What The VA’s Self-Audit Missed

Darin Selnick VA Advisor, Concerned Veterans For America
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So you thought the VA scandal couldn’t get any worse? Well, it just did.

The Department of Veterans Affairs released the results of their Veterans Health Administration internal audit yesterday, which evaluated, and then confirmed, allegations of falsified wait times exposed two months ago. While the initial reports of bureaucratic failure came out of Phoenix, the report shows that the systemic problems are nationwide.

Small reforms might help the situation, but a real legislative overhaul is necessary to fix the degrading VA system.

The Results

The audit, according to the Associated Press, found more than 57,000 veterans waiting 90 days or more for their first medical appointments. An additional 64,000 “fell through the cracks” – not being scheduled any appointments at all.

But how reliable is a report on the VA that was carried out by the VA?

Although these numbers do, to a degree, reflect and confirm reports of falsified wait times (with 13 percent of interviewed schedulers having reported being told by supervisors to falsify wait times to appear shorter) there are clear holes in the report that need to be further investigated. Especially when at least one instance of such practices was identified in 76 percent of VA facilities.

The Problems

The first problem is the faulty execution of the study. The audit planned to interview 10 respondents per facility across 731 facilities, but when it was all said and done, results showed they only saw six people per facility across 596 facilities. This resulted in half the sample size they initially were planning for.

The questionnaire clearly showed that the wording of the questions allowed for murky responses and equally convoluted interpretations instead of asking straightforward questions that would confirm or deny allegations clearly.

Among other problems cited in the site reports, was this: “Employees indicating reluctance to participate in the survey due to fear they would be subject to disciplinary action due to deviation from national policy.”

A fear of subjugation that leads to reluctance of participation often results in selection bias in participants. Therefore, participants would likely be limited to those that were not involved in the actions in question, or those that already wanted to blow the whistle on something.

For these reasons, the VA’s results must be taken with a grain of salt. If true widespread subjective interviewing were to take place from a third party, like the Government Accountability Office (GAO) for example, results may reflect even more alarming levels of gross misconduct from VA leadership.

The Solution

The first thing that needs to be done is to allow the GAO to conduct its own interview process with its own methodology. One thing the VA audit did confirm was an undeniable climate of fear surrounding VA employees, if they didn’t comply or spoke out against filing practices.

If a higher percentage of employees felt comfortable speaking out against misconduct we would likely see percentages of misconduct rise with it.

Reformatting questions to more clearly uncover potential management inefficiencies or misconduct could also raise the number of falsified records – as well as reported cases of retaliation against those who refused to do so.

Reform Outside the Numbers

Last week it was announced that a bi-partisan bill is being forged by Senators Bernie Sanders and John McCain. This is in addition to Representative Jeff Miller’s Department of Veterans Affairs Management Accountability Act of 2014 (H.R. 4031), which passed overwhelmingly by a vote of 390-33 in the House of Representatives, and the just-passed Veterans Access to Care Act (H.R. 4810), which passed even more overwhelmingly by a vote of 426-0.

The bill would do two main things to improve accountability and transparency at the VA:

First, it would allow veterans who have experienced unreasonably long wait times at VA hospitals, or live more than 40 miles from a facility, the choice to obtain private doctors outside the VA healthcare system. Second, it would give the VA secretary the power to fire poorly performing senior executives.

The Senate needs to act quickly to finish putting together this bi-partisan piece of veterans’ legislation that will start the process of true reform of the VA and give veterans the accountability they demand from the VA and true choice in obtaining their healthcare. Never again should veterans die due to delays in the VA healthcare system.

Darin Selnick is a 7-year veteran of the United States Air Force, was an appointee for the Bush Administration at the Department of Veterans Affairs from 2001-2009, and is the primary VA advisor for Concerned Veterans for America.