The Department of Veterans Affairs (VA) told medical staffers to “scrub” and delay veterans’ medical appointments to clear up their own schedules, according to a VA document obtained by The Daily Caller.
TheDC recently reported that VA staff in Michigan engaged in “scrubbing,” a process by which staffers convince veterans over the phone that they don’t need their scheduled medical appointments and then bump them another six months or so. The practice was actively encouraged by VA officials.
An undated explainer document found on a VA webpage, entitled “Make Room For Patient Centered Care,” (a Web Cache of which can be viewed here), offered workers “some tips for freeing up space in your appointment grid.”
The VA document encouraged staff to “Increase Revisit Intervals.”
“There are no specific rules on when you need to see patients for return visits,” the document read. “Pushing back return visits by just a few weeks can have huge benefits.”
“For example, a provider with a panel of patients who average 2.34 visits a year [about the VA average] sees the average patient every 22 weeks [52 weeks ÷ 2.35]. That equates to 2350 visits for a panel of 1000 patients. Pushing that back only two weeks makes the return visit rate 2.15 times a year which equates to 2150 panel visits per year. You just picked up 200 slots a year, or almost one slot a day! Do the math on your own panel.”
The VA also encouraged staffers to “Scrub Your Schedule.”
“Patient often call in for appointments that they really don’t need,” the VA doc said. “They may just need a prescription refill or a form filled out. Look at the list of patients scheduled for visits in the next week or so, review the chart, and give them a call. They may be just as happy as you are to eliminate a trip to the clinic. The Navy’s Medical Home clinic in Bethesda assigned a nurse to this task and found that they could eliminate about 30% of their scheduled appointments!”
The agency encouraged staffers to prioritize “Telephone Visits.”
“Speaking of calling patients, why not set up telephone appointments in the first place?” the report said. “Phone calls can be quicker alternatives to face to face encounters. Identify patients that you think would be agreeable to such an arrangement, and whose clinical condition does not require a face to face encounter, and instead of scheduling a clinic visit schedule a time to call them. Make sure you have the right phone number, and make sure you document the encounter as a telephone visit. You may find that setting aside specific hours in your schedule for telephone visits will allow you to reduce the number of face to face visits significantly.”
VA told staffers to book “Group visits” — because apparently going to the agency for medical care is a “social event” for veterans.
“Many of your patients share similar conditions and characteristics. And coming to the clinic for many is a social event as well as a clinical event anyway,” the VA said. “So why not combine the two and set up group visits for patients with similar diagnoses, such as diabetes or hypertension. By grouping them together, you can open up some time in your schedule while providing the patient education and mutual support that are some of the benefits of group visits.”
The VA did not return a request for comment by press time.