Confessions of a VA scheduler

- Bay Area veterans say they're still facing excessive wait times for benefits and health care. The VA Inspector General found 307,000 veterans may have died waiting for access to the VA health care system.

Veterans who do get enrolled say significant delays for medical service persist.

"They gave me an appointment six months down the road, and then called to say they had to cancel," said Winter Haven veteran Keith Brown. "It can be a year before you get the actual appointment."

That conflicts with information provided by the Department of Veterans Affairs, which showing wait times have improved following the VA scandal of 2014.

Nick McSwain says there may be a reason for that. He said when he worked as a VA scheduler through the beginning of 2015, he was told to disregard patients' desired dates for appointment, then note the actual scheduled date as the 'desired' date -- thereby showing no delay based on what veterans requested.

"It says 'What is the desired date' (in the system) and instead of using that date, we use the appointment we actually give them so it shows no gap," said McSwain.

He also claims veterans who complained had to wait even longer for future appointments.

"Vets who should have been seen top priority were passed over because of the way providers feel about this guy. They'd say 'I hate this guy' or 'he's annoying," said McSwain, who also noted that consults for specialty health care piled up when he worked in a scheduling center. "There have been times when stacks of consults disappeared."

VIDEO: Watch more of his interview above, or click here

A spokeswoman for U.S. Rep. Gus Bilirakis said his district offices have opened 314 VA-related cases since January 2, 2015, pertaining to both benefits and health care.

FOX 13 asked the Department of Veterans Affairs to respond to a range of questions and issues raised by Thompson, Brown, and other veterans. The department answered our questions and provided data to show the VA is making progress and notable improvements since the national VA scandal broke in 2014.

The VA provided the following snapshot of data through November 1, 2015:

  1. Between June 1, 2014, and November 1, 2015, the electronic wait list (EWL) went from 56,271 appointments to 46,146, a 17.99 percent reduction.
  2. VHA created 2.5 million authorizations for Veterans to receive care in the private sector from October 29, 2014 through October 28, 2015. This represents a 3 percent increase in authorizations when compared to the same period in 2013/2014.

A spokeswoman at the James Haley Veterans Hospital and clinics also sent us an email including the following statement and response to our questions.

"James A. Haley Veterans' Hospital and Clinics is a continuous improvement organization. We are always looking to improve processes and quality of care for our patients and their caregivers. As a matter of fact, we will be participating in the national VA Access Stand Down this Saturday. The Department of Veterans Affairs is committed to providing timely access to Veterans as determined by their clinical needs.  On Saturday, November 14, VA medical centers across the country will participate in a first ever National Access Stand Down.  A team of clinical leaders, administrators and volunteers will be on site at every VA medical center to reach out to all Veterans identified as having the most important and acute needs to make sure they can be seen either in VA or in the community - including here at JAHVH..."

The James A. Haley Veterans Hospital answered our questions as follows:

What are the current average wait times for primary care, specialty care and mental health care?

Our wait-times are published every two weeks, the same as other VA facilities and current and historical wait time and access data can be reviewed at: http://www.va.gov/health/access-audit.asp

Currently James A. Haley Veterans' Hospital and Clinics average wait times are 1.33 days for Primary Care, 6.33 days for Specialty Care (just as in the public sector, length can vary significantly by Specialty Clinics) and 3.66 days for Mental Health.

JAHVH has more than 90,000 unique patients and we schedule between 4,000-5,000 appointments daily in all areas of our medical facilities and at our outpatient clinics and receive more than 46,000 consults per month in FY 15.

Every new consult is reviewed by a clinical provider as part of the triage process to determine the clinical urgency of the request. Patients are seen as soon as possible based on clinical review - the more acute the need - the faster the patient is scheduled for an appointment on average.

Do lengthy hold times by phone to schedule a doctor or specialist persist? 

Our average wait time to answer the phone is 49 seconds in FY 15 (the national goal is less than 30 seconds) and our abandonment rate is 3.9% (the national goal is less than 5%), but depending on the location within the medical center a person is calling, hold times and speed to answer the phones can vary. We recognize this can be one of the biggest areas of dissatisfaction with patients and the medical center has established a workgroup that is working to improve telephone access to all areas. Additionally, patients are encouraged to use secure messaging if possible to consult with their health care providers.

Are there safeguards to prevent veterans seeking medical appointments from being left on hold indefinitely?  If so, can they be worked around?

The phone system has different features throughout the medical center based on the volume of calls and staffing level of clinic areas.  One tool we use in high volume areas is the Automatic Call Distributor (ACD) lines. These lines will automatically roll over to the next available operator after a certain length of time. Also some clinics are piloting the use a call back feature for patients who choose not to wait on hold.  Secure messaging is always another option that patients can use to communicate with their providers, and if a patient has difficulty reaching a provider, we encourage patients to reach out to the Service Liaisons or Patient Advocates Office.

Do veterans in the Tampa Bay area continue to encounter lengthy delays to see a doctor or specialist once appointments are booked?

Again, wait times vary based on the type of care, but our average wait times range from 1.33 to 6.33 days. If a patient is unable to be seen at our facilities within 30 days of the clinically indicated/preferred date, that patient is offered care through the Choice program and is then eligible to receive care in the community. Wait times in the community can also be lengthy based on the availability of certain specialty care required and can be a longer wait than VA care in some cases. 

We are continuously and proactively reviewing our high demand specialty areas to help further increase capacity and efficiencies. For example, we do "Super Saturday Clinics" in both Ortho and GI to reduce some of the current patient wait times and are actively working to fill vacant provider positions. JAHVH hiring emphasis has been on Patient Aligned Care Teams (Primary Care) and high demand Specialty Care Services to increase access, including Orthopedics, GI, Ophthalmology and Radiology and we've filled over 100 new FTE positions under VACAA funding including providers, nurses and support positions.

During FY 14, JAHVH activated more than 300,000 square feet of new space, which opened up space for specialty care to expand. JAHVH increased specialty care spaces from 34 to 84 exam rooms for a net increase of about 150%, including an additional:

  • 18 in Ortho
  • 14 in GI
  • 17 in Neurology to open in first quarter of FY16

Additionally, extended hours and weekend appointments are offered at Tampa, New Port Richey Outpatient Clinic, and Lakeland Community Based Outpatient Clinic.

How are consults (enabling veterans to seek specialty care) organized and accounted for to prevent them from getting lost?

Consults are managed and organized in compliance with the National Consult Management Business Rules. All notes are kept in individual patient records.

JAHVH also has a Consult Management Committee (CMC) and designated consult managers within each service who are responsible for ensuring the consults do not get lost. The CMC is a standing medical center-level committee designated to receive, monitor, analyze and address all aspects of consult management to meet the facility's mission and commitment to timeliness of care, provide support to enhance communication of Veterans' needs, and outcome of treatment.  As part of these activities, the CMC functions to coordinate the assessment, implementation, and management of consults and related VISTA structures with all other appropriate entities and reports these activities as appropriate. The CMC identifies opportunities for improvement, and recommends corrective action plans. 

Have schedulers within the VA health care system ever been told by VA management to disregard regulations in any way?

Schedulers are trained to follow all scheduling guidelines. Refresher training is provided to schedulers when scheduling errors are identified through observation, periodic and scheduled audits, etc. There was refresher scheduling training completed for all staff who have scheduling options conducted between July - September 2015. Any staff that did not complete this training had their scheduling access removed.

Specifically, have schedulers been told to disregard 'desired' appointment dates, to avoid gaps between 'desired' dates and scheduled dates?  

Employees are fully and regularly trained and should never disregard regulations when making an appointment for patients. JAHVH is audited by both internal and external organizations to review and ensure data and appointment policies and procedures are followed correctly.  JAHVH executive leadership does not advocate or condone any data manipulation or scheduling irregularities. Should an instance of irregularity be identified, it would be reviewed and corrective action would be taken as necessary.

Have veterans who complain about poor service or delays been adversely affected (with longer waits) as a result of their complaints?

We encourage anyone with a specific concern to contact the hospital's team of Patient Advocacy Specialists that work as liaisons for the Director's Office and are on staff specifically to assist Veterans with any issues or concerns they may have. Additionally, we have Service Liaisons, who field incoming calls from Veterans and either answer their questions or route the individuals to the appropriate office to handle their concerns. JAHVH follows national scheduling guidelines and reviews all appointment and consult requests to ensure they are scheduled timely according to the patients' clinical needs and condition.

For veterans who complain they are unable to utilize their choice cards as they would like, how does VA respond?

JAHVH follows the CHOICE Program rules based on the VACAA law that state a Veteran is eligible for non-VA care in the community if he/she lives more than 40 miles from a VA Facility (to include CBOCs even if they don't offer the specialty) or if based on long wait times (patients that have an appointment scheduled greater than 30 days from when the clinically indicated/preferred date). Veterans may file an "excessive burden" appeal. Additionally, on July 31, 2015, the President signed Public Law 114-41, the Surface Transportation and Veterans Health Care Choice Improvement Act of 2015. Title IV, the VA Budget and Choice Improvement Act, makes several changes to the Veterans Choice Program. We are currently awaiting implementation guidance of these changes. More information about the choice program can be found: http://www.va.gov/opa/choiceact/

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