VA Audit: Appointments Gamed, 'Leadership Failed'

An audit of major veterans' hospitals and clinics across the country confirms that appointment schedulers were pressured to game the system to make it appear the facility was meeting a goal of getting veterans in to see doctors within two weeks.

The Department of Veterans Affairs did not release a statement on the audit, which was ordered after allegations surfaced that the VA Medical Center in Phoenix, Arizona, was keeping a secret list of veterans waiting for a doctor's appointment.

The audit says that the two-week standard for getting a veteran requesting an appointment in to see a doctor is "simply not attainable" given the number of doctors the VA has and the growing number of veterans seeking care

"Imposing this expectation on the field before ascertaining required resources and its ensuing broad promulgation represent an organizational leadership failure," the report states.

The two-week timeframe was established as a performance standard by VA Secretary Eric Shinseki, who on Friday resigned. Obama named VA Deputy Secretary Sloan Gibson, a former head of USO, as acting secretary.

The report released today is only Phase I of the national audit. It covered 138 parent medical centers covering 216 sites in all, including outpatient clinics.

The audit recommended the VA accelerate care for veterans now waiting for it; dump the 14-day performance goal from VA executive contracts; suspend executive bonuses in VA health care for 2014; and assess health care supply versus demand to ensure resources are deployed adequately.

Some of the recommendations are already in effect, and were announced by Shinseki earlier this morning in what would be his final speech as VA secretary.

Appearing before the National Coalition for Homeless Veterans Annual Conference in Washington, Shinseki said he had ordered the elimination of bonuses for 2014 for senior executives in the Veterans Health Administration. He also said veterans identified on the unauthorized lists were immediately being brought into the system.

The audit also confirmed an interim VA inspector general's report that found manipulation of patient appointment schedules across multiple VA hospitals and clinics.

Obama, in announcing Shinseki's resignation, said he was handed a copy of the audit by White House Deputy Chief of Staff Rob Nabors, who has been working with the VA looking into allegations of appointment gaming at the VA Medical Center in Phoenix.

Obama said the audit makes clear "that the misconduct has not been limited to a few VA facilities, but many across the country. "

The audit also said manipulation of appointment schedules was pervasive enough that the VA needs to re-examine its entire performance management system. In particular, it should determine if its goals and the way it measures them are realistic.

The VA and Congress have been aware for at least a few years of allegations that some hospital managers pushed staff to keep the wait times within the VA standard, at least in part because it was a factor in whether the official would receive an annual bonus.

The audit also found that efforts to meet veterans' and clinicians' needs led to an overly complicated scheduling process. The process created confusion among scheduling staff and front-line supervisors, it said.

Additionally, the audit found that the VA's use of a so-called "desired date" -- when the patient wants to be seen -- is hard to justify when compared to accepted practices for setting appointments, such as setting a specific date on when a provider is available.

Meanwhile, 13 percent of schedule staff interviewed for the audit said they were told to enter into the "desired date" box a date different from the one the veteran requested. At least one instance of this was identified in 64 percent of the VA facilities visited for the audit.

Also, 7 to 8 percent of scheduling staff said they used alternatives to the authorized electronic wait list, though the investigators did not determine if the alternatives used could be justified under the VA's policy. The interim IG report confirmed that the Phoenix VA hospital was utilizing separate and unauthorized lists of veterans -- which numbered 1,700 -- who were simply waiting to get on the appointments schedule.

Whistleblowers at the Phoenix hospital say up to 40 vets may have died before seeing a doctor, though the IG says there is no evidence of that at this time.

Shinseki said he had believed it when his advisers reported to him that the system was working, and that the Phoenix situation was an aberration.

The IG report and the audit convinced him otherwise.

"Given the facts that I now know, I apologize as the senior leader, Department of Veterans Affairs," he said.

-- Bryant Jordan can be reached at bryant.jordan@monster.com.