The VA, Still The “Best Care Anywhere”

Today, “Economist’s View showcased Paul Krugman’s latest NYT article“Veterans and Zombies”. Paul discusses how the hyped-up VA issues are being used as an example of under performing government healthcare to emphasize how bad the much larger PPACA healthcare reform could be if allowed to proceed. Of course this is not true; but both Mark and Paul missed the data found by the most recent VA audit. The results of the audit were released June 9th. I left a long reply on the thread detailing the findings of the recent VA audit.

There is no comparison to be made of the VA healthcare to private healthcare. The VA is ahead of private healthcare and where private healthcare should be if it were going to improve. In a nutshell, the VA is well beyond the typical private healthcare system in providing “evidence-based protocols of care — not inadvertently ordering up dangerous combinations of drugs, or performing unnecessary surgeries and tests just to make a buck and treating the whole patient and not just one part at a time.” The services for fees cost model does not exist in VA healthcare for veterans.

If you remember, I had recently written “Wait Times at the VA” detailing what the recent Inspector General had discovered in the audit of the VA as reported June 9th “U.S. Department of Veterans Affairs VA Access Audit & Wait Times Fact Sheet System-Wide Overview”. Phillip Longman the author of the “Best Care Anywhere” featured the Inspector General’s report on the Washington Monthly “Just How Long Is The Wait”

“The nationwide Access Audit covered a total of 731 separate points of access, and involved over 3,772 interviews of clinical and administrative staff involved in the scheduling process at VA Medical Centers (VAMC), large Community Based Outpatient Clinics (CBOC) serving at least 10,000 Veterans and a sampling of smaller clinics.” Included in the finding were these issues:

– A complicated scheduling process resulted in confusion among scheduling clerks and front-line supervisors.
– A 14 day wait-time performance target for new appointments was not only inconsistently deployed throughout the health care system but was not
attainable given growing demand for services and lack of planning for resource requirements.
– Overall, 13% of scheduling staff interviewed indicated they received instruction (from supervisors or others) to enter a date different than what
the Veteran had requested.
– 8% of scheduling staff indicated they used alternatives to the official Electronic Wait List (EWL). In some cases, pressures were placed on
schedulers to utilize unofficial lists or engage in inappropriate practices.

Immediate Actions to Be taken as a result of the Audit:

– VA has accelerated care for Veterans currently waiting for health care services. VHA is in the process of contacting in excess of 90,000 Veterans
during the first phase of VA’s “Accelerating Access to Care Initiative.” The first phase is the first appointment.
– VHA will provide Veterans who do not currently have an appointment, or are waiting for additional care or services longer than 30 days the option
to be rescheduled sooner if VA capacity exists, keep their scheduled appointment, or be referred to non-VA providers in the community.
– VA has suspended all VHA Senior Executive Performance Awards for FY14
– VHA will remove 14-day performance goal from employee performance plans
– VHA will revise, enhance and deploy Scheduling Training
– VHA will implement a site inspection process.

What is so different about this if one were to compare the VA to private healthcare is, if the issue occurred in private healthcare nothing would have happened or reported to correct the issue. The VA had set up guidelines for scheduling people, a 14 day window, and a procedure to report on it. People created work-a-rounds to the procedures and processes to surpass the reporting and they got caught. The issue went public. Little if any of this reporting occurs in private healthcare, much less public reporting. Yet Congress and critics think that closing down the VA and turning veterans over to the private healthcare system is a benefit to veterans. It is not a benefit to veterans and is a detriment

Audit Findings: Long Term and Other Actions:

– VHA will overhaul the scheduling and access management directive.
– VHA will roll out near-term changes to the legacy scheduling system.
– VHA will acquire and deploy long-term scheduling software solutions.
– VHA will reassess and establish access timeliness goals.
– VHA will strengthen accountability for integrity in scheduling and access management.

The VA is implementing change to again take on scheduling of Veterans for appointments. That the VA even had a 14 day goal for appointments is far beyond what can be see in private healthcare except if one goes to the ER.

Wait Time Information

On May 15th, the VA had ~ 6 million appointments scheduled across its system. ~57,000 Veterans are waiting to be scheduled for care. ~ 63,000 veterans over the past ten years have enrolled in the VA healthcare system and have not been seen for an appointment. The VA is making contact with those who need scheduling and the new enrollees to clear up the backlog.

– Of the 6,004,350 total appointments scheduled, 96% of them or 5,763,291 appointment were made in 30 days or less.

– Conversely, 242,059 veterans or 4% of the 6,004,350 scheduled appointments were made after 30 days.

– The audit shows that even appointments at the Phoenix, AZ VA (the ground zero of the VA scandal), 89 percent of people enrolled in the system
received an appointment in less than 30 days. The average wait for established patients to see a primary care doc coming to just over 14 days.

– Most everywhere else in the VA system, average wait times for established patients to see a primary care doc are in the range of 2 to 4 days, as
are waiting times to receive specialty care.

Mind you, three months for a doctor’s visit is too long; but, it is not so out of the ordinary as what is being experienced in private healthcare today. The audit did reveal there are ~ 57,000 veterans who have waited for a doctor’s visit longer than 90 days and representing ~ 1% of the 6 million vets taken care of by the VA. Furthermore, there are ~ 63,000 veterans who are more-than-likely not the newly arrived veterans from Iraq/Afghanistan as claimed by CNN and the rest of the media. Much of this numeric can probably be explained by the relaxing of VA regulations on admission into VA care. Many Vietnam Veterans have reapplied to the VA with the idea we may be accepted. I would urge any veteran to apply as the regs do change as well as your income and you can be grandfathered even if the next president tightens the regulations as Bush did.

The VA is not flawless as many of veterans today know and I surely do. Of the 57,000 veterans waiting for an appointment, some veterans may have been forgotten by the VA, some may have moved to another city and missed the appointment, some may have gotten group insurance, and many may have enrolled immediately upon discharge to insure grandfathering and not need an appointment. This was the broad base upon which CNN made up its news story along with other media outlets and politicians with unsubstantiated data which is proving to be more hyperbole than fact.

Sending veterans to private healthcare after breaking up the VA is what CNN, the media, and the politician’s call a “benefit” bestowed upon Veterans. It is not a benefit and will only make healthcare treatment worse for veterans.