Yesterday, Eric Shinseki resigned as the Secretary of Veterans Affairs and President Obama named Sloan Gibson to take his place.
But the question remains: will anything change at the VA?
The final straw for Shinseki was the Interim Report issued on Wednesday by the VA Office of Inspector General. The 35 page report is a scathing condemnation of the conditions at the VA’s Phoenix Health Care System (HCS).
But the report is much more than that. It is a scathing condemnation of the poor management of the VA medical system nationwide.
According to the report, when veterans enrolled for care at the Phoenix HCS, staff from the Phoenix HCS Helpline collected the necessary information about the veteran; including name, address telephone number, Social Security Number, dates of service, DD-Form 214, etc.
But the VA’s eligibility staff didn’t enter that information into a database, instead they, “took a screenshot, and then printed the information.“
From February 2013 through March 2014, the eligibility staff printed the information directly to the VA’s Health Administration Service (HAS) printers in Data Management services at another location in Phoenix.
The personnel from Outpatient Services then had to collect the paper printouts and enter the information into the database containing the Electronic Waiting Lists (EWL). This could take up to two months to complete.
Then in March 2014, the staff at the VA’s Phoenix Health Care System (HCS) changed the way they did things. But the change was a classic example of six of one, half dozen of another, because it really didn’t improve anything.
Instead of printing the screenshot paper printouts directly to printers in Data Management Services, another member of the eligibility staff received the printouts and created a Portable Document Format (PDF) copy of the data every day.
That member of the eligibility staff then forwarded the PDF electronically to Outpatient Services personnel, who then had to enter the information into the database containing the Electronic Waiting Lists (EWL).
The database already exists. The problem, in the case of the Electronic Waiting Lists (EWL) at least, seems to be that the leadership at the VA has never implemented a reasonable procedure for entering someone into the system.
In some places, at least, once the veteran is in the system, the system seems to work well.
When you walk into a VA Health Care Facility you don’t sign in at the desk. Instead, you walk up to a kiosk and you scan your VA ID Car, a white piece of plastic with the VA logo, an American Flag, your photo, your name, and a barcode.
The scanner in the kiosk reads that barcode and displays a screen asking you to enter “the last 4 digits of your Social Security Number.” Anyone who has ever dealt with the VA knows that the VA uses “the last four” to keep track of just about everything.
But Good Grief Charlie Brown, don’t ever change anything, or the VA will have to go back to square one and reinvent the wheel all over. Once again, it is a total failure of the VA leadership nationwide to ensure that the VA has moved into the 21st Century.
For example, if you use a non-VA doctor as your primary care physician, and you decide to change your primary care physician for any reason, the process is pretty simple and seamless.
Your new primary care physician simply sends a request for a copy of your medical records to your former primary care physician and to any specialists that you see, such as a cardiologist or a neurologist.
Your former primary care physician, your cardiologist and your neurologist then provide the records, such as EEGs and EKGs, to your new primary care physician.
But the VA doesn’t work that way. If a veteran chooses to have the VA as his or her primary care physician, the VA will require the veteran to get brand new EEGs and EKGs.
That kind of wasteful mismanagement is why the Interim Report issued by the VA Office of Inspector General on Wednesday is such a scathing condemnation of the poor management of the VA medical system nationwide.
As the second paragraph of the Interim Report states quite clearly.
“Since 2005, the VA Office of Inspector General (OIG) has issued 18 reports that identified, at both the national and local levels, deficiencies in scheduling resulting in lengthy waiting times and the negative impact on patient care. As required by the Inspector General Act of 1978, each of the reports listed was issued to the VA Secretary and the Congress and is publicly available on the VA OIG website”
That statement is on page i of the report, which is actually [age 3 of 35 pages.
In the VA’s typically convoluted fashion; the first two pages of the report are unnumbered, the next four pages are numbered with Roman Numerals, the next page is unnumbered again, and the actual report starts on the eighth page, but that page is numbered page 1.
Here are the links to each of those reports on the Department of Veterans Affairs Office of Inspector General’s website.
- Audit of the Veterans Health Administration’s Outpatient Scheduling Procedures (7/8/2005)
- Audit of the Veterans Health Administration’s Outpatient Waiting Times (9/10/2007)
- Audit of Alleged Manipulation of Waiting Times in Veterans Integrated Service Network 3 (5/19/2008)
- Audit of Veterans Health Administration’s Efforts to Reduce Unused Outpatient Appointments (12/4/2008)
- Healthcare Inspection – Mammography, Cardiology, and Colonoscopy Management Jack C. Montgomery VA Medical Center Muskogee, Oklahoma (2/2/2009)
- Audit of Veterans Health Administration’s Non-VA Outpatient Fee Care Program (8/3/2009)
- Veterans Health Administration Review of Alleged Use of Unauthorized Wait Lists at the Portland VA Medical Center (8/17/2010)
- Healthcare Inspection – Delays in Cancer Care West Palm Beach VA Medical Center West Palm Beach, Florida (6/29/2011)
- Healthcare Inspection – Electronic Waiting List Management for Mental Health Clinics Atlanta VA Medical Center Atlanta, Georgia (7/12/2011)
- Review of Alleged Mismanagement of Non-VA Fee Care Funds at the Phoenix VA Health Care System (11/8/2011)
- Healthcare Inspection – Select Patient Care Delays and Reusable Medical Equipment Review Central Texas Veterans Health Care System Temple, Texas (1/6/2012)
- Review of Veterans’ Access to Mental Health Care (4/23/2012)
- Healthcare Inspection – Access and Coordination of Care at Harlingen Community Based Outpatient Clinic, VA Texas Valley Coastal Bend Health Care System, Harlingen, Texas (8/22/2012)
- Healthcare Inspection – Consultation Mismanagement and Care Delays, Spokane VA Medical Center, Spokane, Washington (9/25/2012)
- Healthcare Inspection – Delays for Outpatient Specialty Procedures, VA North Texas Health Care System, Dallas, Texas (10/23/2012)
- Audit of VHA’s Physician Staffing Levels for Specialty Care Services (12/27/2012)
- Healthcare Inspection – Patient Care Issues and Contract Mental Health Program Mismanagement, Atlanta VA Medical Center, Decatur, Georgia (4/17/2013)
- Healthcare Inspection – Gastroenterology Consult Delays William Jennings Bryan Dorn VA Medical Center Columbia, South Carolina (9/6/2013)
Read them and weep. For almost a decade, the VA’s Inspector General has been waving a red flag about the poor management of the VA Health Care System, and nobody has been listening.
Sloan Gibson has replaced Eric Shinseki as the Secretary of Veterans Affairs, but the question remains: will anything change at the VA?