Inconvenient News,
       by smintheus

Tuesday, June 12, 2007

  The VA's "facts" are no longer operative

In testimony to the House in February the head of Veterans Affairs, James Nicholson, painted a rosy picture of the speed with which VA hospitals schedule appointments for patients. The senior VA doctor, General Michael Kussman, repeated these assertions less than a month ago: "there are 39 million appointments a year, of which 37 million are achieved within 30 days... That’s about 95 percent." The same picture was given in the 2006 VA Annual Report published last November.

As almost any VA patient or staffer could have told Kussman, that can't be right. Now a draft report by the VA Inspector General, obtained by McClatchy, shows that appointments are filled less quickly, and that the VA statistics have been manipulated for public consumption.

Looking at appointments that the VA said took place within 30 days, the inspector general found that only 78 percent of primary-care appointments and only 73 percent of specialist visits were within 30 days.

As it did in 2005, the inspector general found that VA schedulers weren't following department procedures when making appointments.

The VA calculates waiting time as the difference between the appointment date and the patient's "desired date." But the report said schedulers often mistakenly recorded the first available appointment as the desired date, thus understating waiting time...

Schedulers used the wrong desired dates 72 percent of the time for the bulk of visits analyzed, according to the report.


And, again as nearly any vet could have explained, the IG report finds that the standards vary significantly from one hospital to the next.

Some medical centers performed far worse than average. In Columbia, S.C., and Chillicothe, Ohio, only 64 percent of VA appointments were within 30 days of a patient's request, the report said. The high score among centers studied was Detroit at 84 percent.


Tomorrow the Charlotte Observer will print its investigation of how and why wait-list statistics are being manipulated at one VA hopsital:

Within weeks last summer, the number of veterans officially waiting for eye care at the Asheville VA hospital ricocheted from zero to more than 800, down to zero and back up again, according to documents obtained by the Observer.

Documents and interviews about the waiting list detail a problem VA investigators have found with the way the agency tracks patients waiting for care. The Asheville incident also shows the difficulty of gauging how many veterans await service...

Generally, a VA hospital is supposed to put patients on an electronic waiting list if they can't get an appointment within 30 or 120 days, depending on their eligibility level for service. Scheduling is supposed to happen within seven days of when a patient or doctor requests an appointment.

In May 2006, Asheville staffers began telling top management they needed an eye clinic waiting list because they couldn't see patients quickly enough...

In August, workers received clearance to create the waiting list, a task that took two weeks. Then managers said to quickly remove everyone from the list. That happened just before the list would typically have been reviewed by regional managers in Durham.


The McClatchy report follows up upon this one from a month ago, which described some of the ways in which the VA has exaggerated its achievements.

A review by McClatchy of the quality measures the VA itself commonly cites found that:

  • The agency has touted how quickly veterans get in for appointments, but its own inspector general found that scheduling records have been manipulated repeatedly.


  • The VA boasted that its customer service ratings are 10 points higher than those of private-sector hospitals, but the survey it cited shows a far smaller gap.


  • Top officials repeatedly have said that a pivotal health-quality study ranked the agency's health care "higher than any other health-care system in this country." However, the study they cited wasn't designed to do that...


The VA's top health official, Dr. Michael Kussman, was asked in March about the agency's resources for PTSD. He said the VA had boosted PTSD treatment teams in its facilities.

"There are over 200 of them," he told a congressional subcommittee. He indicated that they were in all of the agency's roughly 155 hospitals.

When McClatchy asked for more detail, the VA said that about 40 hospitals didn't have the specialized units known as "PTSD clinical teams."...

Experts inside and outside the VA point to studies showing the agency does a good job, particularly with preventive care, and that it compares favorably with the private sector. While that may be true, McClatchy also found top VA officials buffing up those respectable results in ways that the evidence doesn't support.


The reporter, Chris Adams, goes on to detail many ways in which the VA had been "buffing up" its results. The article needs to be read in full to appreciate the extent of the duplicity which "habitually" attaches to nearly all VA record-keeping.

Incidentally, a simultaneous report from the VA Inspector General on treatment of mental health backed up Adams' finding that PTSD clinics were not as numerous as earlier stated. (The AP produced a summary of the IG report.)

The VA has a terrible record on the crisis of PTSD presented by the Iraq war. At hearings in March, for example, House members heard an earful about such problems.

Under questioning, Kussman also acknowledged that the department was a bit "surprised" by the extent of reported cases of post-traumatic stress syndrome and traumatic brain injury but were making adjustments to cope. "We are ideally poised to take care of" the growing caseload, he said.

That drew an angry response from Rep. Bob Filner, D-Calif.

"I find that kind of misplaced optimism, that defense of the system, a cause of where we are today," Filner said, noting that VA officials in individual clinics themselves had reported an overstressed system.


Perhaps that's a tad unfair to the VA managers, however; they may have been completely pre-occupied with counting their bonuses.

House Veterans Affairs Committee Chairman Bob Filner (D-Calif.) criticized inadequate budget planning by the VA in 2005 and said he was concerned that VA officials who "miscalculated the needs of our veterans were awarded with significant bonuses."

By chance, today the House heard testimony on the VA-bonus scandal.

The VA needs to do a better job of handing out department bonuses based on performance after it awarded $3.8 million to senior budget officials who put health care at risk, investigators said Tuesday....

Rep. Harry Mitchell, D-Ariz., who chairs the House subcommittee on oversight, decried the payments as evidence of improper favoritism. He directed his harshest criticism at VA Secretary Jim Nicholson, who declined to testify before the subcommittee.

All bonus recommendations must be approved by Nicholson.

"When the backlog of claims has been increasing for the past few years, one would not expect the senior-most officials to receive the maximum bonus," Mitchell said in a prepared statement. "Indeed, it appears the bonuses in the central office were awarded primarily on the basis of seniority and proximity to the Secretary."


Because rising to the top within the VA is self-evidently a mark of distinction.

crossposted from Unbossed

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