.”
“The VA has taken immediate steps and sweeping actions to fix system problems identified in this audit,” said Mary Kay Hollingsworth, spokeswoman for VISN 8, which covers most of Florida, south Georgia, Puerto Rico and the U.S. Virgin Islands. “And as part of that, acting Secretary Sloan Gibson announced a number of steps.”
Among other measures, Gibson announced the VA will add staff to get veterans off wait lists, deploy mobile clinics to service veterans awaiting care, hire additional clinical and patient support staff, hold senior leaders responsible by triggering administrative procedures to determine what personnel actions should be taken against responsible individuals and remove senior leaders when appropriate, eliminate the 14-day scheduling goal from employee performance contracts, institute a hiring freeze on most administrative positions and suspend senior executive performance awards for the fiscal year ending Sept. 30.
The audit found that as of May 15, more than 3,600 appointments at the Young center not including surgery or procedures — or 3 percent of the total — were scheduled 30 days or longer not including those on the Electronic Wait List. At Haley, more than 5,300 appointments not including surgery or procedures — 5 percent of the total — were scheduled 30 days or longer, not including the Electronic Wait List. Across VA Sunshine Healthcare Network, about 33,000 appointments were scheduled 30 days out or longer.
Nationally, patients scheduled 30 days out or longer, not including those on the Electronic Wait List, made up 4 percent of the more than 6 million total appointments scheduled, according to the report.
There were 1,983 new enrollee appointment requests at the Young center and 238 at Haley, according to the report.
New patients at the Young center waiting for a primary care appointment waited an average 47.55 days while the same patients at Haley waited 41.95 days.
By comparison, established patients waited an average of 2.85 days at the Young center while they waited an average of 2.07 days at Haley.
New mental health patients waited an average of 39.33 days at the Young center and 27.02 days at Haley, while established patients waited 2.16 days at the Young center and 3.19 days at Haley.
“Florida is home to almost 2 million veterans, making this audit especially alarming since it recommends additional review for the Young VA Medical Center in Tampa Bay,” said U.S. Sen. Marco Rubio (R-FL). “Our veterans deserve the best care, and the American people deserve a VA that operates with greater transparency and accountability.”
“Having even one facility flagged for further review shouldn’t be acceptable when it comes to taking care of our veterans,” said U.S. Sen. Bill Nelson. “And the audit identifies more than that in Florida so the goal now is to make any changes that are needed at these facilities.”
The audit “shows beyond the shadow of a doubt that systemic problems exist within our country’s VA system,” said U.S. Rep. David Jolly, a member of the House Veterans Affairs Committee. The C.W. Bill Young VA Medical Center is among facilities flagged for additional review and it is my hope that any new information will be quickly forthcoming. The Director has assured me there are no ‘secret wait lists’ at the facility, and I know that she continues to work daily to address wait times.”