New patients are those defined as not been seen before in a specific VA facility in the previous 24 months. The VA facility reporting the biggest backlog of new patients waiting for appointments is Tennessee Valley Healthcare System Home in Gallatin, Tenn., with nearly 5,000 patients soldiering through the months-long wait.
The report (PDF), ordered by former VA Secretary Eric Shinseki, was prepared to discover if allegations about inappropriate scheduling practices are isolated instances of improper practices or if broader, more systemic problems exist.
This was in response to whistle-blower's accusations at a Phoenix veterans' hospital, where employees claim that records were altered to conceal delays in treatment.
The audit looked at 731 total facilities, including both VA medical centers and community-based outpatient clinics serving at least 10,000 veterans. More than 3,772 staff were interviewed.
VA staff at 90 clinic sites claimed they had altered desired appointment dates. Most did so at the urging of supervisors. In at least two clinics, someone who was not a formal scheduler was routinely accessing records and changing desired dates to improve performance measures.
At 24 sites, VA staff members said they felt threatened or coerced to enter specific desired dates. At two locations, there were instances were staff were written up for either not complying with supervisors' orders to inappropriately enter or alter recorded desired dates, or for expressing concerns over what they were being asked to do.
“Based on the findings of the audit, VA will critically review its performance management, education and communication systems to determine how performance goals were conveyed across the chain of command such that some front-line, middle and senior managers felt compelled to manipulate VA's scheduling processes,” according to the report.
The pressure to alter records came from a current system that produces a highly stressful work environment and limits the focus on serving veterans, the report found.
The agency is ordering further investigations at 112 locations where interviews revealed indications of fabricated scheduling data or of supervisors ordering falsified lists.
Gibson, the acting VA secretary, directed several steps to address Monday's audit, including a short-term boost in medical services at overburdened facilities, including using mobile units.
The agency has contacted 50,000 veterans awaiting appointments and plans to reach 40,000 others to accelerate care, letting them choose VA treatment or local non-VA health-care providers. Some civilian hospitals are wary of low reimbursement levels and administrative headaches that would come with treating an influx of veterans.
The VA believes it will need $300 million over the next three months to accelerate medical care, money that will come from the agency's existing budget. That will include expanding clinics' hours and paying for some veterans to see outside providers.
The Associated Press contributed to this report
Follow Virgil Dickson on Twitter: @MHvdickson
