Already under fire for secret waiting lists and shoddy care, the Department of Veterans Affairs June 9 released the results of a system-wide audit of the VA’s scheduling and access management practices, which finds that more than 57,000 patients are awaiting initial appointments at VA hospitals and clinics around the country.

According to the VA audit, there are roughly 57,436 veterans nationwide who are waiting to be scheduled for care and another 63,869 who over the past 10 years have enrolled in the VA healthcare system and have not been seen for an appointment.

“We’re providing the details to offer transparency into the scale of our challenges, and of our system itself,” said Acting Secretary of Veterans Affairs Sloan Gibson. “I’ll repeat--this data shows the extent of the systemic problems we face, problems that demand immediate actions. As of today, VA has contacted 50,000 Veterans across the country to get them off of wait lists and into clinics. Veterans deserve to have full faith in their VA, and they will keep hearing from us until all our Veterans receive the care they’ve earned.”

The audit, conducted between May 12 and June 3, looks at 731 VA hospitals and clinics nationwide and reports long wait times for patients trying to schedule initial doctor appointments. The audit’s findings are the latest damaging revelations regarding the VA. On May 30, VA Secretary Eric Shinseki resigned amid the furor resulting from reports of patients dying while awaiting appointments and efforts to cover it up by the Phoenix VA center and many other facilities.

According to the audit, an overly complicated scheduling process resulted in high potential to create confusion among scheduling clerks and front-line supervisors. In addition, the VA acknowledged that meeting a 14-day target wait-time for new appointments was “simply not attainable” given the ongoing challenge of finding sufficient provider slots to accommodate a growing demand for services.

At the same time, the audit revealed that 13 percent of scheduling staff that were interviewed indicated that they received instruction from supervisors or others to falsify appointment dates and to enter a “desired date” different from the date Veterans had requested. Moreover, 8 percent of scheduling staff indicated in the audit that they used alternatives to the official Electronic Wait List or Veterans Health Information Systems and Technology Architecture systems to make wait times look better.

Testifying June 9 before the House Committee on Veterans’ Affairs, Philip Matkovsky, the VA’s assistant deputy under secretary for health for administrative operations, told lawmakers that the VA has “hard-working staff on the frontline who work in a high stress, complicated environment with--quite frankly--completely outdated technology.” In addition, Matkovsky said VA staff rely on an antiquated system that requires numerous workarounds.

“We use the Electronic Wait List if we are unable to schedule a Veteran who’s receiving their first specialty care consult within 90 days,” he added. “The correct use of that is to ensure that we can work a Veteran into an appointment sooner.” However, Matkovsky said that the VA “needs to get eyes” on the Electronic Wait List, manage it, and make sure that frontline staff at the VA’s medical centers are accurately working the list to get patients appointments in a timely fashion.      

“Based on the findings of the audit, VA will critically review its performance management, education, and communication systems to determine how performance goals were conveyed across the chain of command such that some front-line, middle, and senior managers felt compelled to manipulate VA’s scheduling processes,” states the audit report. “This behavior runs counter to VA’s core values; the overarching environment and culture which allowed this state of practice to take root must be confronted head-on if VA is to evolve to be more capable of adjusting systems, leadership, and resources to meet the needs of Veterans and families. It must also be confronted in order to regain the trust of the Veterans that VA serves.”

The VA’s national audit and patient access data are available here.

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