Investigators Visit WRJ VA Facility
White River Junction — Investigators from the inspector general’s office of the Department of Veterans Affairs recently visited White River Junction to look at employee complaints about practices and training related to scheduling patients’ appointments, according to officials at the Veterans Affairs Medical Center here.
“I actually invited (the inspector general) to come in,” Deborah Amdur, the director of the local veterans’ hospital, said in a telephone news conference called Monday to discuss the hospital’s performance as measured in a nationwide audit on patient wait times.
Investigators were here last week but have not yet reported their conclusions, Amdur said.
Amdur said she requested the investigation after some local employees raised questions about patient scheduling issues. Those issues surfaced “after the national audit occurred” in May, she said.
That audit showed that new patients seeking appointments at the White River Junction VA had to wait an average of 30 days to see primary care doctors, 53 days for visits with medical specialists and 28 days for mental health appointments.
Existing patients had much shorter waiting periods: one day for primary care, 4.5 days for specialists, 1.5 days for mental health care.
The audit came as the VA faced nationwide scrutiny for long waiting times for veterans seeking care at some facilities.
The White River Junction facility’s average wait times for initial appointments didn’t meet the goals spelled out in a March 2013 review of VA scheduling practices by the Government Accountability Office. That review, which said that the VA set a goal of scheduling new patient’s primary care appointments within seven days and specialty care appointments within 14 days of the date desired by a veteran or caregiver, found that elements of the VA’s “scheduling policy and training documents ... are unclear and do not ensure consistent use of the desired date.”
The future of the 14-day target as a performance benchmark seems uncertain. In the news conference, Amdur said that she felt the local facility could meet the 14-day standard, but in a follow-up interview she said that her point was that the local VA had done well in meeting what was “a very high standard.”
A bill in the House of Representatives that would allow veterans to seek care outside the VA system if they face appointment delays uses 30 days as a delay threshold. A parallel Senate bill co-sponsored by Vermont Sen. Bernie Sanders allows veterans to seek outside care if they are “unable to receive an appointment within the department’s current wait time goals,” according to a summary of the bill from Sander s’ office Monday night.
But in a news release earlier Monday, the VA said that it was “eliminating the 14-day scheduling goal from employee performance reviews.” The VA also announced a hiring freeze at its national and regional headquarters, twice-monthly updates of access data and plans for an external audit of system-wide scheduling practices.
Measuring delays poses challenges. As an example of what she called the “complexity of data interpretation,” Amdur pointed to the national audit’s finding of an average 28-day wait for mental health services in White River Junction. Because mental health care is “embedded in primary care,” veterans who require mental health care can, in reality, have “same-day walk-in access,” Amdur said.
Over the past 14 months five new psychiatrists have been hired in the mental health unit at White River Junction, said Lanier Summerall, the chief of mental health services. That unit has found itself providing care to about 500 additional patients each year but remains committed to “see patients as soon, as often and as long as they need,” she said.
The VA’s nationwide audit of 731 hospitals and outpatient clinics singled out 112 for “further review,” including facilities in Brockton, Mass., and in central Massachusetts. White River Junction was “not identified as a facility needing any further review,” Amdur said. That indicated that there was no evidence that local employees had been instructed to fudge dates or work outside the electronic scheduling system, according to Amdur. Those were among the problems identified in some locations by the system-wide audit.
Amdur said that there are some problems with local scheduling practices, which are decentralized. “We have identified that we need to have more consistency in scheduling practices (among our) clinics,” she said. Scheduling operations would be “re-centralized,” she said.
The local VA is also adding staffing to its sleep disorder and dermatology clinics, where delays have occurred, Amdur said.
Some local veterans interviewed last week gave the White River Junction facility high marks.
Leslie St. Pierre of Lebanon said that he had never had to wait for more than a month for an appointment at the local VA and had “never had to wait longer than 20 minutes” to be seen on the day of an appointment.
“This hospital would rate a tripe A+,” said retired Lt. Col. Richard Lillien of South Woodstock. “They treat us like kings.”
Amdur said that the goal at her hospital was to ensure that “when veterans need this care they’re getting timely.”
Rick Jurgens can be reached at firstname.lastname@example.org or 603-727-3229. Valley News staff writer Nora Doyle-Burr contributed to this report.
Veterans hospitals in Brockton, Mass., and in central Massachusetts are among the 112 facilities that will be subject to further investigation by the Department of Veterans Affairs as the result of the audit. An earlier version of this story incorrectly identified the VA Medical Center in Manchester, N.H., as being one of those hospitals that will be further investigated.