As of April, the average waiting times for appointments were seven days for primary care, 10 days for specialty care and four days for mental health care, according to VA’s most recent data.
However, the Government Accountability Office said in a report released Monday that for new enrollees, VA calculates wait times from the day that veterans set a specific appointment with a VA representative, rather than from when they first ask VA to contact them to schedule one.
The report 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 got 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.
The average waiting time for that entire sequence at the six medical centers the GAO studied ranged from 22 to 71 days. Of the 180 new enrollees the GAO tracked, 60 still had not 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 they were left off the eligibility list in error.
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.
In addition, the 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 effect, the VA continues to ignore the main forms of data manipulation while it continues to come to Congress, to this committee, saying there is no data manipulation,” the committee’s chairman, Rep. Jeff Miller (R-Fla.), said during a hearing Tuesday. “The obvious result of VA reporting only a portion of a veteran’s actual wait time is artificially low results.”
“It is time for VA to stop using misleading data to tout wait time successes that simply do not show the real wait-time experience of our veterans,” he said.
David Shulkin, VA’s undersecretary for health, said Tuesday that he is “very, very impatient to get this problem resolved and I am very concerned that we have data out there that is not necessarily understandable by people. I am concerned when I hear about mistakes being made.”
However, several members of the committee and witnesses stressed that the issues have persisted for years.
Debra Draper, director of the GAO’s health-care team, said that “since 2000 and particularly over the past five years we have consistently reported on the VA’s failure to insure veterans timely access to health care.”
“I wish I was here today to discuss better news but unfortunately that’s not the case,” she said. The new report “found many of the same problems as we have previously reported. . . . to date, we have seen, at best, little progress by the VA in addressing the issues.”
Larry Reinkemeyer, an official with VA’s independent inspector general’s office, similarly said that office has been raising concerns about wait times since 2005. The inspector general has investigated so many allegations of manipulation in the past several years that it recently began bunching its findings by state.
“We continue to see the [official VA] data as unreliable,” he said. “The data that has been discussed today, we don’t see it. Every facility we go to, it’s not accurate.”
Shulkin said that in his review of 72 inspector general reports, only 11 found intentional manipulation. Those resulted in 29 employees being disciplined, he said, although four were fired and five retired first.
He said that since 2014, VA has been taking other steps, including eliminating a prior cash bonus for employees when certain wait-time targets were met, boosting training for schedulers and upgrading software.
“You paint much too rosy a picture. The system is broken,” said Rep. Doug Lamborn (R-Colo.). “People want real reform, real change and not just talking points about how everything is about to be fixed.”
Shulkin said, “I am acknowledging that we still have significant issues and we have a lot of work to do. . . . we’re headed in the right direction but we are a long way from declaring that we’ve got this problem solved.”
Shulkin and several committee members also called for updating a 2014 law passed in the wake of the first disclosures, the Veterans Access, Choice and Accountability Act. The law allows veterans facing long waits or lengthy travel distances to obtain health-care services from other providers at VA’s expense, but has been relatively little used in practice.
Miller and several other committee members also called on VA to be more aggressive in taking disciplinary actions. The 2014 law restricted the appeal rights for VA’s senior executives, but despite those limits, hearing officers recently overturned the department in three high-profile cases.
VA has 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.
The House already has passed a bill, now pending in the Senate, to extend across 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 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.