- Forty-three percent veterans who requested appointments within the Veterans Affairs health system failed to receive the care they asked for, according to testimony from Government Affairs Office (GAO) Director of Healthcare Debra A. Draper. Fewer than 20% of the 150 consults reviewed by the office were conducted within 90 days, while 40% of physical therapy patients waited up to 152 days without “any apparent action” to schedule an appointment. The findings add to a troubling dossier of evidence suggesting deeply rooted problems in the way the VA system provides access to care despite its advanced electronic scheduling system and highly-regarded EHR.
Following an Office of the Inspector General (OIG) report identifying 1700 veterans who were left off the VA’s official electronic wait list at the Phoenix VA medical center and the results of an internal audit pinning the number of ignored or improperly allocated patients at 120,000 system-wide, Draper’s testimony to the House of Representatives’ Committee on Veterans Affairs delves deeper into the delays and abuses of the VA’s scheduling system that has outraged lawmakers and made several prominent heads roll.
The VA’s regulations require that all consult requests be reviewed within seven days of receipt and fully completed within 90 days. However, Draper says, due to a lack of standardized processes among VA facilities, officials “could not accurately determine whether patients actually received the care they needed, or if they received the care in a timely fashion. According to VHA officials, approximately 2 million consults (both clinical and administrative consults) were unresolved for more than 90 days.” Of the 150 consults reviewed for the GAO’s report, 21% were not initially reviewed within the first seven days of the request, she adds.
The report also reveals that poor coordination with non-VA healthcare providers led to the death of at least one patient who failed to receive necessary cardiac surgery following several delays, lost information, and appointments canceled by the VA. At one facility, Draper notes, eighteen patient appointments were canceled without clinical review on the same day that a task for addressing unresolved consults was due.
GAO determined that the VA did not adhere to its own business rules, limiting the usefulness of the system’s data in determining the true extent of wrongdoing throughout the VA’s healthcare facilities. “Ultimately, the lack of independent verification and documentation of how VA Medical Centers addressed these unresolved consults may have resulted in VHA consult data that inaccurately reflected whether patients received the care needed or received it in a timely manner,” Draper writes.
The report recommends that the VA take action to standardize its data reporting systems and consistently implement wait time procedures that accurately reflect the administration of patient care. The VA should also conduct routine internal reviews to ensure that staff members are adhering to regulations.
“It is important that VA assess the extent to which these actions are achieving improvements in medical appointment wait times and scheduling oversight as intended,” Draper concludes. “Ultimately, VHA’s ability to ensure and accurately monitor access to timely medical appointments is critical to ensuring quality health care to veterans, who may have medical conditions that worsen if access is delayed.”