Federal VA Audit Confirms Data Manipulation Allegations
June 10, 2014 in News
Scheduling staff at some Veterans Affairs clinics across the country used methods other than the department’s official electronic wait list or health IT system to make it appear that veterans had shorter wait times for care, according to a federal audit of the centers released yesterday, Health Data Management reports (Slabodkin, Health Data Management, 6/10).
According to the New York Times, the audit — which involved 731 VA medical facilities — for the first time provided information on the scope of a growing scandal surrounding reports of delayed care and subsequent cover-ups (Oppel, New York Times, 6/9).
The investigation comes in response to an allegation in April by a former employee at the Phoenix VA Health Care System.
Sam Foote, a retired physician at the clinic, claimed that employees at the practice inaccurately used the center’s electronic health record system and “deliberately” created a secret waiting list to hide documentation of delays in care. According to Foote, up to 1,600 patients were placed on a secret electronic waiting list at the Phoenix center, sometimes waiting months to over a year to have an appointment scheduled.
The waitlist scandal resulted in the resignation of Department of Veterans Affairs Secretary Eric Shinseki (iHealthBeat, 5/30).
The audit found that more than 57,000 veterans have been waiting for medical appointments at Veterans Affairs medical centers throughout the country for longer than three months, the New York Times reports.
It showed that nearly 64,000 additional veterans have been enrolled in the VA health system for longer than a decade but have not yet seen physicians despite requests for appointments (New York Times, 6/9). Meanwhile, nearly 43,000 appointments had been scheduled for more than 90 days in the future as of mid-May, Reuters reports (Lawder/Stephenson, Reuters, 6/9).
The audit also showed wide variations in wait times at VA centers across the country. For example, patients waited an average of 17 days for appointments at a VA center in Bedford, Mass., compared with 81 days at a center in Baltimore (Jaffe/Hicks, Washington Post, 6/9).
Evidence of Data Manipulation
The audit also confirmed claims that a VA goal of scheduling patients for appointments within 14 days created incentive for administrators to manipulate data to ensure long wait times would not reflect poorly on their job performance, the Times reports.
Specifically, it found:
- At least one instance of data manipulation regarding patient wait times occurred in about 76% of VA hospitals and clinics;
- 13% of appointment schedulers said they had been instructed by superiors to falsify wait-time data (New York Times, 6/9); and
- 8% of scheduling staff said they had used alternatives to the VA’s electronic wait list or its health information systems and technology architecture systems to make it appear veterans had shorter wait times (Health Data Management, 6/10).
According to VA, the scheduling goal will no longer be included in employees’ performance reviews (New York Times, 6/9).
IT Systems Present Few Challenges
According to frontline staff members at VA health centers, the department’s IT systems — such as the VistA EHR system and the electronic wait list — were not a top barrier or challenge to job performance. Staff members were asked to catalog how various aspects of their jobs presented challenges or obstacles in providing timely care.
However, the audit showed that software and telephone equipment “were frequently described as antiquated and problematic” by staff members (Conn, “Vital Signs,” Modern Healthcare, 6/9).
The audit recommends that the VA:
- Conduct routine internal reviews to ensure that staff members are following regulations;
- Consistently implement wait time procedures that accurately reflect patient care; and
- Overhaul its data reporting systems (Bresnick, EHR Intelligence, 6/10).
White House press secretary Josh Earnest said that the findings highlight President Obama’s commitment to solving the issues while providing “a look at exactly what the scope of this problem is.”
Acting VA Secretary Sloan Gibson said the audit “shows the extent of the system problems we face … problems that demand immediate action” (Washington Post, 6/9).
According to Reuters, VA said it is working to contact all veterans who are waiting for care (Reuters, 6/9).
Following the audit’s release, Gibson pledged to spend $300 million to increase VA medical employees’ hours and to contract with private care centers to allow veterans to seek care outside the VA health system. In addition, he said he would institute new patient satisfaction surveys and VA centers and eliminate the 14-day scheduling goal (Washington Post, 6/9).
Further, Gibson said the VA inspector general would conduct an external audit of the agency’s scheduling practices (Kesling, Wall Street Journal, 6/9).
Monday House Hearing
Just hours after the audit’s release on Monday, the House Veterans Affairs Committee heard testimony from the VA Office of Inspector General, VA officials and the Government Accountability Office, the Washington Post‘s “Federal Eye” reports.
According to “Federal Eye,” the hearing mostly focused on several reports that warned of the inappropriate scheduling practices prior to reports of the national scandal.
Specifically, testimony touched on:
- Leadership problems within the VA, including reports that superiors had ordered employees to falsify documents and the department’s “cover-up culture”;
- The possibility of criminal investigations, which several lawmakers have called for;
- Protecting whistleblowers who shed light on the inappropriate practices;
- Persistent IT issues at VA, including outdated scheduling technology; and
- Whether to allow veterans to seek care outside of the VA health system (Hicks, “Federal Eye,” Washington Post, 6/10).