The Veterans Affairs Department “has not been fully effective” in its hiring practices or its use of existing personnel to improve veterans' access to psychiatrists, according to a report by the VA inspector general.
The report follows up on a similar study released in April 2012 that found that the VA's “mental health performance data is not accurate or reliable” and first-time patients were not receiving timely mental health evaluations.
It was noted in the new report that, between fiscal 2012 and 2014, the VA did increase its number of outpatient psychiatrists by almost 15% to nearly 1,800. During that period, outpatient psychiatrist encounters increased by 10% while the number of individuals receiving outpatient psychiatric care grew by approximately 9%.
In all, the VA had about 2,800 psychiatrists on staff in 2014 and paid them more than $733 million in salaries and benefits, according to the report. Starting in 2012, the VA increased its annual maximum pay rate for psychiatrists from $195,000 to $250,000. By 2014, the VA inspector general reported that the average pay and benefits for a VA outpatient psychiatrist had increased to almost $261,000. (Psychiatrist pay ranged between $203,800 and $266,000 in this year's Modern Healthcare physician compensation survey.)
The VA's total mental health bill was $6.7 billion for 2014, of which about $4 billion was for outpatient care. In all, the inspector general said that VA psychiatrists saw about 870,000 individual veterans that year.
The VA established a recommended minimum staffing level in 2014 of 1.22 outpatient psychiatrists for every 1,000 mental health patients. The inspector general reported that individual facilities were not required to meet this target and, as of December 2014, 94 facilities had not met it. The VA estimated that another 335 psychiatrists were needed to meet demand, according to the report.
The report concluded that the VA failed to specifically address a systemwide priority for psychiatrists and it let individual regions determine their own staffing needs. As a result, 94 out of 140 VA facilities did not have enough psychiatrists to meet their demand as of December 2014, according to the inspector general.
Hiring alone did not improve access. The inspector general reported that the Minneapolis VA Medical Center increased its psychiatrist staff level by more than 14%, but the number of patient encounters there dropped by more than 21%.
Complicating the matter was the inconsistent or inappropriate use of current procedure terminology, or CPT, codes to record what type of encounter took place and establish the value of the visit. The inspector general sampled the coding at six facilities and found that facilities used different CPT codes for similar encounters and that some psychiatrists had inappropriately recorded duplicate codes for a single visit.
“While (the Veterans Health Administration) significantly increased the number of psychiatrists providing outpatient clinical care, veterans' access to those psychiatrists can still improve,” the inspector general wrote. “By identifying the appropriate number of psychiatrists that facilities need, and implementing effective clinic management business rules, VHA could optimally place and use psychiatrists.”
