In an investigation released this week, the Veterans Health Administration was again found to have been incorrectly reporting the wait times experience by veterans seeking care. The scandal first caught national attention in 2014, when investigations discovered widespread wait-time manipulation, and more than 100 facilities were investigated. Those revelations led to the resignation of then-Secretary of the Department of Veterans Affairs Eric Shinseki, as well as laws intended to increase accountability at the Department and increase access to care outside of VA facilities for veterans. Unfortunately, this new audit found that the pattern of misreporting wait-times continues.
Persistent problems with manipulation of wait-time figures could indicate that the dysfunction at the agency is more intractable than initially thought, and fixing these problems could be even more difficult.
New reforms have not been able to fully address the flaws within the Department or ensure that veterans get timely access to care. The Veterans Choice Act of 2014 allowed veterans who had to travel more than 40 miles or faced wait times of more than 30 days to access care outside of VA facilities. The Veterans Choice Improvement Act, passed in 2017, expanded upon these initiatives, by paying co-pays and deductibles for veterans directly instead of reimbursing them later. However, wait-time inaccuracies that continue to this day are preventing a significant number of veterans from being deemed eligible. The country cannot keep failing its veterans in this way. Reforms passed by Congress should be enforced with accurate wait-time data.
In the latest audit, the VA Office of Inspector General investigated wait times at the main VA medical facilities in one of the network’s 18 regions throughout the country, encompassing facilities in Missouri, Illinois, and Kansas. The investigation found that 18 percent of appointments for new patients had wait times longer than 30 days, significantly higher than the estimated 10 percent shown by the Veterans Health Administrations system. The average wait time for this 18 percent was 53 days.
The incorrect wait-time data “resulted in veterans not being identified as eligible for Choice.” Whether through incompetence or willful misreporting, the VA is undercutting reforms and limiting the number of veterans who should be deemed eligible for the Choice program.
For veterans seeking new mental health or specialty care appointments, which are supposed to be the areas of expertise for VA facilities designed to deal with the specific problems and traumas facing veterans, the medical facilities did not record accurate wait times for 38 percent of these appointments. Medical facility staff inappropriately discontinued or canceled 27 percent of consultations, leading to either delays or in some cases, veterans not receiving the requested care at all.
Unfortunately, the results of this audit are similar to ones from March 2017 in a different region of the country. That audit also found that actual wait times were significantly higher than the figures reported by the electronic scheduling system, and a significant number of veterans were inappropriately not made eligible to receive care through the Choice program.
Time and again, investigations have found wait-time data has been inaccurate or misreported. A significantly higher share of veterans wait longer than the 30-day threshold shown by the official system’s electronic records, and many of these veterans should have been made eligible for the Choice program.
The problems within the department were recognized soon after the initial scandal broke in 2014, and the VA Accountability and Whistleblower Protection Act was enacted to make it easier to discipline poorly-performing VA employees. The goal of the act was to increase accountability and improve the culture within the Department. While it may still deliver, so far the effects have not been promising.
As a recent article from Politico and Pro-Publica notes, firings at the VA have increased almost 60 percent. However, only four senior leaders have been fired since the law took effect, and the vast majority of actions are against low-level staffers such as food service workers or housekeepers. The culture and accountability crises will not be solved if leadership members who oversaw the wait-time manipulation are not taken to task.
Problems with wait-time reporting, and air of malaise and incompetency at the VA, are threatening to become so commonplace that they no longer generate the outrage that they once did. This would be tragic and tantamount to accepting a situation in which too many veterans still struggle to receive access to timely care, even as we approach four years from the initial scandal. We should not let these problems be pushed out of the American consciousness, and should instead recommit to the investigations, hearings, and reforms needed to address them.
Charles Hughes is a policy analyst at the Manhattan Institute. Follow him on Twitter @CharlesHHughes.
Editor’s Note: This piece was originally published by Economics21 at the Manhattan Institute.