Some progress since VA scandal left veterans waiting for care

The Veterans Administration is enormous. The system estimates it will provide health care to about 6 million veterans this fiscal year, employing a staff of about 343,000 full-time equivalent employees, with an appropriation request of approximately $81 billion. 

So, it was a scandal in 2014 when news broke that VA facilities around the country were hiding the wait times — sometimes lasting months — experienced by thousands of veterans as they sought medical care. 

Here, we’ll take a look at whether any changes have occurred.

First, a quick review of what happened.

• Hidden, forgotten: Some 1,700 veterans using the Phoenix VA were kept off of official wait lists while they were waiting for an appointment with a primary care physician, the VA inspector general reported. That hid the amount of time veterans had to wait and left them at risk of being forgotten and never getting a clinical appointment they requested. In addition, "inappropriate scheduling practices are a systemic problem nationwide."

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• Deaths caused? It could not be confirmed whether wait times were to blame in the deaths of 40 Phoenix VA patients cited by a whistleblower. But the inspector general found that 45 Phoenix VA veterans experienced "unacceptable and troubling lapses in follow-up, coordination, quality and continuity of care." 

• Resignation, apology: Secretary of Veterans Affairs Eric Shinseki resigned, apologizing for the scandal of employees throughout the VA system conspiring to hide the wait times.

Some progress has been documented with wait times within VA facilities. But problems remain, as shown in testimony to the House Committee on Veterans’ Affairs at a hearing on July 24, 2019, that was done as a five-year follow-up to the scandal.  

The VA completed more than 1 million more appointments in 2018 than in the previous year, while wait times declined, Teresa Boyd, assistant deputy under secretary for health for clinical operations told the committee. 

She noted that a January 2019 study in the Journal of the American Medical Association found that access to care within VA facilities appeared to improve between 2014 and 2017. The study examined wait time data for outpatient appointments in primary care, dermatology, cardiology, and orthopedics in 15 metropolitan areas.

On its website, the VA says that as of mid December 2019, veterans had 11 million appointments scheduled, and 90.9% "are scheduled for care within 30 days of the requested date." Of those scheduled more than 30 days out, 5.7% were considered to be "time sensitive or urgent."

The VA has taken steps to address recommendations by the U.S. Government Accountability Office to improve wait-time measurement and its appointment scheduling policy, but more actions are needed to fully address most of the recommendations, Debra Draper, director of health care at the watchdog agency, told the committee. 

VA's first internal audit, in 2018, was unable to evaluate the accuracy and reliability of its wait-time data, the GAO found. 

Not all VA facilities were using an electronic wait list to track new patients that needed medical appointments, putting patients at risk for being lost for appointment scheduling, according to the GAO.

The VA has fully addressed GAO’s recommendations on implementing a consistent policy and providing adequate training, Draper told the committee. 

Still, GAO found cases in which the VA took more than three months to initially enroll veterans in health care benefits.

A December 2018 analysis by ProPublica and PolitiFact showed that in the four years since the government began sending more veterans to private care — in a program called Veterans Choice, aimed at getting around long wait times at VA facilities — veterans experienced longer waits for appointments and taxpayers bore higher costs.

Two companies hired to run Choice had been paid nearly $2 billion for overhead, including profit — about 24% of the companies’ total program expenses. 

In June 2019, the VA replaced Veterans Choice with Community Care, a program promoted as overhauling and consolidating the network of private health care providers where veterans can use their benefits. 

Three months after the launch, one veterans group complained that the new program’s benefits were not being communicated effectively to veterans, but another veterans group called the new effort a success, The Hill reported.