Staff at hospitals for veterans in Texas covered up wait times through massive manipulation of the scheduling system, a deep investigation into Department of Veterans Affairs medical centers in the state revealed.
Since the waitlist scandal broke at the Phoenix VA in 2014, the inspector general has launched a nationwide probe into appointment scheduling practices at medical centers, in an effort to shed light on existing practices. That probe is now finished. Dozens of investigative reports are being progressively rolled out.
The latest reports concern medical facilities across Texas.
Despite overwhelming testimony that schedulers were pressured and bullied into “zeroing out” wait times, the VA inspector general concluded that executives’ hands are clean — that none of them directly and purposefully ordered employees to manipulate the scheduling system.
The procedures are virtually the same as those unveiled in other medical centers across the country discussed by recent inspector general reports, such as Florida, Illinois and Louisiana. In other words, employees here in Texas, too, were trained to “zero out” veteran appointments by modifying a patient’s desired date to match with the first available appointment date, in order to remove the gap between the two and give off the impression that there was no wait time.
In other cases, employees just made sure that the appointment date was within the 14-day scheduling requirement, even though it wasn’t close to the actual desired appointment date expressed by the veteran. One employee told the IG that if an appointment was over 14 days, she was told by an administrative support assistant to “fix it.”
Oddly, the inspector general determined that no executives ordered the manipulation of wait times. Employees implored the IG to understand they were without malicious intent, and were just doing as instructed by supervisors. The manipulation occurred as a result of poor training or problems with decentralized scheduling, the employees said.
VA officials quickly hailed the IG’s report in a letter sent to the press and to Congress. “It is important to note that OIG has not substantiated any case in which a VA senior executive or other senior leader intentionally manipulated scheduling data,” the letter read, according to the Austin American-Statesman.
But the IG did find numerous cases suspiciously close to ordering manipulation. At a facility in Kerrville, one supervisor said that she was trained to equate a veteran’s desired date with the first available date, adding that a superior threatened to fire her if she did not keep wait times to zero. This practice occurred from 2007 to March, 2014.
Another scheduler at the medical center in San Antonio said he also adopted the same practice, “because he did not want to be removed from his job.”
When schedulers did not “fix” any wait times longer than 10 or 14 days, a scheduling error would pop up, and those scheduling errors counted against employees in performance evaluations.
In Houston, a former supervisor told investigators that if patients were scheduled outside the 14-day time frame, schedulers who committed the “error” would undergo written counseling.
A longer testimony from a supervisor at the Outpatient Clinic in Harlingen reveals the nature of indirect harassment from VA officials:
“Supervisor 2 reported that scheduling was being conducted inappropriately. He had witnessed that clerks were using the ‘next available date’ and making it the patient’s desired date. He felt that the fear of reprisal from the TVCB Health Care System management official and from the former chief of MAS was real. He described an environment in which the TVCB Health Care System management official berated people in the morning report if they had numbers that were not within standard. He stated people ‘got smart’ and quit reporting numbers outside the standard.”
At Out Patient Clinic McAllen, a supervisor said that “if you were outside the standard, you had to explain the reason in meetings, which was a humiliating experience.”
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