The C.W. Bill Young VA Medical Center boasted this week that an independent accreditation group found the facility followed the patient-scheduling rules of the Department of Veterans Affairs and used no inappropriate practices.
The Joint Commission's nationwide review of scheduling practices was ordered earlier this year after allegations that some hospitals cooked their books, using prohibited bookkeeping practices to make it appear veterans got medical care faster than was true.
"The report was good news for us," Young VA spokesman Jason Dangel said Friday.
But that stands in contrast to the VA's spring audit of the facility, which noted that some scheduling employees said they were "encouraged" to alter the dates patients asked for appointments. This could boost the hospital's performance statistics, making it appear veterans got medical care faster than they did.
The VA acknowledged this audit had its limitations because it was done quickly. But the Young VA, located near Seminole, and other facilities were referred to the agency's investigative watchdog, its inspector general, for further review.
It's unclear whether the Joint Commission looked at this practice and cleared the Young VA of wrongdoing because both the VA and the commission said the report is confidential and refused to release a copy to the media.
Dangel said the Joint Commission, which visited the hospital on Oct. 20 and 21, looked at a variety of hospital operations, including scheduling and access to care, and found no problems in the quality of care offered. But neither he nor the Joint Commission would confirm specifically whether it looked at the same issue as the VA's audit, which was released in July.
How this secrecy reconciles with VA Secretary Robert McDonald's goal when ordering the review of "restoring trust in our system" is a point that may be up for debate with agency critics and Congress.
"The findings are encouraging," said U.S. Rep. David Jolly, R-Indian Shores. "But I'm concerned they may be of little to no value if they are not transparent and available for review by members of Congress and the public."
VA officials in Washington did not return messages seeking comment. Dangel, however, said the Young VA does not use prohibited practices to boost performance measures.
Such measures were formerly used by the VA to help determine bonuses for its leadership.
VA appointment scheduling begins with what the agency calls the patient's "desired date." That is the appointment date requested by a veteran. The VA says its goal is to have a patient seen by doctor as close as possible to the desired date.
Most VA hospitals through the years, including the Young VA, have reported statistics showing the overwhelming majority of veterans are seen within 14 days of their "desired date."
The VA reported to Congress in July, however, that its audit found evidence that employees were "encouraged" by supervisors or others at 76 percent of VA facilities to change a patient's "desired date." The Young VA was on that list.
For example, a veteran might request a doctor's appointment for Dec. 1. But an appointment slot may not be available on that date, so the veteran is seen on March 1 instead. But if the scheduler reports that March 1 was the patient's actual "desired date," the hospital's books would reflect a timely appointment - the veteran was seen on the day requested.
An Inspector General spokesperson could not be reached to comment on the status of its investigation of Young VA appointment scheduling. Dangel said he did not have information on it.
The VA earlier this year discredited the use of "desired dates" as a measure of hospital performance.
"Meeting a 14-day wait-time performance target for new appointments was simply not attainable given the ongoing challenge of finding sufficient provider slots to accommodate a growing demand for services," the VA said in July.
Some veterans interviewed by the Times said they have long been puzzled how the Young VA and other facilities could report that most patients are seen within two weeks of their "desired date" when their own experience is that they frequently wait far longer.
Marine Corps veteran Raymond Gadreault, 66, of Clearwater said he has waited several months to get many appointments. And he said he is rarely asked by the hospital when he wants to be seen by a doctor or for a test.
Instead, he said, a card arrives in the mail telling him when to report for an appointment. Often, the card arrives just a few weeks beforehand.
"They don't consult you," Gadreault said. "They just say, 'Here's the date. Show up.'"
But Dangel , the Young VA spokesman, said employees are supposed to ask veterans for the date they want to be seen. They may not get the day, he said, but they are asked.
Suzanne Klinker, the Young VA director, said in a memo to local veterans groups and others that the Joint Commission's survey "is another example of our core values - integrity, commitment, advocacy, respect and excellence - being visible in our actions."
Contact William R. Levesque at firstname.lastname@example.org or (813) 226-3432.