The Numbers Game
Healthcare has always been at the forefront of controversy in the United States. Recently, new healthcare laws are trying to bring more Americans off the streets and into hospital waiting rooms at a cheaper cost. Small businesses, employers, and many middle-class folks are stuck in the middle of polarizing politics and legal challenges about the new government-backed healthcare system.
Whatever side you happen to stand on relating to the issue, we can all agree that having the opportunity to see a doctor in a reasonable timeframe is important. Some health risks are silent killers, and others can be masked as lesser illnesses for years.
The United States Department of Veterans Affairs, or the VA, has prided itself on being a leader in promoting the best care for the men and women who have served this nation. Unfortunately, years of mismanagement have created a culture of entitlement at the VA.
Rather than meet the challenge to better serve our veterans, clinic directors and senior staff at several VA clinics across the country coached their staff on how to “game the system” in order to make their clinics appear more efficient. Meaningful improvements in-patient wait times—designed to get more veterans into the doctor’s office—turned out to be falsified data whose only benefit was to provide salary increases and bonuses to senior staff.
Many of these problems started in 2010 with former VA Director Eric Shinseki. Shinseki approved a plan of attack to get more veterans in the doors of the VA. Fourteen was the magic number, as the new goal of the VA was to get all new patients appointments within fourteen days. With little to no oversight, some clinics figured out clever “workarounds” that inflated their appointment waiting times.
Not long after Shinseki set aggressive metrics for improving appointments and wait times at the VA, an internal memo documented a growing problem. This memo described in detail how some VA clinics were using “inappropriate scheduling practices” to help boost their numbers. Some of these practices include:
- VA clinics cancelled an appointment for patients on purpose, claiming that the patient canceled the appointment instead of the clinic. This practice allowed for clinics to artificially manipulate scheduling practices to help keep appointments within 30 days.
- Some clinics would cancel patients’ appointments if they failed to arrive 10 to 15 minutes before their appointment, helping to boost their “Missed Opportunity” ratings.
- Scheduler’s would create “fake” appointments to either hold spots for patients or to simply boost appointment numbers in the electronic monitoring system.
- Clinics would misuse “test patients” in the scheduling system to book out clinics while doctors or staff were on vacation.
- Schedulers routinely failed to include what day the patient would like to be seen, instead marking the day of their appointment as their “Desired Date.” This date was meant to help patient’s get medical care by a date of their choosing. Instead, clinics would use the appointment date as this “Desire Date,” inflating numbers and falsely decreasing wait times.
- The VA would put “New Patient” consultations and follow-up appointments above the needs of “Established Patients” because it looked better on evaluations.
It should come as little surprise that the VA handed out enormous bonuses in the following years. According to NBC News, in 2013 the VA paid nearly $2.8 million in bonuses to senior executives. What’s even more amazing is that all of the 470 senior managers in the VA received a “fully successful performance review.”
The painful truth about all of this is the patients that were given the run around were all veterans. As we know from last year’s fallout with the VA, many clinics kept written waiting lists for patients instead of inputting data into an electronic scheduling system. This written system let clinics manage appointments off the books to make their wait times seem shorter, despite the obvious fact that some patients’ worsening medical conditions were set to the side. Many veterans died because of a more than decade long struggle to fix wait times and improve scheduling at the VA.
Those that have served in the Armed Forces should not be treated like a quota that needs to be reached. They are not just appointments on a calendar or marks on a list. Veterans require extensive healthcare options—not government metrics. Let’s hope the VA has purged those who care more about meeting their numbers for the month then the well-being of those who signed up to protect this nation.