The Department of Veterans Affairs continues to face significant management challenges related to healthcare delivery, according to testimony delivered Thursday to the House Committee on Veterans' Affairs.
As demand for healthcare grows, the VA's efforts to reduce waiting times are hampered by an anticipated short-term surge in demand for specialty outpatient care over the next 10 years, testified Cynthia Bascetta, director of health care, veterans health and benefits issues, for the General Accounting Office.
"Too many veterans continue to travel too far and wait too long for appointments, especially when they require hospital admissions or consultations with specialists on an outpatient basis," Bascetta said.
More than 25% of veterans enrolled in VA healthcare--more than 1.7 million--have to drive at least 60 minutes to reach the nearest VA hospital. In 2000, the VA established standards for acceptable travel times for hospital care, but it has not done so for specialty care.
Bascetta noted that a presidential task force reported in July 2002 that veterans in some regions struggle to gain timely access to care. In Florida, for example, the average waiting time for a first outpatient appointment was more than a year.
"VA operates and maintains a large portfolio of aged health care assets, primarily buildings," Bascetta said. "This infrastructure is no longer effectively aligned with VA's new delivery model that emphasizes outpatient care. As a result, VA faces difficult realignment decisions involving capital investments, consolidations, closures and contracting with local providers."
The VA operates more than 800 delivery facilities, including more than 600 community-based outpatient clinics and 162 hospitals. In 2002, the VA spent $23 billion to provide healthcare to 4 million of the 6.2 million veterans enrolled. While the overall population of veterans is expected to decline in the next 20 years, the number of those enrolled will decrease at a slower rate, the report says.
The complete testimony is available at the GAO Web site.
Some part-timers are no-shows
In other veterans health news, VA inspector general Richard Griffin testified at the Thursday committee hearing that some part-time doctors employed by VA medical centers are not showing up for scheduled duty.
Managers are not keeping track of these physicians or enforcing attendance policies, Griffin said.
"Some part-time physicians were not present during their scheduled tours of duty, were not providing VA the services owed under their employment agreement, or were 'moonlighting' on VA time," he said.
He said an audit requested by VA Secretary Anthony Principi found, for example, that attending physicians at four VA medical centers were not present to supervise residents in six of 29 clinics reviewed.
Also, there was no documentation to show any patient care workload 33% of the time during a 14-day review where 223 part-time physicians were scheduled for at least four hours of duty.
In 2001, the VA spent $400 million to employ 5,129 part-time physicians.