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How VA clinics falsified appointment records

By Pauline Jenkins

Associated Press

LAST UPDATED: 09:35 a.m. HST, May 27, 2014

WASHINGTON >> Fake appointments, unofficial logs kept on the sly and appointments made without telling the patient are among tricks used to disguise delays in seeing and treating veterans at Veterans Affairs hospitals and clinics.

They're not a new phenomenon. VA officials, veteran service organizations and members of Congress have known about them for years.

The "gaming strategies" were used to make it appear veterans were getting appointments within target times set by the department, according to a 2010 department memo to VA facility managers aimed at fighting the practices.

The memo from William Schoenhard, then the VA's deputy undersecretary for health operations and management, said that when a medical appointment wasn't available within the 30-day target time then used by VA, some schedulers would:

-- Make a fake appointment within the 30-day period but not tell the patient. The appointment would be canceled later and a new appointment would be made to meet a new 30-day target.

-- Note on a paper log the actual distant date of an appointment, but not enter it into computer until within 30 days of the date.

-- Give the patient an appointment at whatever date was next available, but log it in the computer as the date the veteran had asked for.

Schoenhard's nine-page memo ordered the practices stopped and instructed managers on how to detect them. Then he added:

"Please be cautioned ... additional new or modified gaming strategies may have emerged, so do not consider this list a full description of all current possibilities of ... practices that need to be addressed."

Or as Sen. Patty Murray, D-Wash., put it at hearing this month: "As soon as new directives are put out, they're torn apart to find out how to get around the requirements."

"Cooking the books" at VA hospitals has exploded into public view since allegations arose that up to 40 patients may have died at the Phoenix VA hospital while awaiting care. The department's inspector general said he's found no evidence so far that any of those deaths were caused by delays. He's widened his office's probe to include 26 VA centers but hasn't specified just what is being investigated at the newly added locations.

There are some 1,700 VA health facilities nationwide, including hospitals, clinics and residential rehabilitation centers. Investigators are now trying to determine how widespread is the practice of falsifying records. But the fact it is a problem has been detailed in VA inspector general reports and Government Accountability Office reports to Congress going back a decade.

The 2010 Schoenhard memo cited practices identified by a task force monitoring access to care.

"We have worked very hard ... to root out these inappropriate uses of the scheduling system and these abuses," VA's Robert Petzel testified at a Senate hearing this month. "This has been a very important thing to us for at least the last four years."

Petzel was the top VA health care official until he was forced to resign ahead of his retirement previously scheduled for later this year.

"It's not that people haven't brought this up before, it's just the word 'secret' lists blew it up in the media," Vietnam Veterans of America's Richard Weidman said in an interview. "They weren't secret, they were handwritten" logs kept aside from computerized scheduling. "People should stop the hysteria and say what the root of this problem is."

The problem, according to Weidman and several other veteran service organizations, is there are not enough medical personnel to meet the demand for VA health care. Several of the groups have complained for years that the VA budget -- though continually rising -- is too small to provide enough doctors, medical centers and services.

The number of veterans relying on VA for health care has jumped 17 percent since 2009. Operating the largest single health care agency in country with 9 million patients and 85 million appointments a year, the agency has struggled to keep its head above water. It has hired more medical workers and opened 55 more community outpatient clinics, bringing to 820 the number of those clinics nationwide.

VA also has added 21 more mobile clinics to serve veterans in rural areas and now has a fleet of 79 of them.

When it comes to how long it takes to get an appointment, VA stands apart from much of the health care industry. VA now has a 14-day target for seeing patients once they seek appointments and the agency is supposed to chart the timeliness of each of them. Some lawmakers have suggested the target is unrealistic and said basing employee bonuses and pay raises on meeting it is outrageous.

In the private sector, some large health provider networks set standards, but there's little data on how well the standards are followed, making comparisons difficult. Also, the majority of private physicians in the U.S. are not part of a network.

But like the VA, appointment wait times in the private sector vary widely by geography and the attending physician's specialty.

Independent reports have found that though access is a problem, VA care is equal to or better than that in the private sector.

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AhiPoke wrote:
"Independent reports have found that though access is a problem, VA care is equal to or better than that in the private sector." - I know people who work in VA facilities and find this impossible to believe. The only way this is possible is through distorting facts and words.
on May 27,2014 | 09:40AM
juke wrote:
you work for them
on May 27,2014 | 11:28AM
meat wrote:
How about putting a name to that "independent report".
on May 27,2014 | 11:38AM
localguy wrote:
It might surprise you how good VA medical care can be. Read the truth here: http://www.forbes.com/sites/harlankrumholz/2014/05/23/3-things-to-know-before-you-rush-to-judgment-about-va-health-system/
on May 27,2014 | 12:11PM
juke wrote:
like you really know.you never been to the va.and your not a vet
on May 27,2014 | 04:33PM
localguy wrote:
Wrong answer. Retired Army and worked at Ft Shafter. So you didn't qualify to join the military, could not pass all the exams, know your limitations, or all of the above?
on May 27,2014 | 06:17PM
Winston wrote:
Question: Would an agency which has aggressively lied about appointment wait times, resulting in de facto health care rationing, have similar capacity and motivation to lie about or manipulate quality assessments?
on May 27,2014 | 09:53AM
localguy wrote:
This question also applies to our utterly dysfunctional congress and senate. Continually lying about the work they will or did accomplish. Can't trust a word they tell you.
on May 27,2014 | 11:53AM
juke wrote:
cant trust a word you say
on May 27,2014 | 04:34PM
localguy wrote:
Like you would have a clue. Do you ever post anything of intelligence or just what ever you see scratched on the walls around the commode at the adult shop?
on May 27,2014 | 09:36PM
Maipono wrote:
Obama and his supporters always held this "single payer" system as the shining example of how good Obamadon'tcare should be.
on May 27,2014 | 09:54AM
Winston wrote:
Second question: Would an agency which has aggressively lied about appointment wait times, resulting in de facto health care rationing, have similar capacity and motivation to cull patients by disease category to improve health care quality results? Sounds barbaric/improbable, but then so does faking appointments.
on May 27,2014 | 09:55AM
primowarrior wrote:
According to reports, the VA currently has thousands of job openings that they can't fill due to a nationwide shortage of qualified individuals, and competition from the private sector. Are they looking for qualified people overseas? That may not be ideal, but it seems to me that they should be doing everything possible to get those positions filled with qualified professionals to make sure that vets are getting the care they need.
on May 27,2014 | 10:14AM
cojef wrote:
Am veteran of WW II and did receive medical care at the Fort Wayne, Indiana VA hospital back in 1955 soon after graduating from college(GI Bill). At that time did not have any savings or assets and was admitted immediately without having to wait at all. After retiring in 1990 and some time later attempted to qualify to receive medical benefits but was denied because my retirement income was too high. This process took a long, long time. This is one of the bottlenecks that contribute to the lengthy waiting time up the chain of medical care. What awaits is chaos. Wait, wait is he mantra, until some one dies.
on May 27,2014 | 10:31AM
KaneoheSJ wrote:
And Congress knew about this. Did you know that they receive lifetime membership at VA hospitals just for serving one term in Congress? And without having served in the military? It is just wrong that Congress gave themselves this perk. They are using a resource that is for our veterans. While our veterans have a hard time receiving medical care these retired Congressmen are receiving the service meant for them. This while resources are limited. It just goes in line with their legislating laws that do not apply to them such as the insider trading laws.
on May 27,2014 | 11:12AM
localguy wrote:
KaneoheSJ - Where did you get that line of shibai about congress getting lifetime care at VA hospitals. Not even close. Read the real story at the links below. Way too many posting rookies out there. http://www.voicesfortroops.org/Learn_More/Learn_About_The_Issues/Fact_or_Fiction__Congressional_Benefits.html and here http://www.factcheck.org/2009/08/health-care-for-members-of-congress/
on May 27,2014 | 12:07PM
juke wrote:
and your the number one rookie of them all
on May 27,2014 | 04:35PM
localguy wrote:
Clearly you just started posting, a graduate of the Nei's failing educational system, one of the UH special ed students showing the general their art work. Sad.
on May 27,2014 | 06:15PM
DAGR81 wrote:
.Very disturbing practice, but even more disturbing is the fact that these practices were known, and the President and Shinseki did nothing about it for 5 years. "Action" was not initiated until the scandal was made public and at the head of it all are two "local boys".
on May 27,2014 | 11:24AM
localguy wrote:
Not even close to being true, just a shibai post. Might find this interesting about the VA. http://www.forbes.com/sites/harlankrumholz/2014/05/23/3-things-to-know-before-you-rush-to-judgment-about-va-health-system/
on May 27,2014 | 12:03PM
DAGR81 wrote:
Not even close to being true, just a shibai post. Might find C-span interesting.
on May 27,2014 | 01:45PM
localguy wrote:
You just can't handle the truth, clearly a product of the Nei's failing educational system, one of the UH special ed students in the news showing the General their art work. Soo where is your link to back up your shibai?
on May 27,2014 | 06:19PM
KB wrote:
THIS IS THE JOB FOR EACH STATE 'S GOVERNMENT . ARE THEY TALKING ABOUT HAWAII TOO ? . to solve any thing problem we need to be specific; Let us not be pawns in the political game and nothing happens. thank you
on May 27,2014 | 01:40PM
juke wrote:
if you went to the va in hawaii in the last 10 years.you know the answer
on May 27,2014 | 04:37PM
localguy wrote:
Actually Hawaii's VA offers very good care to include a hospice next to Tripler Army Medical Center. Soooo, is it true you get your posting information off the rest room walls?
on May 27,2014 | 06:20PM
false wrote:
Some must be held accountable for this. This is horrible.
on May 27,2014 | 05:20PM
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