VA audit reveals how Iowa medical centers are performing

For one Cedar Rapids veteran, an appointment at a local Veterans Affairs clinic has turned into a headache.

The 69-year-old made a doctor's appointment after his legs began to swell. But when his wife wound up in the hospital days before his appointment, he needed to reschedule.

The veteran, who asked The Gazette not to use his name because he's still trying to obtain that doctor's appointment, said he called the clinic a number of times over several hours leading up to and even after his scheduled appointment in mid-July, but was unable to reach anyone until late in the afternoon.

He decided to go into the clinic the following business day and was then told he would have to wait three weeks before he'd be able to reschedule. A clinic employee told him his VA doctor had retired and he needed to be appointed a new one.

'And he said it'd probably be August before I got (a new appointment),” the veteran said.

He added that he's had many positive experiences with the Iowa City VA Health Care System and clinics in the past.

'But this leaves me with what? Going to a private doctor? I don't know what to do,” he said.

Audit reveals long wait times

A nationwide audit of VA health care facilities found that none of the 141 medical facilities examined across the country met the 14-day wait-time target, which the VA set in 2010, adding the target 'was simply not attainable given the ongoing challenge of finding sufficient provider slots to accommodate a growing demand for services.”

President Barack Obama has asked for $68.4 billion for the VA in 2015, according to the Office of Management and Budget. This is a 3 percent, or $2 billion, increase from the 2014 budget and allots $56 billion for medical care - a 2.7 percent increase above the 2014 enacted level.

The audit, conducted by the VA's Veterans Health Administration, took place May 12 to June 3 and included 731 site visits and data collected from 10 'front-line staff” members per facility through questionnaires.

It found that more than 100,000 veterans had to wait 90 days or more for appointments.

It was released on June 9, and the VA is posting regular updates, with the most recent data out on June 19.

Overall, 13 percent of scheduling staff interviewed said they received instruction to enter a date different from what the veteran requested in the appointment scheduling system. This misrepresentation happened at least once in 76 percent of VA facilities.

Since the start of the VA hospital scandal, in which some hospitals were found to have misreported patient wait times that may have led to 40 veterans' deaths in Phoenix, VA Secretary Eric Shinseki resigned and two more senior officials - the undersecretary for health and the general counsel - have left.

'The Hous Committee on Veterans's Affairs will accelerate its investigation from this point forward,” said VA Committee Chairman Jeff Miller, R-Fla., according to the Wall Street Journal.

Miller said that Sloan Gibson, acting secretary, would have 'no honeymoon period.”

'I continue to call for criminal investigations of the VA,” said Rep. Steve Israel, D-NY, in the same Journal story. 'If there was wrongdoing, if people covered things up, if they doctored forms - they need to be investigated, they need to be prosecuted and they need to be punished.”

In Iowa

Here in Iowa, the average wait time for new patients was 43 days at the Iowa City medical center and 39 days at the Central Iowa medical center in Des Moines. Site audit teams visited the Iowa medical centers on May 15 and May 16.

The audit showed that while the majority of veterans were able to schedule an appointment within 30 days of their desired dates - 90 percent in Iowa City the and 91 percent in Central Iowa - there were still a fair amount of veterans who had to wait more than 90 days to see a doctor.

In Iowa City, 680 veterans had to wait between 91 and 120 days for an appointment and another 356 had to wait more than 120 days. In Central Iowa, there were 63 veterans who had to wait between 91 and 120 days, and 110 veterans who had to wait more than 120 days.

There were more than 6.1 million appointments scheduled across the VA as of June 1, with 35,373 scheduled in Iowa City and 21,002 scheduled in Des Moines.

The Iowa centers are average in size compared to those nationwide, with medical centers far outpacing them - including Atlanta where there are 117,000 appointments scheduled and Bay Pines, Fla., where there are 122,000 - and centers far smaller - including Walla Walla, Wash., where there are only about 8,000 schedules appointments and in Sheridan, Wyo., where there are 4,933.

The Iowa City VA Health Care System oversees the operations of nine outpatient clinics and the Medical Center within a designated area spanning 50 counties - 33 in Eastern Iowa, 16 in western Illinois and one in northern Missouri.

The information released also shows that wait times vary depending on the type of appointment scheduled. For the month of April, new patients had to wait an average of 44 days for a mental health appointment compared with 27 days for a primary care appointment in Iowa City.

In Des Moines, new patients waited an average of 24 days for a mental health appointment and 20 days for a primary care appointment.

According to the audit, staffing problems frequently were cited as an obstacle to scheduling veterans and were reported at many sites. Employees commonly reported difficulties and distress related to being understaffed, both in terms of scheduling staff and health care professionals.

VA officials at the Iowa City medical center were contacted for comment about wait times and staff turnover rates but did not respond.

Calling for change

A June Gallup poll found that 55 percent of U.S. veterans said that access to medical care through the VA was very or somewhat difficult. The poll also found that the recent controversy has negatively affected how veterans view the VA, with 60 percent saying they are now less confident in the ability of the VA to care for veterans.

Republicans and Democrats on a national level both have called for changes in how the VA does business - but the two sides have very different ideas on what those changes should be done.

The Republican-controlled House and Democratic-controlled Senate are moving legislation that gives the VA chief more authority to fire senior executives. But chairman Miller said he intends to bring up legislation that would partially privatize the VA, allowing veterans who have waited for an appointment for 30 days or more to go to a private doctor.

The Senate wants to open additional VA facilities to accommodate more people.

Ernie Butler, a retired staff sergeant in the Air Force, said he's against the idea of privatizing care, calling it a 'knee jerk” reaction from Congress.

Congress is 'quick to point fingers, but not at themselves,” he said.

The 61-year-old, who is now the director of sports and recreation of the Paralyzed Veterans of America, was in Cedar Rapids last week for the National Paralyzed Veterans of America year-end trap and pistol shoot.

'I think it's very important veterans are treated at the VA because they understand veterans,” he said.

Butler said he's received wonderful care from the VA in the past, but added the system certainly has its problems. The VA faces unrealistic demands, he said, and it needs better staffing and more realistic administrative controls.

'They (Congress) just need to roll up their sleeves and get in there and fix it.”

During the same event, Joseph Fox Sr., a retired Marine, called the recent problems embarrassing and disgraceful. The VA, he said, has turned a 'blind eye” to the problem.

'They (veterans) depend on the VA to honor the contract they signed,” he said.

By the numbers

Central Iowa

'Total appointments: 21,002

'Appointments under 30 days: 19,244

'Appointments 31-60 days: 1,270

'Appointments 61-90 days: 315

' Appointments 91-120 days: 63

'Appointments beyond 120 days: 110

'Average wait time mental health: 24

'Average wait time primary care: 20

'Average wait time specialty care: 17

Iowa City

'Total appointments: 35,373

'Appointments under 30 days: 32,100

'Appointments 31-60 days: 1,552

'Appointments 61-90 days: 685

'Appointments 91-120 days: 680

'Appointments beyond 120 days: 356

'Average wait time mental health: 44

'Average wait time primary care: 27

'Average wait time specialty care: 23

Nebraska-Western Iowa

'Total appointments: 36,555

'Appointments under 30 days: 33,686

'Appointments 31-60 days: 1,753

'Appointments 61-90 days: 905

'Appointments 91-120 days: 188

'Appointments beyond 120 days: 41

'Average wait time mental health: 10

'Average wait time primary care: 27

'Average wait time specialty care: 23

Source: Veterans Affairs Health Administration