The Department of Veterans Affairs suspended a program that sent teams of doctors and monitors to try to improve its worst-performing facilities for approximately two years, according to a published report.
The Wall Street Journal, citing agency doctors and internal records, reported that the visits were "paused" beginning in early 2011. Dr. Carolyn Clancy, the head of the agency's quality and safety program, said the VA had begun to revive the program about a year ago.
The Journal report specifies seven VA hospitals that have consistently received a rating of one star out of a possible five from the VA since at least 2011. Those hospitals are located in Augusta, Ga.; Little Rock, Ark.; Providence, R.I.; Murfreesboro, Tenn.; Oklahoma City; Phoenix; and Puget Sound (Seattle), Wash. The star rating system measures hospitals according to key performance standards, including death rates among acute-care patients and among patients suffering from congestive heart failure and pneumonia. Length of stays and readmission rates are also taken into consideration.
It is not clear why the agency halted the visits, though the Journal report cites current and former VA doctors who claim that top managers of the agency played down the utility of basing the ratings system on specific medical outcomes.
Dr. Clancy claimed to the Journal that each of the hospitals with the poorest rating "has gotten at least one visit in the last year or year and a half."
The report comes as a government report released Monday found that more than 57,000 veterans have been waiting 90 days or more for their first VA medical appointments, and an additional 64,000 appear to have never gotten appointments at all after enrolling.
"This behavior runs counter to our core values," the report said. "The overarching environment and culture which allowed this state of practice to take root must be confronted head-on."
Richard Griffin, the VA's acting inspector general, said his office was investigating 69 VA medical facilities nationwide for possible wrongdoing, up from 42 two weeks ago. The investigations could result in criminal charges, which Griffin said may be needed to combat senior VA leaders who have allowed and even encouraged fraudulent scheduling practices often referred to as "gaming" the system.
"Once someone loses his job or gets criminally charged for doing this, it will no longer be a game. And that will be the shot heard around the system," Griffin said Monday night at a hearing of the House Veterans Affairs Committee.
Acting VA Secretary Sloan Gibson said earlier Monday that VA officials have contacted 50,000 veterans across the country to get them off waiting lists and into clinics and are in the process of contacting 40,000 more.
The controversy forced VA Secretary Eric Shinseki to resign May 30. Shinseki took the blame for what he decried as a "lack of integrity" through the network. Legislation is being written in both the House and Senate to allow more veterans who can't get timely VA appointments to see doctors listed as providers under Medicare or the military's TRICARE program. The proposals also would make it easier to fire senior VA regional officials and hospital administrators.
House Speaker John Boehner, R-Ohio, said the report demonstrated that Congress must act immediately.
"The fact that more than 57,000 veterans are still waiting for their first doctor appointment from the VA is a national disgrace," Boehner said.
The new audit said a 14-day agency target for waiting times was "not attainable," given poor planning and a growing demand for VA services as Vietnam-era vets age and younger veterans from the Iraq and Afghanistan wars enter the system. The 2011 decision by senior VA officials to set the target, and then base bonuses on meeting it, was "an organizational leadership failure," the report said.
A previous inspector general's investigation into the troubled Phoenix VA Health Care System found that about 1,700 veterans in need of care were "at risk of being lost or forgotten" after being kept off an official, electronic waiting list.
The report issued Monday offers a broader picture of the overall system. The audit includes interviews with more than 3,772 employees nationwide between May 12 and June 3. Respondents at 14 sites reported having been sanctioned or punished over scheduling practices.
Wait times for new patients far exceeded the 14-day goal, the audit said. For example, the wait time for primary care screening appointment at Baltimore's VA health care center was almost 81 days. At Canandaigua, New York, it was 72 days. On the other hand, at Coatesville, Pennsylvania, it was only 17 days and in Bedford, Massachusetts just 12 days. The longest wait was in Honolulu — 145 days.
But for veterans already in the system, waits were much shorter.
For example, established patients at VA facilities in New Jersey, Connecticut and Battle Creek, Michigan, waited an average of only one day to see health care providers. The longest average wait for veterans already in the system was 30 days, in Fayetteville, North Carolina, a military-heavy region with Fort Bragg Army Base and Pope Air Force Base nearby.
It was not clear whether all 64,000 veterans who did not get appointments remained interested in being seen by the VA.
Despite the long waiting list, the audit said most veterans seeking care are able to get timely appointments. About 96 percent of the 6 million appointments scheduled at VA facilities as of May 15 were slated within 30 days, the report said.
That reassuring statistic came with a warning, however. Under VA guidelines that have since been rescinded, veterans were supposed to be seen within 14 days of their desired date for a primary care appointment. The inspector general described a process in which schedulers simply selected the next available appointment and used that as the purported desired date. That practice allowed numerous — and false — zero-day wait times, the IG said.
Gibson, the acting VA secretary, said the department is hiring new workers at overburdened clinics and other health care facilities across the nation and is deploying mobile medical units to treat additional veterans.
The VA believes it will need $300 million over the next three months to accelerate medical care for veterans who have been waiting for appointments, a senior agency official said in a conference call with reporters. That effort would include expanding clinics' hours and paying for some veterans to see non-VA providers. The official said he could not say how many additional health providers the VA would need to improve its service.
The report said 112 — or 15 percent — of the 731 VA facilities that auditors visited will require additional investigation, because of indications that data on patients' appointment dates may have been falsified, or that workers may have been instructed to falsify lists, or other problems.
Boehner said the House would act on legislation this week to allow veterans waiting at least a month for VA appointments to see non-VA doctors, and said the Senate should approve it, too. An emerging bipartisan compromise in the Senate is broader than that, but senators have yet to vote on it.
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The Associated Press contributed to this report.