By Rose Hoban

Veterans at VA hospitals and clinics in North Carolina and Virginia had longer wait times for appointments, care and referrals to specialists, including for mental health care, than the electronic scheduling system showed  to regional Veterans Affairs leadership.

An audit released last week by the Veterans Health Administration Office of the Inspector General found that 36 percent of appointments for new patients at facilities in the Veterans Integrated Service Network that covers North Carolina and Virginia had wait times of longer than a month.

For people with extended waits for new appointments, their average wait was 59 days. And because of inaccurate wait time data supplied to the VISN leadership, those same veterans were denied the opportunity to seek treatment outside the VA system under the Veterans Choice Program.

VISN 6 is the Mid-Atlantic Health Care Network, comprised of VA Health Care facilities in Virginia and North Carolina. Image courtesy: Dept of Veterans Affairs

“For those veterans who did not receive care through Choice within 30 days, we estimated they waited an average of 98 days to receive their care,” the report said.

The audit noted that inspectors reviewed the cases of 84 patients in the longer-wait-time group who either died or had “significant delays in care.” Reviewers determined that none of these patients had suffered “any harm.”

“Much of the data covered in the audit captures a period extending back into 2014, offering a refracted portrayal of our care for Veterans. since the environment has been in a state of continual regulatory and operational change,” said a statement from the regional leadership.

Delayed start

The audit looked at a sample of more than 1,400 appointments made from October through December 2015. Auditors from the Inspector General’s office visited a dozen facilities in Virginia and North Carolina, including hospitals and healthcare centers in Asheville, Charlotte, Durham, Fayetteville, Greenville, Kernersville, Wilmington and Salisbury, as well as smaller clinics throughout the state.

The auditors found that in their sample of new appointments, 36 percent of veterans had to wait for an average of 59 days. Extrapolated out to the entire region over the same time period, it appears that as many as 20,600 people had similar waits for care.

“This was notably higher than the 5,500 appointments (10 percent) that VHA’s electronic scheduling system showed were scheduled greater than 30 days,” the report read.

A further breakdown of those numbers found that potentially:

  • Of 10,700 primary care appointments, 3,500 (33 percent) had wait times greater than 30 days with an average wait time of 51 days.
  • Of 4,800 mental health care appointments, 780 (16 percent) had wait times greater than 30 days with an average wait time of 59 days.
  • Of 41,500 specialty care appointments, 16,300 (39 percent) had wait times greater than 30 days with an average wait time of 60 days.

The report found that the inaccuracies in wait time data occurred because “medical facility staff did not consistently enter correct clinically indicated or supported preferred appointment dates” when they were making appointments for new patients.

This means that in about three-quarters of the appointments with long wait times, staff members erroneously entered dates into the scheduling system for clinics that weren’t seeing patients on a given day or entered appointments that were not for the correct clinical service.

And those inaccuracies made it appear as though wait times were shorter than 30 days.

“VA data reliability continues to be a high-risk area,” wrote Assistant Inspector General Larry Reinkemeyer in the report.

Referring to a report on VA data published by the US Government Accountability Office in 2015, Reinkemeyer said VA data reliability was a problem “because of inadequate oversight and accountability.”

“In its report, GAO stated VA’s oversight efforts are often impeded by its reliance on facilities’ self-reported data, which lack independent validation and are often inaccurate or incomplete.”

Officials respond

“We recognize that there is always opportunity for improvement,” said Mark Shelhorse, MD, acting Mid-Atlantic Health Care Network (VISN 6) director in his statement.

“Since 2014, we have continually taken steps to ensure proper scheduling practices and have made substantial investments to apply the right combination of staff, facilities, and tools to increase access to care for Veterans in the VISN.”

The release noted that in the last two years, five community-based outpatient clinics and three health care centers had been opened in Virginia and North Carolina region.

“In fact, VISN 6 has opened more than one million square feet of clinical space over the last year,” the statement said.

The VA Durham Medical Center director DeAnne Seekins said in a separate statement her facility has been facing increased demand, and has been scaling up.

“Since April 2014, we hired 1,325 staff, including more than 100 physicians and 250 nurses. Today, 3,428 clinical and support staff stands ready to provide quality healthcare that meets the unique needs of Veterans,” Seekins said.

Seekins said that as of February, about 93 percent of patients were being seen within 30 days of a desired appointment date, and that wait times for mental health services had been whittled to 3.2 days. She also said that Durham’s Scheduler Service Line was a best practice noted by the Inspector General’s auditors.

She admitted there’s a need for improvement, even while noting the Virginia and North Carolina region is the fastest growing VA network in the country. About 337,000 veterans are currently registered to receive care from VA facilities in the two states.

Limited “Choice”

After initial reports of significant delays in getting veterans care nationwide, in 2014, Congress passed the Veterans Access, Choice and Accountability Act, which allows veterans to obtain care at a nearby civilian medical facility if waits at a VA center are longer than 30 days.

The law also required that the VA post wait times for scheduling an appointment online.

Reinkemeyer’s team found that the data available on the public postings and the information going to VISN 6 leadership was not reflective of the reality in the clinics.

And because of inaccurate data, auditors “estimated staff did not identify about 13,800 of these 15,300 appointments (90 percent) where veterans should have been added to the Veterans Choice List.”

Data: VHA, OIG

The errors occurred because, “VISN 6 and medical facility management did not ensure staff from medical facilities consistently implemented [Veterans Health Administration] scheduling requirements,” the report read. This occurred despite the fact that, since the nationwide scandal broke in 2014, the VA has “provided periodic guidance and training to clarify scheduling procedures.”

The inspectors also found internal audits on scheduling, which have been required since the beginning of 2008, were not being performed in the medical facilities. Earlier in 2014, the auditors noted that regional leaders provided guidance and examples of how to do the scheduling audits to medical facilities in North Carolina and Virginia.

Only “some” audits of scheduling staff were performed, however. And the documentation on those audits provided only spotty information for reviewers from the Office of Inspector General on how many scheduling clerks were audited, what their error rates were and whether the results were even discussed with the staff members making the mistakes.

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Rose Hoban is the founder and editor of NC Health News, as well as being the state government reporter. Hoban has been a registered nurse since 1992, but transitioned to journalism after earning degrees...