VA Now Has Shorter Wait Times Than Private Clinics, AMA Study Claims

Wait times at Department of Veterans Affairs hospitals and clinics have gone down significantly from recent years and are now shorter on average than those in private-sector health care, at least in big cities, according to a new study from the Journal of the American Medical Association (JAMA).

Critics of the study pointed out that main contributors to the JAMA report were current and former VA executives, including Dr. David Shulkin, who was fired as VA secretary last year by President Donald Trump.

In a statement, VA Secretary Robert Wilkie said the JAMA report published Jan. 18 showed that the VA "has made a concerted, transparent effort to improve access to care" since 2014, when wait-times scandals and doctored records led to the resignation of former VA Secretary and retired Army Gen. Eric Shinseki.

"This study affirms that VA has made notable progress in improving access in primary care, and other key specialty care areas," Wilkie said.

The cross-sectional JAMA study of wait-time data from VA facilities and private-sector hospitals focused on primary care, dermatology, cardiology and orthopedics in 15 major metropolitan areas.

The findings were that "there was no statistically significant difference between private sector and VA mean wait times in 2014" and, in 2017, "mean wait times were statistically significantly shorter for the VA," the JAMA report said.

"In 2014 the average wait time in V.A. hospitals was 22.5 days, compared with 18.7 in the private sector," the study said, but in 2017, "mean wait time at V.A. hospitals had gone down to 17.7 days, while rising to 29.8 for private practitioners."

The study, titled "Comparison of Wait Times for New Patients Between the Private Sector and Department of Veterans Affairs Medical Centers," relied on wait-time data provided by the VA and calculated private-sector data from a survey conducted by a physicians' search firm, Merritt Hawkins, using the so-called "secret shopper" method in nearly 2,000 medical offices in metropolitan areas.

"For the secret shoppers method, the research associates at MH [Merritt Hawkins] called physicians' offices asking to be told the first available time for a new-patient appointment," the JAMA study said.

"This earliest availability was recorded as the wait time. However, the VA data record scheduled wait times, which may not reflect the earliest available appointment," the study said.

The JAMA report also noted that rural areas and follow-on care were excluded from the analysis and said that "follow-up studies are critical to analyze access to the entirety of VA health care," since nearly one-quarter of veterans live in rural areas.

The overall conclusion of the report was that "access to care within VA facilities appears to have improved between 2014 and 2017 and appears to have surpassed access in the private sector for 3 of the 4 specialties evaluated," with the exception of orthopedics.

In 2014, the VA was rocked by wait-time scandals and allegations of manipulated data at the VA medical center in Phoenix, Arizona. "This incident damaged the VA's credibility and created a public perception regarding the VA health care system's inability to see patients in a timely manner," the JAMA report said.

The VA has since worked to improve access and reduce wait times.

"There is evidence suggesting that these efforts have improved access to care, including reports that 22% of VA patients are now seen on the same day as the requested appointment," the report said. However, "Despite, these efforts, the adequacy of access to VA care remains unclear."

As a result of the 2014 scandals, the VA initiated the Choice program to expand private-care options for veterans. Last year, Congress passed and President Trump signed into law the VA Mission Act to consolidate and streamline the Choice program, which has been riddled with inefficiencies.

In June, the Government Accountability Office issued a report stating that many veterans who opted for the Choice program to avoid wait times still faced delays that could stretch for months before seeing a doctor.

In response to the JAMA report, a posting on the Disabled American Veterans website came under the heading: "Veterans Affairs Spins 'JAMA Study' It Authored On VA Wait Times."

In addition to Shulkin, the posting noted that another contributor to the JAMA study was Dr. Carolyn Clancy, the former acting head of the Veterans Health Administration. She was replaced in July by Dr. Richard Stone as acting head of the VHA and has now taken the position at the VA of deputy under secretary for discovery, education and affiliate networks.

Stone, the former deputy surgeon general of the Army, has yet to receive Senate confirmation. The VHA has not had a permanent head since Shulkin left the position in January 2017 to become VA secretary.

-- Richard Sisk can be reached at richard.sisk@military.com.