The VA Office of Inspector General investigated a complaint from a medical support assistant (MSA) who alleges that VA facilities in Central and South Texas do not follow proper appointment scheduling protocols. The following VA facilities were part of the OIG’s investigation:
- VA Hospital and Specialty Clinic – San Antonio (VASA)
- VA Federal Clinic – North Central Texas (VAFC)
- Frank Tejeda VA Outpatient Clinic (OPC)
- Outpatient Clinic – Austin (OPCA)
- Consolidated Outpatient Appointment Center – Kerrville (COPAC)
- VA Medical Center – Temple (VAMC)
The complainant claims that he was “trained to zero out a patient by making the first available date the patient’s desired date.” The complainant was instructed to manipulate appointment dates by making a veteran’s desired appointment date the date on the schedule, which makes the wait time zero days.
The practice of gaming the system by fixing appointment wait times extends across all of the facilities mentioned above. The OIG interviewed various VA employees and reviewed available data from scheduling platforms and uncovered that almost all schedulers and clinics had wait times that equal zero and, in some instances, “many schedulers had created dates one or two months prior to the desired date.”
An MSA admitted that she would “document a patient’s desired date in close enough proximity to the appointment date to not go past the 14-day requirement, regardless of the desired date.” The scheduler claimed that an administrative assistant would provide her with a list of VA patients and the time between their desired dates and the appointment dates to review it for wait times over the acceptable wait time of fourteen days. If the wait time for any appointment was over fourteen days, she was instructed to “fix it.” The scheduler told the OIG investigator that on one occasion the administrative assistant told her “not to have the desired date and appointment date on the same day because it would look like they were gaming the system.”
An MSA stated that she was instructed to make patient wait times equal zero at OPCA by two supervisors. She asserted that she was taught how to manipulate the desired date by one of the supervisors and another employee. The MSA moved to a different facility and was again trained to make the patient wait times equal zero.
A supervisor at COPAC stated that “from 2007 to March 2014, she and other schedulers were taught to make the patient’s desired date the first available date. She stated a former VA supervisor threatened to fire her if she did not make the wait times equal zero.”
An MSA at OPCA revealed that she made the patient’s desired date the first available date to zero-out wait times. She stated that the practice of making wait times equal zero was used at OPCA from 2008 to 2013. She told the OIG investigator she was never aware that the way she was scheduling appointments was wrong.
An MSA at VASA said that when he started his employment, he was recording the desired date from patients correctly. According to the investigator, the MSA stated “there was a list that came out showing that his patient wait times were extended. He stated he was approached by his supervisors regarding his extended wait times. He stated he was on the list because of the extended wait times.” The MSA “began to use the first available date as the patient’s desired date because he did not want to be removed from his job.”
An MSA at COPAC said that he was “first trained to schedule patients by making patients’ desired dates the first available date.” During the interview, the MSA told the investigator he was “instructed that if the wait time for the patient exceeded ten days, it would be a scheduling error that he would have to fix. Scheduling errors are recorded and counted up at the end of the year to go against a scheduler’s performance evaluation.”
A supervisor at VASA claims that a supervisor and lead clerk taught her to schedule. She stated, “When she first learned to schedule, she was taught to make Wait Time Two (the amount of time from the patient’s desired date to the appointment date) equal zero by scheduling a patient’s desired date on the first available date.” The supervisor alleged that “if the wait time were too long then her name would be reported on a list, and she would be contacted by either the lead clerk or the supervisor to fix the error.” To avoid having her name on the list, she made the wait times zero.
The administrative officers, directors, and managers interviewed by the investigator denied the allegations. However, the OIG’s investigation substantiated the allegations made by numerous employees at the facilities.
The VA OIG reviewed multiple “performance evaluations, self-assessments, and rating narratives.” The review uncovered that there are goals or metrics associated with wait times, but the investigator reported that his review “did not reveal any evidence that a VA employee was provided an increased performance rating or a bonus specifically for patient wait times.” Why would any VA facility put anything in writing related to how appointment wait times affect performance ratings and bonuses? However, there is a mountain of evidence that suggest appointment wait times is a top priority for VA facilities, and VA bureaucrats engaged in unethical practices to ensure that wait times met the 14-day standard.
The investigation concluded that MSAs and non-MSA schedulers are setting patient appointments using the appointment date as the desired date. The review of the patient appointment data for the facilities in San Antonio, Kerrville, and Austin “revealed that the improper scheduling was systemic, and was not limited to a particular clinic or supervisor.”
The VA is failing America’s veterans. It is unacceptable to maintain the status quo at the VA. The solution to the problems that fed gov bureaucrats have created for the VA is to disband the entire VA health care system and allow veterans to use private sector hospitals and physician practices for their health care needs.