May 28, 2014 in Nation/World

Appointment maneuvers at VA were prohibited in 2010 memo

Pauline Jelinek Associated Press
Access to care

The VA announced Saturday that it would allow veterans to seek care at private clinics and hospitals in areas where the department’s capacity to expand is limited. On Tuesday, the department provided some details of its initiative, announcing, for example, that VA clinics are looking at extending their hours to include nights and weekends. The VA will make a minimum of three attempts to contact new patients who face waits of 30 days or more for an appointment to see if they can be seen sooner. If patients cannot be seen sooner at a VA facility, they will be offered the option to seek care at a private facility, under the new initiative.

WASHINGTON – Fake appointments, unofficial logs kept on the sly and appointments made without telling the patient are among tricks used to disguise delays in seeing and treating veterans at Veterans Affairs hospitals and clinics.

They’re not a new phenomenon. VA officials, veteran service organizations and members of Congress have known about them for years.

The “gaming strategies” were used to make it appear veterans were getting appointments within target times set by the department, according to a 2010 department memo to VA facility managers aimed at fighting the practices.

The memo from William Schoenhard, then the VA’s deputy undersecretary for health operations and management, said that when a medical appointment wasn’t available within the 30-day target time then used by VA, some schedulers would:

• Make a fake appointment within the 30-day period but not tell the patient. The appointment would be canceled later and a new appointment would be made to meet a new 30-day target.

• Note on a paper log the actual distant date of an appointment, but not enter it into the computer until within 30 days of the date.

• Give the patient an appointment at whatever date was next available, but log it in the computer as the date the veteran had asked for.

Schoenhard’s nine-page memo ordered the practices stopped and instructed managers on how to detect them. Then he added:

“Please be cautioned … additional new or modified gaming strategies may have emerged, so do not consider this list a full description of all current possibilities of … practices that need to be addressed.”

Or as Sen. Patty Murray, D-Wash., put it at a hearing this month: “As soon as new directives are put out, they’re torn apart to find out how to get around the requirements.”

“Cooking the books” at VA hospitals has exploded into public view since allegations arose that up to 40 patients may have died while awaiting care at the Phoenix VA hospital. The department’s inspector general said he’s found no evidence so far that any of those deaths were caused by delays. He’s widened his office’s probe to include 26 VA centers but hasn’t specified just what is being investigated at the newly added locations.

There are some 1,700 VA health facilities nationwide, including hospitals, clinics and residential rehabilitation centers. Investigators are now trying to determine how widespread is the practice of falsifying records. But the fact it is a problem has been detailed in VA inspector general reports and Government Accountability Office reports to Congress going back a decade.

The 2010 Schoenhard memo cited practices identified by a task force monitoring access to care.

“It’s not that people haven’t brought this up before, it’s just the word ‘secret’ lists blew it up in the media,” Vietnam Veterans of America’s Richard Weidman said in an interview. “They weren’t secret, they were handwritten” logs kept aside from computerized scheduling. “People should stop the hysteria and say what the root of this problem is.”

Independent reports have found that though access is a problem, VA care is equal to or better than that in the private sector.

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