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8/10/2019 VA 2008 Patient Wait Times Memo
1/6
epartmentor
Veterans ffairs
-...
M e m c ~ r a n d u m
f,
ate:
e p t e m b ~ r 2
2 8
.
,_.
;
,
From: Assistant Inspector General for n v e s t l g ~ t l o n s (51)
Subj:
Administrative Investigation - Improper Altering of Patient
~
It
Times
and Failure to Use the electronic d List, Phoenix VA
Heal
h Care
System, Arizona
(2007.()311
1'-IQ-0190)
To:
Ofreclor,
Phoenix VA Health Care System
1.
The VA Office of Inspector General
(OIG),
Administrative
l n v e t i ~
ations
Division,
lnvestigEIIted an allegation thQt VA employees altered patient wait
tin
1es In an effort to
Improve tf1elr performance measures at the Phoenix VA Health Cant
System.
Employees allegedly cancelled and
resched1,11ed
appointments
for tl.e
same date and
time
.
tnu&
oreating a O d
8/10/2019 VA 2008 Patient Wait Times Memo
2/6
';
.
within 30 days of the deeired date only f9r a service connected dis< tbility
AJI
other
veterans must be scheduled
tor care
within 120 days
of
the
deslrec
dete. Polley
defines "desired date as the earliest date on which the patient or clinician specifies
the patient needs to
be
seen. Veteran6 who cannot
be
scheduled 'or appointments
within the 30- or 120-day requirement ehould be Immediately placEd
on
the EWL .
VHA Olrectlve
2008-0SS.
4.
The following exempl
..
clarffy how the VistA pacl
8/10/2019 VA 2008 Patient Wait Times Memo
3/6
than a 30-day wait time, along with Instructions to remake those polntments.
Further, another 6Cheduler told us that
when
he Initially made appc lntments,
he
immediately remade the seme- appointment, If It reflected more
tha
, a 30-day
wait
tlme. He further said that every morning,
his
supervisor ran a
repo
t
of
appointments
made tor servic& oormeoted veterans and that anything with more h
an
a 30.(fay welt
time
we&
c h F ; ~ n g e d .
As
a result,
he
said
thl t
the schedulers "tralnet themselves'' to
change the lnltl1l sppointmenta automatloally'to avoid ehowing up m his list.
7. Another supervisory scheduler told us that the
ins1ructed sche
8/10/2019 VA 2008 Patient Wait Times Memo
4/6
r
10. told us
that when
she
f1rst arrived ;
t
the medical
center In 2004,
it
was standard practlca
to
alter appointments, and employees readily
admitted to her that
it
"gaming" the system. She said that prlo to the VA
Scheduling Directive, schedulers changed or cancelled appolntme 1ts to avoid any
Indication that they made appotntments
with
mont than a 30-day wJlt
ttme. and she
said that old habits were hard
to
break. She told us that since she became a
supeJVisor, she Instructed her staff to schedule correctly and that s
1e
r e l ~ d on her
front llne managers
to
make sure they followed her instructions. S 'e said that she ran
reports to monitor ano compare the appointmentz with the physlcJE ns' n o t ~ . She said
that a report she ran 3 weeks ago reflected more than 400 appoint nents with walt
times greater than 30 days
and
that about 10 percent
of
those werl done Incorrectly.
She told us that ell schedulers took scheduling training, along with one-onone training
for 3 weeks when oriented to their Individual positions. and tha1 sC iedUiers were
aware of the new VA SCheduling Directive. Records reflected that
the
employees we
in1ei'Viewed took the required scheduler training in 2007 or 2008.
11.
told us th t he supervised
all
sc 1edulers n primary
care and specialty cllnies and that he was ultlmate v resDonslble fc ~ t h e i r ~ c h e d u l i n g
practices. H'i' said that the previous enc ouraged "fixing"
appointments, but since
anc'
came onboard,
the
pn ctlce no longer
existed. He said that he was not aware that schedulers were maki 1g appointments,
cancelling
them,
end rebooking them to zero out the walt times. F1rrther, he
$aid
that
employees were instructed to correct only improperly scheduled a11POintments
and
that they ran a dally report to check for appointments with a wait til ne of more than 30
days, correcllng only those that were
rnade
Incorrectly.
12. gave us the following example of an incorrectly
madf
' appointment: A
physician's note said to give a patient the "next available" appointr
1ent.
The scheduler
went Into the scheduling program on May 1, found the next avallat le appointment wes
on August 1, or 90 days from then. If the scheduler put In May 1 as the desired" date,
they were Incorrect, as that created a wait time of 90 days said thBt the
scheduler should instead
put
In a "desired'' date o August 1 to ave ld a 90-day walt
time. He told us that
schedulel' 3
were not supposed to use the
"ne
ct available''
function
in
the VistA package,
e5
it
"skewed
the
numbers."
Howe'v
:tr,
example
was contrary to VHA Directive 2006-055, Attachment o,
thlch
states that
when an appointment Is scheduled as a ''Next Available," the d ~ l e d dale" defaults to
the date the appointment is created and that this is proper when a patient asks to see
a clinician as soon as possible or
the
cl'nic
la
n requests the patient be scheduled
for
the
next available appointment. In example, the proper
way
to schedule
the August 1 appointment would be to use the "Next Available" rurction, which
defaults the "desired" date to May
~ t h u s creating
a 90-day walt ti fie.
13. Records reflected that the 2005 Performance Plan for schedu
~ r s
listed the use of
the scheduling package as a critical element and that for a fully su
~ o e s s f u J
rating, the
s e h A r i l l l ~ r
should have no more than four substantiated instances )f non-compliance.
told ue that schedulers were not permi :ted
more
than four
4
8/10/2019 VA 2008 Patient Wait Times Memo
5/6
errol'$ quarterly and that $Upervisors
rev
i
ewed
appointments to
chEek
for any errol'i.
old us that he believed that scheduling was Incorporated into the schedulers'
pemon ~ e e r i p t i o n s and that performance walt times would fall un ~ e r
the
'umbrella
of scheduling. One supervisor
told us that
schedulers were not pressured
to
reduoe
walt
tlmes and that their performance plans did not contain wait tirr e measures;
however,
another
supervisor
told
ua
that
patient
walt tlmea
were
cc
n ~ i n e
in his
own
performance measures. Two
schedulera
told us that making appo ntments with
more
than e 30-dy walt time
adver&ely
affected their performance
evak. atlons.
Failure to Use thp Electronic Walt
Ust
14. The OIG report
udit
o
lleged
Manipulation
of
Waiting
Tl
nes
in Veterans
Integrated Service Network
3
stilted
that
EWL.s
were
a
key tool t
tsed In
determining
how well medical facilities met their patient care requirements 8nd Nere Instrumental
In
making sure all veterans were treated timely It further stated
th at
Incomplete SWL.s
o m p r o m i ~
VHA's ability
to
access
and
manage demand for
meolical
care.
15. told us that the medical oenter used the EWL and that if a patient could not
be
scheduled for
an
appointment within 120
dayi
they were enter d Into
the EVv'L.
On
the contrary,
1 1d
us that only the
medical center's d
mtal
patients
were
p l e ~ on the EWL. ne said that whvn
he
arrived at the medical c mter
in
2006, ther&
were 1.000 dental patient$
on
It,
but by
the EJnd of
the
yee.r the
nun tber was
zero.
'
told us lha1 the
EWL
was
designed
for
patients who
coulc
not be seen in
30 days of a desired date: that the medical center uswd and monit< red the EWL; end
that when they found a patient mistakenly listed on
the
EWL, they :orrected the error.
Howevef'.
t h ~ ~ o l d us that
the
medical centt r did not use the
EWL. She tsald that Pfevlous and current managers, specifically , told etaff
to get patients
off
the EWL bv scheduling appointments for them a lei to not
use
lt.
totd us
that the medical center dl not have
electronic wait ltSts. one supervisory ached
1 1ler
told
ut
thst the E'.i /L was never
Implemented at the medical center, and another
SEiid th t
the
Instructed him to atop using it.
16.
One scheduler told
ut
that
hli
never used the EWL, because
told
him
not to use lt. Ano1h9r told us that VA Central
Offic
a sent an electronic
message saying that schedulers
could yse the
EWL; howevet,
he
said that
he
had
not yet been trained
on
It nor had his
supervisor
said he could uee lt. A third
scheduler told us lhat his ellnle did not
vcu
t h ~ EWL:
he
did not ha
Je
access to it; and
that two different supervisors and the . told him not to use
ft. He said that his clinic had plenty or eppomtments exceeding
30
days,
but if
a
patient needed a follow
up In
1
f
2 weeks, to accommodate
the p.ltient, his
ctlnlc had
to overbook. Atlotner sCheduler said that rather than use the EWL for patienb that
could not get appointments
within
the required time, she either t e l ~ phoned
the
patient
a1 a later date
or
ha
8/10/2019 VA 2008 Patient Wait Times Memo
6/6
16
received training on It In a report titled
Service Connected
Vetera IS AwfJiting
Appointments S 50.100 Percent dated April 22, 2008, we discov ~ r e d 39
appointments with a wait time in excess
of
30 days, with 8
of
those being more than
100 days, and none were on the EWL.
17.
We
concluded
that
it was an accepted past practice at U\e
Phc
enix
VA
Health
Care System to alter a p p o i n t m e n t ~ to avoid
wait
times greater thar 30 days, and that
through a failure
to
properly communicote a requirement to adhere to policy, some
employees continued th is practice. rh sad that altering wait
times
continued until
she
became a supervisor; one
stJpervlsor be
l
eved
the practice
ceased In 2007; and another said it c e ~ s e d in January 2008 . How Ver, one scheduler
said he continued the practice untll March 2008, and two others ssld that they still alter
appointments. Further,
m n ~ g e m e n t
and sta'ff
were
confused as t) the proper
way 1o
~ c h e d u l e
pallent appointments. .example
of an lnN'Irrp,.ltv l:cheduled
appointment was actually the correct
way, and
the instructed
on&
scheduler
to
go
strictly by "desired" dates, even though policy ~ p e o i f i e s
times
when scheduling a Knext available" appointment Is appropriate . Ac ditionally,
scheduler performance
plans
reflected that
they
should
have nom
)re than four
instances
of
non-compliance; however, lt was left to Interpretation
ls to what
constituted
noncompllance.
Some
schedulers
believed that
lnclut
led
making
appointments with a
walt
time greater than 30 days, further adding to the scheduling
confus ion. Finally, employees were confused tiboutthe use of the
E\NL.
told us
that It was
being
used, whereas, said they only used it I :Jr dental oatients.
Jaid that they used and monitored the EWL, but
the
said that they did not
use ft. One
supervisor said that tMey
never
Implemented the
EWL, and another
~ i d
that
they
were instructed to stop using
it.
1
e We
suggest
that . nsure
that
all
HAS staff, from
managen
to schedulers, use
the VIstA scheduling
p c k g ~
properly
to
manage appointments ir compliance with
VA
pollcyi provide clarification on performance standards
to
sched Jlers and
tMeir
Upe rvisors to ensure that
schedu
l
ers
are
not
penalized for followh19 VA
policy;
and
ensure veterans are placed on EWLs when appointments cannot le scheduled within
the 30- or 120-day requirements.
We
are providing this memoran um
to
for'.
information and official
use
and whatever action deern approp
iate.
It
Is
s u b j e ~
to
the provisions
of the
Privacy
Act of
1974 (5
U S ~
552a). discuss the
contents
or
this
memorandum
with those named in it, within the
be
unds of
the
Privacy
Act; however, it may not
be
released to them. No response
is
nec:essary. If have
any questions, please contael Director, Admin strative
lnvel3tigations DiviSiOn.
at
(202) 461-4500.
6