Blame is top of mind in political circles when it comes to the scandal surrounding appointment scheduling, hidden waitlists and delayed patient care at Department of Veterans Affairs health care facilities.
In Maine, that blame game has reached a fever pitch among some Republicans as they try to accuse U.S. Rep. Mike Michaud — the Democrats’ nominee for governor — of presiding over the agency’s malfeasance as the ranking Democrat on the House Veterans Affairs Committee.
Who knew a minority party member of Congress from Maine’s 2nd District had so much influence over day-to-day operations at the Department of Veterans Affairs?
The rush to blame Michaud is simplistic and distorts the nature of the numerous failures the Department of Veterans Affairs must address in order to better serve veterans and regain public confidence. Those failures clearly point to management missteps by top brass and internal shortcomings of individual health care facilities in the VA system.
At the Phoenix facility, where the current controversy got its start, the VA’s Office of the Inspector General found that 1,700 veterans were on a secret, unofficial waitlist for doctors’ appointments. The shorter, “official” waitlist, with 1,400 veterans, made it appear as if the facility was scheduling appointments for patients faster than it actually was.
Based on the Phoenix facility’s “official” data, the average wait time for a 226-veteran sample reviewed by the inspector general was 24 days — 10 days longer than the VA’s stated 14-day goal. When the real data were factored in, the wait time for those 226 veterans grew to 115 days for a first primary care appointment.
The hidden waitlist practice obscures the full extent of one of the VA’s chief liabilities — limited access to care — making it easy for VA facilities entrusted with safeguarding veterans’ health to lose track of and neglect the needs of their patients.
The practice hasn’t been confined to the Phoenix facility — where, according to CNN, 40 veterans died while awaiting care. Rather, it points to a management failure emanating from the top. According to a VA care access audit released this week, the widespread manipulation is a direct result of the agency’s goal to schedule appointments for veterans within 14 days. The agency implemented the goal and attached financial incentives to it without taking the proper steps to determine whether the goal was attainable, given available resources.
The VA has long struggled to get a handle on wait times in its vast medical network of hundreds of clinics and hospitals that serve 230,000 veterans daily and 6.5 million each year. In 2002, the department introduced an electronic waitlist for patients who couldn’t secure near-term appointments as a way to track the entire wait time process in a uniform way.
But individual VA facilities continued to stray from the newly instituted scheduling procedures and understate the number of veterans waiting for appointments. In some cases, managers told schedulers to go against established procedures. In other cases, the missteps could be attributed to poor scheduler training. In others, the VA didn’t set policies with sufficient detail.
The task became more complicated as veterans returned from Afghanistan and Iraq and signed up for VA services at higher rates than previous groups of veterans. There’s also increased demand from Vietnam-era veterans as they age and seek care. Between 2005 and 2012, the number of outpatient appointments provided by the VA increased 45 percent, to 84 million from 58 million.
The VA’s inspector general continued to track the wait time issue, make recommendations for changes and track the VA’s progress in taking action. All inspector general reports are public, and the inspector general regularly updates congressional oversight committees, such as Michaud’s House Veterans Affairs Committee.
Few other health care organizations in the U.S. have such a level of oversight. And, on the whole, few U.S. health care organizations rival the VA for quality. Multiple reviews show the VA outperforms private hospitals on virtually all quality measures. The level of oversight, however, guarantees that Americans hear most about the VA’s problems.
Surely Michaud, and many others, could have been more proactive in pressing the VA to act on the inspector general’s frequent findings of botched scheduling. But it’s important to recognize Michaud’s role: He’s a member of an oversight committee, not a high-level VA manager presiding over a giant organization’s successes and very public failures.