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VA audits find stressed, overworked staffs made scheduling mistakes

The Department of Veterans Affairs American Lake campus is a fast-growing part of VA Puget Sound.
The Department of Veterans Affairs American Lake campus is a fast-growing part of VA Puget Sound. Staff file, 2012

Schedulers at Department of Veterans Affairs clinics across Washington state were so stressed out by patient growth and low staffing two years ago that they took questionable short-cuts in booking medical appointments, according to a group of audits released this week.

VA investigators launched the investigations in spring 2014, when the agency was under fire for doctoring reports on patient wait times at its hospital in Phoenix, a practice that later was determined to be fairly common across the country.

Altogether, the VA pursued complaints about scheduling misconduct at 77 sites. It did not begin releasing most of those reports until the past month.

In Washington state, the inspector general followed three tips:

▪ An allegation that a supervisor at the VA clinic in Chehalis instructed a scheduler to misrepresent patient requests for medical appointments.

The audit determined that happened on a handful of occasions over three years.

▪  Charges that the VA hospital in Spokane inaccurately tracked requests for mental health appointments.

The IG report confirmed Spokane staff members used unsanctioned scheduling methods in 2013 and 2014.

▪  A complaint from a former VA scheduler that suggested a supervisor at the American Lake hospital in Lakewood instructed her employees to misrepresent their contacts with patients in an internal Microsoft database.

The manager and seven of the complainant’s former coworkers disputed his allegation and the inspector general considered it unsubstantiated.

The lapses in the state clinics took place at a time when the VA set a goal for itself to see almost all patients within 14 days of a request for an appointment.

The pledge was made even as the system swelled with new veterans coming home from Iraq and Afghanistan and it expanded services to veterans of past conflicts.

Today, the VA tries to see patients within 30 days of a request for an appointment, a goal that more closely aligns with its past practices.

The VA hospital in Seattle meets that standard for 91 percent of its patients, while American Lake hits the goal about 86 percent of the time, according to the VA’s more recent wait-time report.

The local system sees about 100,000 patients a year, almost double the number it served at the beginning of the Afghanistan war in 2001. It continues to grow at a pace of 5 percent a year.

Among the three new reports, only the one on Spokane suggests patients might have experienced unwarranted delays in care because of administrative problems at the clinics and hospitals.

“Some patients were rescheduled multiple times while waiting three to four months between appointments,” a Spokane mental health scheduler told the auditors.

In 2014, leaders of VA Puget Sound, which oversees the local facilities, said they were surprised by reports of scheduling misconduct at their hospitals and clinics.

Nine of 27 schedulers interviewed at American Lake that spring told the inspector general they were instructed to schedule appointments for dates that were different than the ones patients wanted.

That report was released to Congress, where lawmakers cited its nationwide findings as confirmation that VA supervisors were instructing staff members to misrepresent scheduling data.

The new reports released this week do not reveal new information about that survey.

In a statement to The News Tribune, VA Puget Sound officials said they have taken steps to improve scheduling practices since the 2014 audits.

They’ve also hired about 200 more full-time employees than the local system had two years ago. Later this year, the VA plans to open an outpatient clinic in Bremerton. Next year, it’s due to open a mental health research facility in Seattle.

The efforts are intended to expand capacity and improve care for patients.

“While we were confident the investigation would not identify any scheduling irregularities, we continued to move forward in finding new ways to improve access to care for our Puget Sound veterans,” the VA Puget Sound statement said.

Adam Ashton: 253-597-8646, @TNTMilitary

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