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VA standard for veterans awaiting appointments hiked from 30 to 120 days

Tampa Bay's two veterans hospitals have changed a much-watched measure of their performance by increasing from 30 to 120 days the time a patient must go without an appointment before being placed on a waiting list, interviews and documents obtained by the Tampa Bay Times show.

Critics of the U.S. Department of Veterans Affairs say the change is part of a wider VA trend of fudging statistics showing how well facilities serve veterans.

The VA denies the charge.

But at James A. Haley VA Medical Center in Tampa, a switch from 30 to 120 days this month left the hospital's waiting list for outpatient appointments much improved. It dropped from March's 4,981 patients to 1,800 this month, Haley figures show.

The VA Medical Center at Bay Pines in Seminole increased its waiting list threshold from one to four months in late 2010, earlier than Haley, Bay Pines said.

Bay Pines' waiting list has trended downward as well since late 2010 because the hospital went to the 120-day time frame, said Bay Pines spokeswoman Faith Belcher. Bay Pines' list hit 326 in October 2010, climbed to 1,408 in December 2010 and fell steadily most of 2011, VA figures show. This month, Bay Pines has 269 veterans on the waiting list.

Officials at the hospitals, and national VA officials, said the facilities are not violating VA policy, which no longer mandates any specific time frame for placement on waiting lists.

Critics of the VA said the agency has a long history of toying with its performance measures and not quickly scheduling appointments. Earlier this year, the VA inspector general said the VA had overstated how quickly veterans in need of mental health treatment were evaluated. (Haley and Bay Pines figures during the last year show very few patients encountered delays in getting mental health care.)

"This is a typical practice by VA hospitals that are not making their numbers," said Gordon Erspamer, a California lawyer who has represented several veteran advocacy groups.

If the VA is late providing care, he said, "Then the VA redefines the meaning of late. … It makes things easier to accept more delay. And the VA is largely insulated from any accountability."

Officials at the two hospitals said they strive to treat patients as soon as possible. They said the statistics show they are successful at doing so.

"It is our goal to be able to see every patient when that patient wants to be seen. As a result, we very closely monitor our underperforming areas and teams meet weekly to discuss ways to make improvements," said Belcher.

Hospital officials said the waiting lists are a small proportion of all the patients they treat. At Bay Pines, for example, 100,000 appointments are scheduled a month.

The waiting lists are about more than bragging rights. Called Electronic Waiting Lists, they are used by every veterans hospital in the nation to measure performance and allocate resources.

More importantly, the lists allow hospitals to identify and help veterans who might be unable to get a timely out­patient appointment with a medical professional. All agree the lists are critically important.

While the VA said the waiting lists are generally used only for new patients, the lists at Bay Pines and Haley have included established patients.

Mark Ballesteros, a VA spokesman in Washington, D.C., said the waiting lists are monitored daily. He said the list's "target time frame" is "generally understood, but not mandated, to be within about 14 days."

In 2007, the VA was roundly criticized after the agency's inspector general found the VA had repeatedly underestimated wait times for wounded veterans and forced many to wait more than 30 days.

The inspector general said the VA had falsely reported to Congress that it scheduled 95 percent of its appointments within 30 days of a patient's requested date. The true figure was actually 75 percent, a report said.

In 2010, documents show, the VA changed national policy on waiting lists. The VA simply eliminated the 30-day threshold for veterans receiving VA benefits because of a service-connected wound, injury or condition.

Carolyn Clark, a Haley spokeswoman, said Haley after 2010 "continued to use the 30-day measure as a way to track those veterans so they could be seen earlier if an opening became available."

Officials at Haley and Bay Pines said the numbers on waiting lists are extremely variable. A doctor taking a vacation, said Bay Pines' Belcher, can affect the numbers.

Regional VA officials ordered Bay Pines, Haley and other Florida VA facilities in a memo earlier this year to comb their waiting lists for patients who had been placed on them in error. Some veterans, it was thought, were being placed on the lists even when they were not awaiting an appointment.

"It is important that we have an accurate measure … as it affects the perception of access," the memo said.

The errors "made it seem like the list was being inflated," Shella Miller, Haley's chief of health administration, said in an interview. "There were more people on the (list) than there should have been."

But it also appears that Haley did more than just correct errors on the list. It ended the practice of placing veterans on the list after 30 days.

A March 30 email to a wide variety of staff at Haley, including those who schedule patient appointments, said waiting lists "will only be used for patients, new and established, whose appointment cannot be scheduled within 120 days from the patients' desired date."

Haley and Bay Pines officials said they decided on 120 days because that was the default time frame in VA software used to schedule appointments.

William R. Levesque can be reached at levesque@tampabay.com or (813) 226-3432.

Percentage of patients scheduled
for appointments within 14 days

Bay Pines Haley
Primary care, new patient 85.8 92.5
Primary care, existing patient 91.9 93.1
Specialty care, new patient 81.1 93.4
Specialty care, existing patient 92.9 96.7

Source: U.S. Department of Veterans Affairs

VA standard for veterans awaiting appointments hiked from 30 to 120 days 04/29/12 [Last modified: Monday, April 30, 2012 12:55am]

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