'Ghost panels' found at Iowa City VA hospital

Veterans assigned to teams without primary care doctors

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More than 1,200 veterans receiving care at the Iowa City Veterans Affairs Hospital were assigned to “ghost panels” — primary care doctors who was not actively providing care — in early 2016, a new report by the watchdog arm of the U.S. Department of Veterans Affairs found.

And while the Iowa City VA has taken efforts to ensure ongoing patient care, the Inspector General’s office in Washington, D.C., reminded the hospitals in the report released Thursday that it is required that patients be reassigned to other primary care teams when physicians leave.

The Iowa City hospital — along with the Black Hills, S.D., facility — was one of two in the Midwestern VA health network listed in the report as using so-called ghost panels. Those 1,245 patients at the Iowa City VA listed as having been in ghost panels represented nearly 3 percent of the system’s active primary care patients.

“The use of ghost panels at any Veterans Administration facility to misrepresent the true panel size is disconcerting,” U.S. Rep. Dave Loebsack, D-Iowa City, said in a statement. “The fact that the VA has created an environment where the use of ghost panels appears to be in use across the nation is unacceptable. ... VA leadership must be held accountable for their actions.”

Ghost panels gained national attention over the past several years as VA hospitals were widely reported to have tried to game the system to make patient loads and wait lists appear smaller.

The recent inspection was done after U.S. Rep. Timothy Walz, D-Minn., heard from multiple providers about ongoing issues at the St. Cloud, Minn., VA hospital.

Walz requested the Inspector General’s office review the use of ghost panels at all VA hospitals in the Upper Midwest Veterans Integrated Service Network, which includes Iowa, Minnesota, Nebraska, South Dakota and North Dakota as well as parts of Illinois, Kansas, Missouri, Wisconsin and Wyoming.

The region serves about 300,000 veterans.

The review was conducted between Dec. 29, 2015, through Feb. 11, 2016. In total, only about 2,300 of the 287,095 active primary care patients, or .8 percent, were assigned to ghost panels.

The Inspector General’s report concluded the use of ghost panels was not “pervasive,” but noted the existence of them is inconsistent with Veterans Health Administration policy.

The report continued that the Inspector General’s office did not identify “a negative impact on patients since the facilities had enacted efforts to ensure ongoing patient care.”

Iowa City staff told the Inspector General’s office that the panels were from two primary care physicians who accepted positions at other VA facilities — one in August 2015 and the other in November 2015. Recruitment efforts to fill these vacancies were not expected to have exceeded six months, the report said.

“Staff told us that they employed several different strategies to meet ongoing patient care needs for patients assigned to those (primary care) panels,” the report said. “Efforts included reassigning acutely ill patients to other (primary care physicians) with panel capacity, assigning surrogate providers to receive and manage electronic health record alerts on a weekly basis, and using a pool of providers to see patients assigned to these panels.”

The Iowa City VA confirmed that explanation in a statement to The Gazette, saying the Health Care System experienced a staffing change last fall that left two Patient Aligned Care Teams (PACT) temporarily without assigned providers.

“Those two patient panels remained with the PACT during the vacancy period in an effort to create a seamless customer experience for the veterans being served,” Jonathan Pruett, a hospital spokesman, said in an email.

“By doing this, veterans on each panel could continue their relationship with the nurse care manager, clinical associate and administrative clerk they were accustomed to — and only a temporary change in provider would be experienced.”


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