Rush of Vets to Non-VA Care a Concern

June 12, 2014 | Tom Philpott

tom-phipottMILITARY UPDATE: VA, IG Warn Against Rush of Veterans into Private Care

A report by the Department of Veterans Affairs’ inspector general and a separate “access audit” of appointment scheduling practices across VA healthcare facilities confirm system-wide abuses to distort wait times for care, which have put patients at risk and shaken confidence in how VA hospitals and clinics are staffed, managed and resourced.

Yet even as the acting IG and another senior VA official confirmed the depth of the patient wait-time scandal at hearing Monday of the House veterans affairs committee, as well as possible criminal activity by some administrators, they cautioned irate lawmakers against sending thousands more VA patients into the private sector for healthcare needs.

The caution flags haven’t slowed Congress. On Tuesday, the House unanimously passed the Veterans Access to Care Act (HR 4810) from Rep. Jeff Miller (R-Fla.), VA committee chairman. It would require VA to offer non-VA care to enrolled veterans who cannot get an appointment within VA wait time goals or who live more than 40 miles from a VA medical facility.

On Wednesday, the Senate voted 93 to 3 for similar language as part of a more comprehensive bill, the Veterans’ Access to Care through Choice, Accountability and Transparency Act of 2014 (S 2450), from Sens. Bernie Sanders (I-Vt.), VA committee chairman, and John McCain (R-Ariz.).

VA already spends 10 percent of its health care budget, about $5 billion a year, on private sector care. In 2013, VA authorized and reimbursed for 15.3 million non-VA outpatient visits, a 72 percent increase since 2008. Eligibility for such care is complex, however, and varies by veteran status and circumstance. Pre-authorization usually is required.

In response to the appointments scandal, Congress wants VA to experiment for two years with giving many more veterans easier access to non-VA care. Veteran service organizations long have feared such moves as a step toward dismantling their prized, fully integrated VA health system. Big government critics say it will improve access to care but save tax dollars.

At Monday’s hearing, VA officials, including the acting inspector general, and a health expert from the Government Accountability Office, warned against a rush of veterans into private sector care, saying it could backfire if not carefully coordinated and properly resourced.

Testifying on results of a VA flash audit of patient access and wait times, Philip Matkovsky, assistant deputy under secretary for health administrative operations, apologized on behalf of VA leaders for a “systemic and totally unacceptable lack of integrity” found in appointment processing at some facilities, calling it “a breach of trust” and “indefensible.”

He also described a $300 million initiative to accelerate access to care in coming months with more medical staff overtime, expansion of VA clinic hours and more referrals to private sector providers as necessary.

Many VA facilities apparently manipulated wait time data to pretend to meet internal goals for providing timely access to care, which then would qualify senior staff for performance bonuses and promotions.

Richard J. Griffin, acting IG, testified that in addition to the Phoenix VA hospital where a whistleblower physician first exposed data manipulation, and said it had led to preventable deaths, IG teams were investigating 69 other VA facilities where there was evidence of data manipulation.

Griffin described two methods used to disguise actual wait times. The most common begins with a veteran calling for an appointment “120 days out because that’s the first available” and yet that appointment gets scored as being the veteran’s desired date. The facility then posts “zero waiting days” though the veteran actually waited four months.

“The other scenario is you get that appointment 120 days out. Two weeks before that appointment, it gets cancelled in the system and it gets recreated,” Griffin said. “The veteran is no wiser to the fact his appointment was cancelled because it’s been recreated for the same time and date.” But the appointment log shows a wait of two weeks not 120 days.

In Phoenix, the IG reviewed a statistically valid sample of 226 appointments for primary care. On average, patients waited 115 days for appointments. Only 16 percent were seen within the VA goal of 14 days. What the facility reported for those patients, however, was an average wait of 24 days with 57 percent treated within 14 days.

“Those are similar to what we found,” Matkovsky said of a nationwide “access audit” VA recently ran across more than 730 hospitals and clinics.

The IG report is preliminary and doesn’t answer whether vets died from delays in diagnosis or treatment. That will require analysis of VA and non-VA medical records, death certificates and autopsy reports by IG clinical teams. The IG is coordinating these investigations with the FBI.

Only one confirmed death from scheduling delays was discussed at Monday’s hearing. Debra A. Draper, director of health care for the Government Accountability Office, used it as a cautionary tale for lawmakers pressing to give veterans easier access to private sector care.

Last September, she said, VA diagnosed a veteran as having two aneurisms and scheduled heart surgery. A November operation was cancelled due to VA staffing issues. In December VA approved non-VA care, referring the patient to a local hospital. By late December, the non-VA care provider had lost the veteran’s information so VA had to resubmit its surgery request. In February, before surgery could be performed, the veteran died.

Use of more non-VA care will expand capacity but there are “potential pitfalls,” Draper said. For example, VA doesn’t tracked wait times for non-VA care and so it cannot estimate what waits will be for type of local care.

Griffin and Matkovsky also raised caution flags. The IG noted the value of an integrated health system to care for vets with multiple conditions. Matkovsky said transferring records with non-VA providers remains a hurdle.

“We need to ensure that there is sufficient non-VA care coordination staff in facilities. You can’t simply feed into community [care] and assume it’s going to take place,” Matkovsky warned. “We have to coordinate that care.”

Several committee members said they shared his concern. The next day the House passed Miller’s bill to expand access to non-VA care 426-to-0.

Let your elected officials know how you feel about this issue.

Send comments to Military Update, P.O. Box 231111, Centreville, VA, 20120, email milupdate@aol.com or twitter: Tom Philpott @Military_Update

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Tom Philpott has been breaking news for and about military people since 1977. After service in the Coast Guard, and 17 years as a reporter and senior editor with Army Times Publishing Company, Tom launched “Military Update,” his syndicated weekly news column, in 1994. “Military Update” features timely news and analysis on issues affecting active duty members, reservists, retirees and their families.

Visit Tom Philpott’s Military Update Archive to view his past articles.

Tom also edits a reader reaction column, “Military Forum.” The online “home” for both features is Military.com.

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Comments

  1. retiredmilitary says:

    Google this. Obama Administration Knew About VA’s Secret Wait Lists For Years

    • USMarine4 says:

      Yep – saw it. You aren't surprised are you. I'm not!

      Ed makes a good point. I am now under Medicare with TFL. The wait time to make an appointment for my doctor now averages 30 days. I checked around, and that appears to be the standard. To see a PA/NP is 7 days or less but the level of experience is severely lacking. Many hesitate to bring the doctor into the diagnosis and treatment situation. Not good! ObumerCare will only make it worse still.

    • wtpworrier says:

      Of course he did, and so did the President before him, but the President can't do anything until congress act, er…do their job in other words. Congress acted and passed a bill, and the President will sign it.
      "That is the way of things, the way of the Force", YODA….hehehehe!

      • Idmtmedic says:

        He has a pen and a phone doesn't he?

        • retiredmilitary says:

          And a set of golf clubs that are getting a workout once again this weekend. This time in California with his elitist friends that will be throwing him a dinner.

  2. EdUSMC0311 says:

    This is all funny to me. I use private insurance and am about to switch to the VA. Wait times are longer in the community than at my local VA. In fact, I imagine a lot of vets talking about how bad the VA sucks have never actually tried to use private doctors. It’s a mess. At the VA, everything is under one roof. In the community, I have to drive all over and they lose my shit all the time. Not to mention the VA is free and I spend a ton of money using private docs. If Vets are goin to clog up the private sector, I’ll use the VA lol.

    • wtpworrier says:

      It'll come to em soon enough. But I digress, people have to see it for themselves before they really believe it.

    • Idmtmedic says:

      Ed, the only problem with your statement is that the facts regarding VA care are coming to light. You think problems with civilian doctors is bad wait until it is managed under Obummer care. Some VA care is outstanding and some civilian care is outstanding. Entrenched administrators have monetarily gained while degrading care to Vets. It's systemic and no accountability. Hopefully your VA care will be outstanding, as it should be, but do not go in with blinders on lest you be the next one writing your Congressman to no avail.

  3. USMarine4 says:

    Overtime for doctors is the worst thing they should consider. Mistakes are made by fatigued medical staff at the detriment of the vets. There is plenty of work for the VA doctors as is which is the problem with scheduling. Adding more patients to an already overloaded system is just plain dumb. It is appropriate to move the overload to non-VA care just so long as the referral and approval process for specialty care is streamlined with no waiting period due to indecision by VA approval personnel.

    Once the VA hires more doctors and support staff, start bringing those are current overloads back into the VAMC system – not before.

  4. JJ Murray says:

    Obama and his folks don't care about the repercussions. If they did they would never have passed Obamacare knowing that it would create a doctor shortage. So, making the "gesture" of opening the field for vets by sending them to the private sector where they probably won't be able to find a doctor only matters to them because the morons out there will praise him for his "intentions" while ignoring the results.

    • wtpworrier says:

      Awww them right wingers, always somebody else fault. Look at the bright side, This is a perfect time to train more doctors…to replace the ones that got into politics, because they wanted more money. I guess money is more important to them than plying their chosen profession and helping others.

      "Necessity is the Motherhood of inventions"

      • Idmtmedic says:

        A brain surgeon probably doesn't need the money but I can tell you this. He sure as hell knows how to fix the healthcare mess. By the way, train more doctors? Lmao. Soooo how long do you think it takes to "train" a doctor and why would they get more doctors if the government is going to tell them how much money they can make? I'm sure all of those lawyers out there would be ok with the government telling them how much they should be making huh? Wait a minute, how many lawyers we have in Con-gress?

      • Yellow Devil says:

        That's rich. You leave with that quote that but confuse "necessity" with "government induced 2000+ page mandate." I keep asking left-wingers if they read the bill they rabidly supported, I still have yet to receive a positive response. I couldn't get past page 1042, because unless the rest of the bill was to rescind the first part of it, I realized it wasn't really about healthcare. It was about politicians having a monopoly on power and our personal choices.

  5. This scheduling problem is not new at the VA. Some of the hospitals have solved it a long time ago. Remember when all of the auto worker were laid off, and were losing their medical care? Well, around here, they were advised to go to the VA. At the VA in Ann Arbor, Michigan, at first, we had them parking everywhere, literally. But the last question that was asked of each patient before they left, was "Is there anything else that I can do for you?" They soon ironed it all out, and everything was running smoothly. The hospital has proceeded to continue with improvements to make it better for us patients, and the staff and volunteers are all top notch. Maybe they should use this hospital as an example for the others? Of course I know that every hospital has it's own little glitches, but here they handle them well.

  6. Be extremely careful of going to Civilian care as a veteran and expecting the VA to pay for it. You must have written authorization. The packet is at least 15 pages long. I know Viet vets who were told by the 24/7 phone nurses to go to a civilian hospital for emergency care since the VAMC closest to them was 70 or more miles a way. One of them now has a bill from the civilian hospital for over $25k and VA has refused to pay it since even though the VA nurse told him to go it was not authorized on paper. I was instructed to find an orthopedic clinic for injections that were needed and was sent the voucher request but one has to have a particular clinic/doctor already lined up before they VA will issue the voucher. VA sent with the forms, 4 pages, type written, of possible locations within 120 miles of me but none of those listed would accept the VA voucher due to previous problems with payments of the authorized voucher. Finally had to demand that the VAMC closest to me do the injections prescribed this one time. We'll see what happens the next time the injections are needed…. but I aint holdin my breath. I have found lately that if one continues to call every other day or so about an earlier appointment for procedures, exams, X-rays, Cat scans, etc., you just might cut the waiting time period by as much as 1/3rd if you are willing and able to go to your local VAMC in the evening

  7. Grunt0311 says:

    This is just another extension of mistrust in our VA system and untimely
    Making veterans sign up for Obamacare! I'm a United States veteran who served
    My country disabled in the military. Why should I have to pay for Obamacare?
    The tea party who infiltrated our ranks is behind these problems in our govt.
    Just to make a hallmark for their selfs under the guise of self-individualism.
    Medicare is here to stay just like social security!

    • I served 20 years in the Navy, am 40 percent disabled and I GET to pay for TRICARE, yearly premiums, copays and Pharmacy copays.

      So why should I have to pay, Grunt0311? It's unclear how long you served…

    • CPO,USN, (Ret.) says:

      What does the Tea Party have to do with Obamacare? The Tea Party is against Obamacare!? How does the Tea Party have anything to do with your situation?
      Suck it up Marine and quit whining! Self reliance is a beautiful thing!

    • It is also unclear what % disabled you are. But the fact that you are willing to rely on Medicare, leads me to believe that you are over 65. Just off the top, going to VA, you would pay little to nothing is my guess. If you are 50% or over, it is nothing. The only thing that you will need the Medicare for is your eye care and dental care. If you are at 100% those are all taken care of by the VA. In fact, I suggest that you drop the Medicare, and keep the money for yourself if you are at 100%. It is all legal.

  8. Grunt0311 says:

    The first hospital they should clean up is the John Haley in Tampa,Fl. The second is Bay Pines.

  9. Still not real clear to me. My and my brother`s VA Medical Center is 60 plus miles one way but we do take the shuttle bus but often getting there hours before our appointments. We have no trouble getting appointment through our local VA OPC clinic. Does this mileage apply to us allowing non-VA treatments. Don`t think so but unsure?

  10. Let me add my two cents, this nations' medical care system is short on everything. The VA is the largest on this planet. I have to use what older people have about get your needs met: 1 persistence; tenacity, keep copies of records every record that is created. keep a copy of records on hand to every new appointments. some suggestions

  11. Our gov't has a chronic habit of failing to see the consequences of the things they do or fail to do……especially after a horizon that extends beyond their next election cycle. That it is why it is critical to remove entrenched politicians and establish term limits for all federally elected politicians. For example, with the significant increase in survival rates of wounded combatants (wounds that normally have claimed a a life in Vietnam) because of advances in medical and patient delivery systems, how under prepared did the VA find itself after all the hyperbole Bush,Cheney, and Obama throw out there? A vast majority of our decision makers have never worn the uniform, let alone worn it under fire! McCain has, and served as a POW in Vietnam for 5 years. Yet, we can't get him out of our ears about how Rome is going to fall if we don't go bomb somebody in the next 24hrs. Time for a new senator Arizona? Point 2: How long does it take to train and educate a doctor? 6,7, maybe 8 years or more for specialists? Yet our gov't Sallie Mae has seen fit to rape our middle class families to ensure they remain slaves to the banks who hold their student loans. How many people are going to want to graduate hold a 6 figure debt to become a doctor and then work for the VA and treat the wounds of war for a lifetime unless there is a partial loan forgiveness in their somewhere. Come on Wash. DC, it's time to stop financing the war on the backs of the service members and their families. You've already cut our Tricare in some regions of the country, yet the billions in weapons contracts keep flowing to the weapons contractors! After 13 years of war….let's not have our soldiers marching to the beat of our General's when they get home because of your apathy for those who made you all very wealthy…serving as PUBLIC SERVANTS!

  12. That’s our gov’t hard at work again! Ready to fight another war, but no thought as to handle the wounded and injured when they return! They complain that Tricare is the most expensive benefit paid out to service members. Here’s a deal for ya congressmen: “We won’t collect on tricare if you stop sending us to needless wars and creating more wounded and infirm service-members’!