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VA issues go beyond alleged wait-time problem


By Rachel Landen
Posted: May 24, 2014 - 12:01 am ET
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Veterans Affairs hospitals and clinics serving tens of thousands of American military veterans rank among the best in the nation for quality of care and patient satisfaction. But red tape, inefficient appointment scheduling and a maldistribution of facilities are contributing to backlogs that prevent some patients from getting prompt access to care, experts say.

Last week, President Barack Obama publicly commented for the first time on allegations of long wait times, off-the-books waiting lists, and patients dying while waiting for treatment at VA facilities in Arizona and other states. Obama said if the allegations prove true, he would consider removing VA Secretary Eric Shinseki and holding other VA officials accountable.

Preliminary results from the VA's review of patient scheduling are expected this week. “We have to find out first exactly what happened,” he said at a White House news conference after meeting with Shinseki. White House deputy chief of staff Rob Nabors is directing a broader review.

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But Obama said the problem of veterans waiting too long for care has been an issue for decades and is compounded by the influx of veterans from the wars in Iraq and Afghanistan and an aging baby boomer generation of veterans. He also touted his administration's progress in boosting VA funding, expanding benefits, making it easier for veterans with post-traumatic stress, traumatic brain injuries, and mental health issues to get treatment, and improving care for female veterans.

According to the VA, the number of unique patient visits at VA facilities in 2013 was 5.7 million, compared with 4.8 million a decade earlier. VA medical spending also rose, from $25.5 billion in 2003 to $56 billion last year—an increase that kept pace with healthcare cost inflation (See editorial). About 85 million appointments are scheduled each year.

“The problem is not that they don't have the money,” said Darin Selnick, a veterans' affairs adviser for the Concerned Veterans for America who was a political appointee at the VA from 2001-09. “If you don't know how to spend it wisely and don't know how to manage things, this is what happens.”

While waiting for the results of the investigations, Obama said he wanted VA officials to take immediate action to improve scheduling and cut wait times. He also stressed that parts of the healthcare system have worked well. “I don't want us to lose sight of the fact that there are a lot of folks in the VA who are doing a really good job,” he said. But that “never excuses the possibility that somebody was trying to manipulate the data in order to look better.”

Republicans quickly blasted Obama's statement that he would wait for the investigation results, saying previous probes proved that waiting times are too long. “The president has made a lot of promises to our veterans,” said House Speaker John Boehner (R-Ohio). “It's time to keep them.”

MH Takeaways

While many veterans express satisfaction with VA care, there are care delays due to administrative inefficiencies and inadequate capacity.
Still, many veterans have expressed satisfaction with VA medical care, and RAND Corp. researchers have found VA care equal to or better than care in non-VA facilities. In April, the American Customer Satisfaction Index reported that more than 90% of veterans rated VA care positively on customer service and inpatient and outpatient care.

Experts say one factor behind the care delays is the cumbersome process the VA must go through to determine veterans' eligibility and priority for medical care based on their injuries and disabilities. “What the VA most needs is to relax (the) administrative gatekeeping,” said Phillip Longman, a senior research fellow at the New America Foundation who has studied the VA system.

Debra Draper, healthcare team director for the Government Accountability Office, said the VA needs to clarify its policies and procedures. When her agency previously looked at wait times and scheduling at VA facilities, it found that policies were often ambiguous and open to staff interpretation.

Longman said another problem is that some geographic areas with higher concentrations of veterans lack adequate VA care capacity. The movement of retiring older veterans from the Northern states to the Sunbelt states has strained VA hospitals and clinics in those areas. For instance, Florida has a veteran population of more than 1.5 million, while New York has less than 900,000. But New York has 12 VA medical centers while Florida has nine.

Other observers, however, said the bottom-line issues are truth and accountability. “The VA has to produce real honest statistics that will let the public, the Congress, the American Legion, and the VFW know how many people are seeking medical and disability benefits and how long the actual wait time is,” said Ronald Abrams, joint executive director for the National Veterans Legal Services Program. “It's a systemic problem that can only be fixed by a complete study of the system.”

Obama seemed to agree: “I want people on the front lines, if there's a problem, to tell me or tell Rick Shinseki or tell whoever's their superior, that this is a problem. Don't cover up a problem.”

Follow Rachel Landen on Twitter: @MHrlanden


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