VA 2008 Patient Wait Times Memo

8/10/2019 VA 2008 Patient Wait Times Memo

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epartmentor

Veterans ffairs

-...

M e m c ~ r a n d u m

f,

ate:

e p t e m b ~ r 2

2 8

.

,_.

;

,

From: Assistant Inspector General for n v e s t l g ~ t l o n s (51)

Subj:

Administrative Investigation - Improper Altering of Patient

~

It

Times

and Failure to Use the electronic d List, Phoenix VA

Heal

h Care

System, Arizona

(2007.()311

1'-IQ-0190)

To:

Ofreclor,

Phoenix VA Health Care System

1.

The VA Office of Inspector General

(OIG),

Administrative

l n v e t i ~

ations

Division,

lnvestigEIIted an allegation thQt VA employees altered patient wait

tin

1es In an effort to

Improve tf1elr performance measures at the Phoenix VA Health Cant

System.

Employees allegedly cancelled and

resched1,11ed

appointments

for tl.e

same date and

time

.

tnu&

oreating a O d


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';

.

within 30 days of the deeired date only f9r a service connected dis< tbility

AJI

other

veterans must be scheduled

tor care

within 120 days

of

the

deslrec

dete. Polley

defines "desired date as the earliest date on which the patient or clinician specifies

the patient needs to

be

seen. Veteran6 who cannot

be

scheduled 'or appointments

within the 30- or 120-day requirement ehould be Immediately placEd

on

the EWL .

VHA Olrectlve

2008-0SS.

4.

The following exempl

..

clarffy how the VistA pacl


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than a 30-day wait time, along with Instructions to remake those polntments.

Further, another 6Cheduler told us that

when

he Initially made appc lntments,

he

immediately remade the seme- appointment, If It reflected more

tha

, a 30-day

wait

tlme. He further said that every morning,

his

supervisor ran a

repo

t

of

appointments

made tor servic& oormeoted veterans and that anything with more h

an

a 30.(fay welt

time

we&

c h F ; ~ n g e d .

As

a result,

he

said

thl t

the schedulers "tralnet themselves'' to

change the lnltl1l sppointmenta automatloally'to avoid ehowing up m his list.

7. Another supervisory scheduler told us that the

ins1ructed sche


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r

10. told us

that when

she

f1rst arrived ;

t

the medical

center In 2004,

it

was standard practlca

to

alter appointments, and employees readily

admitted to her that

it

"gaming" the system. She said that prlo to the VA

Scheduling Directive, schedulers changed or cancelled appolntme 1ts to avoid any

Indication that they made appotntments

with

mont than a 30-day wJlt

ttme. and she

said that old habits were hard

to

break. She told us that since she became a

supeJVisor, she Instructed her staff to schedule correctly and that s

1e

r e l ~ d on her

front llne managers

to

make sure they followed her instructions. S 'e said that she ran

reports to monitor ano compare the appointmentz with the physlcJE ns' n o t ~ . She said

that a report she ran 3 weeks ago reflected more than 400 appoint nents with walt

times greater than 30 days

and

that about 10 percent

of

those werl done Incorrectly.

She told us that ell schedulers took scheduling training, along with one-onone training

for 3 weeks when oriented to their Individual positions. and tha1 sC iedUiers were

aware of the new VA SCheduling Directive. Records reflected that

the

employees we

in1ei'Viewed took the required scheduler training in 2007 or 2008.

11.

told us th t he supervised

all

sc 1edulers n primary

care and specialty cllnies and that he was ultlmate v resDonslble fc ~ t h e i r ~ c h e d u l i n g

practices. H'i' said that the previous enc ouraged "fixing"

appointments, but since

anc'

came onboard,

the

pn ctlce no longer

existed. He said that he was not aware that schedulers were maki 1g appointments,

cancelling

them,

end rebooking them to zero out the walt times. F1rrther, he

$aid

that

employees were instructed to correct only improperly scheduled a11POintments

and

that they ran a dally report to check for appointments with a wait til ne of more than 30

days, correcllng only those that were

rnade

Incorrectly.

12. gave us the following example of an incorrectly

madf

' appointment: A

physician's note said to give a patient the "next available" appointr

1ent.

The scheduler

went Into the scheduling program on May 1, found the next avallat le appointment wes

on August 1, or 90 days from then. If the scheduler put In May 1 as the desired" date,

they were Incorrect, as that created a wait time of 90 days said thBt the

scheduler should instead

put

In a "desired'' date o August 1 to ave ld a 90-day walt

time. He told us that

schedulel' 3

were not supposed to use the

"ne

ct available''

function

in

the VistA package,

e5

it

"skewed

the

numbers."

Howe'v

:tr,

example

was contrary to VHA Directive 2006-055, Attachment o,

thlch

states that

when an appointment Is scheduled as a ''Next Available," the d ~ l e d dale" defaults to

the date the appointment is created and that this is proper when a patient asks to see

a clinician as soon as possible or

the

cl'nic

la

n requests the patient be scheduled

for

the

next available appointment. In example, the proper

way

to schedule

the August 1 appointment would be to use the "Next Available" rurction, which

defaults the "desired" date to May

~ t h u s creating

a 90-day walt ti fie.

13. Records reflected that the 2005 Performance Plan for schedu

~ r s

listed the use of

the scheduling package as a critical element and that for a fully su

~ o e s s f u J

rating, the

s e h A r i l l l ~ r

should have no more than four substantiated instances )f non-compliance.

told ue that schedulers were not permi :ted

more

than four

4


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errol'$ quarterly and that $Upervisors

rev

i

ewed

appointments to

chEek

for any errol'i.

old us that he believed that scheduling was Incorporated into the schedulers'

pemon ~ e e r i p t i o n s and that performance walt times would fall un ~ e r

the

'umbrella

of scheduling. One supervisor

told us that

schedulers were not pressured

to

reduoe

walt

tlmes and that their performance plans did not contain wait tirr e measures;

however,

another

supervisor

told

ua

that

patient

walt tlmea

were

cc

n ~ i n e

in his

own

performance measures. Two

schedulera

told us that making appo ntments with

more

than e 30-dy walt time

adver&ely

affected their performance

evak. atlons.

Failure to Use thp Electronic Walt

Ust

14. The OIG report

udit

o

lleged

Manipulation

of

Waiting

Tl

nes

in Veterans

Integrated Service Network

3

stilted

that

EWL.s

were

a

key tool t

tsed In

determining

how well medical facilities met their patient care requirements 8nd Nere Instrumental

In

making sure all veterans were treated timely It further stated

th at

Incomplete SWL.s

o m p r o m i ~

VHA's ability

to

access

and

manage demand for

meolical

care.

15. told us that the medical oenter used the EWL and that if a patient could not

be

scheduled for

an

appointment within 120

dayi

they were enter d Into

the EVv'L.

On

the contrary,

1 1d

us that only the

medical center's d

mtal

patients

were

p l e ~ on the EWL. ne said that whvn

he

arrived at the medical c mter

in

2006, ther&

were 1.000 dental patient$

on

It,

but by

the EJnd of

the

yee.r the

nun tber was

zero.

'

told us lha1 the

EWL

was

designed

for

patients who

coulc

not be seen in

30 days of a desired date: that the medical center uswd and monit< red the EWL; end

that when they found a patient mistakenly listed on

the

EWL, they :orrected the error.

Howevef'.

t h ~ ~ o l d us that

the

medical centt r did not use the

EWL. She tsald that Pfevlous and current managers, specifically , told etaff

to get patients

off

the EWL bv scheduling appointments for them a lei to not

use

lt.

totd us

that the medical center dl not have

electronic wait ltSts. one supervisory ached

1 1ler

told

ut

thst the E'.i /L was never

Implemented at the medical center, and another

SEiid th t

the

Instructed him to atop using it.

16.

One scheduler told

ut

that

hli

never used the EWL, because

told

him

not to use lt. Ano1h9r told us that VA Central

Offic

a sent an electronic

mail

message saying that schedulers

could yse the

EWL; howevet,

he

said that

he

had

not yet been trained

on

It nor had his

supervisor

said he could uee lt. A third

scheduler told us lhat his ellnle did not

vcu

t h ~ EWL:

he

did not ha

Je

access to it; and

that two different supervisors and the . told him not to use

ft. He said that his clinic had plenty or eppomtments exceeding

30

days,

but if

a

patient needed a follow

up In

1

f

2 weeks, to accommodate

the p.ltient, his

ctlnlc had

to overbook. Atlotner sCheduler said that rather than use the EWL for patienb that

could not get appointments

within

the required time, she either t e l ~ phoned

the

patient

a1 a later date

or

ha


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16

received training on It In a report titled

Service Connected

Vetera IS AwfJiting

Appointments S 50.100 Percent dated April 22, 2008, we discov ~ r e d 39

appointments with a wait time in excess

of

30 days, with 8

of

those being more than

100 days, and none were on the EWL.

17.

We

concluded

that

it was an accepted past practice at U\e

Phc

enix

VA

Health

Care System to alter a p p o i n t m e n t ~ to avoid

wait

times greater thar 30 days, and that

through a failure

to

properly communicote a requirement to adhere to policy, some

employees continued th is practice. rh sad that altering wait

times

continued until

she

became a supervisor; one

stJpervlsor be

l

eved

the practice

ceased In 2007; and another said it c e ~ s e d in January 2008 . How Ver, one scheduler

said he continued the practice untll March 2008, and two others ssld that they still alter

appointments. Further,

m n ~ g e m e n t

and sta'ff

were

confused as t) the proper

way 1o

~ c h e d u l e

pallent appointments. .example

of an lnN'Irrp,.ltv l:cheduled

appointment was actually the correct

way, and

the instructed

on&

scheduler

to

go

strictly by "desired" dates, even though policy ~ p e o i f i e s

times

when scheduling a Knext available" appointment Is appropriate . Ac ditionally,

scheduler performance

plans

reflected that

they

should

have nom

)re than four

instances

of

non-compliance; however, lt was left to Interpretation

ls to what

constituted

noncompllance.

Some

schedulers

believed that

lnclut

led

making

appointments with a

walt

time greater than 30 days, further adding to the scheduling

confus ion. Finally, employees were confused tiboutthe use of the

E\NL.

told us

that It was

being

used, whereas, said they only used it I :Jr dental oatients.

Jaid that they used and monitored the EWL, but

the

said that they did not

use ft. One

supervisor said that tMey

never

Implemented the

EWL, and another

~ i d

that

they

were instructed to stop using

it.

1

e We

suggest

that . nsure

that

all

HAS staff, from

managen

to schedulers, use

the VIstA scheduling

p c k g ~

properly

to

manage appointments ir compliance with

VA

pollcyi provide clarification on performance standards

to

sched Jlers and

tMeir

Upe rvisors to ensure that

schedu

l

ers

are

not

penalized for followh19 VA

policy;

and

ensure veterans are placed on EWLs when appointments cannot le scheduled within

the 30- or 120-day requirements.

We

are providing this memoran um

to

for'.

information and official

use

and whatever action deern approp

iate.

It

Is

s u b j e ~

to

the provisions

of the

Privacy

Act of

1974 (5

U S ~

552a). discuss the

contents

or

this

memorandum

with those named in it, within the

be

unds of

the

Privacy

Act; however, it may not

be

released to them. No response

is

nec:essary. If have

any questions, please contael Director, Admin strative

lnvel3tigations DiviSiOn.

at

(202) 461-4500.

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