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Sunday, September 23, 2007

VA's Inspector General Audit on Service Wait Times Rebukes Congressional Testimony

The U.S. Department of Veterans Affairs Office of Inspector General released an audit [pdf] earlier this month revealing a far less successful level of service is provided to its clients than has been reported to Congress. From the Seattle Times:

The VA overstated to Congress how quickly it cares for veterans, understates how many are waiting for care and may be "gaming" its own system to show better results, according to an internal investigation.

The review by the VA inspector general's office, released Monday, examined 700 outpatient appointments for primary and specialty care scheduled in October 2006 at 10 VA medical centers.

Three-fourths of veterans were seen within the required 30 days, far fewer than the 95 percent claimed by the Department of Veterans Affairs. Of the veterans kept waiting more than 30 days, 27 percent had more serious service-connected disabilities, such as amputees and those with chronic problems including frequent panic attacks. Under Veterans Health Administration (VHA) policy, such patients must be scheduled within 30 days of their desired appointment date.

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In addition, despite warnings by the inspector general in 2005 to more accurately report wait times, department officials last year also may have understated the number of veterans on their electronic waiting lists by more than 53,000.

"While waiting time inaccuracies and omissions from electronic waiting lists can be caused by a lack of training and data-entry errors, we also found that schedulers at some facilities were interpreting the guidance from their managers to reduce waiting times as instruction to never put patients on the electronic waiting list," VA investigators wrote.

"This seems to have resulted in some 'gaming' of the scheduling process," the 34-page report said.

VA undersecretary for health Michael Kussman partly agreed that the agency should take additional steps to improve scheduling with better training, procedures and accounting of records. ...In April, Kussman testified to Congress that 95 percent of veterans were receiving the timely appointments. The VA's 2006 annual report, issued last November, makes similar claims.

The department also is struggling to reduce a severe backlog of disability payments, with delays of up to 177 days to process an initial claim...The VA medical facilities reviewed in the inspector general's report were for both primary and specialty care in Birmingham, Ala.; Atlanta; Columbia, S.C.; San Antonio, Temple and Dallas in Texas; Cincinnati; Detroit; Indianapolis; and Chillicothe, Ohio.

This past week, a week after the audit results were released, the Associated Press reported on Nicholson's Congressional testimony:

Outgoing VA Secretary Jim Nicholson acknowledged Tuesday that he's struggling to reduce backlogs in disability claims from Iraq war veterans, saying current efforts won't be enough to cut down waits that take months.

Addressing Congress for a final time before stepping down Oct. 1, Nicholson also pointed to persistent problems between the Pentagon and Department of Veterans Affairs in coordinating care for veterans and urged Congress to embrace proposals by a presidential commission to fix gaps.

"They have some very good ideas in there," he said.

Nicholson's testimony to a House Veterans Affairs Committee painted a mixed picture of a VA that has initiated measures to boost mental health and other care but has struggled to keep up with growing demands due to a prolonged Iraq war.

Nicholson, who took office in early 2005, said the department has hired 1,100 new processors to reduce delays of up to 177 days in processing disability payments. But he predicted another rise in compensation and pension claims this year, citing the additional applications pouring in during "the midst of war."

The increase, he said, is coming from Iraq war veterans as well as veterans from previous conflicts who were prompted to file additional claims for new or additional benefits amid the current public focus on war-related injuries in Iraq.

Even with new staff, the VA can only hope to reduce delays to about 145-150 days — assuming that the current level of claims doesn't spike higher.

Nicholson defended himself, pointing to some of his successes:

On Tuesday, Nicholson said he's proud that he pushed forward initiatives to require screenings for brain-related injury, add storefront walk-in clinics and boost mental health counselors.

At the same time, Nicholson acknowledged continuing problems that will fall upon his yet-to-be-named successor and expressed sympathy to injured veterans who might have unfairly suffered as a result of unnecessary red tape.

"We have learned that, in many instances, we were not as sensitive to those needs as we could have been — and we have tried to adjust, while at the same time caring for veterans of different wars and different eras," Nicholson added in written testimony. "My heart has gone out to service members or veterans who seem to have slipped through the cracks."

Separately, Nicholson also called for creation of a new VA assistant secretary position for acquisition and construction to oversee billions of dollars of purchases for VA facilities. On average, VA buildings are 57 years old, and the cost of purchasing land, design and construction of a new hospital costs about $750 million.

"The magnitude of these numbers and the complexity of the acquisition process indicate that there must be the very highest levels of supervision and accountability," he said.

Among the achievements Nicholson cited:

_Launching a campaign to reduce high rates of obesity and diabetes in veterans. Some 25 percent of veterans under VA care suffer from adult-onset Type II diabetes, which can lead to blindness, renal failure or amputations.

_Creating a new multi-campus academy in partnership with U.S. nursing schools to address a nursing shortage and encourage nurses to work for the VA.

_Hiring suicide prevention counselors at each of VA's 153 hospitals and creating a 24-hour prevention hotline in July.

_Centralizing the VA's information technology system to minimize the risk of data loss. That came after nearly 26.5 million veterans' personal information was put at risk of identity theft last year after a VA employee lost a computer hard drive.

Not everyone, however, is singing Nicholson's praises.

Dan Moffet writes a searing Palm Beach Post opinion piece today on who might be President Bush's worst political appointee:

The dark horse in the race for most incompetent appointee (MIA) is Veterans Affairs Secretary Jim Nicholson, who is leaving office Oct. 1 after an impressive 32-month run of sustained ineptitude.

Mr. Nicholson made himself a contender with an eclectic display of bad management and indifference toward veterans' needs: He was $1.3 billion short on his first budget. He oversaw the debacle over outpatient conditions at Walter Reed Hospital. He gave $3.8 million in bonuses to VA administrators while soldiers returning from Iraq waited and waited and waited to see doctors. He allowed the theft of 26.5 million vets' personal data because of inadequate security controls over laptop computers. ...

Mr. Nicholson, who got his job as a reward for serving as the Republican National Committee chairman, made what should be his final appearance before Congress last week. Predictably, it was another embarrassment.

Members of the Senate Veterans Affairs Committee listened with appropriate skepticism as Mr. Nicholson tried to dismiss the results of a VA inspector general's report released this month. The auditors examined hundreds of outpatient appointments for care at 10 VA medical centers. The investigators found that the VA was consistently distorting its record on wait times for injured and ailing veterans. ...

The numbers that Mr. Nicholson was able to get right are discouraging as ever. He admitted that the VA has been unable to make progress in reducing the backlogs of disability claims, a chronic problem that has been exacerbated by veterans returning from Iraq and Afghanistan with physical and mental injuries. Vets still have to wait about six months to get rulings on their claims.

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