Two Ky. veterans facilities tabbed for further review


Joe Arnold

Posted on June 10, 2014 at 1:11 AM

Updated Tuesday, Jun 10 at 5:45 AM

LOUISVILLE, Ky. (WHAS11) -- Two Kentucky Veterans Administration medical clinics are among 31 outpatient facilities nationwide flagged for further review and investigation after a VA audit regarding wait times and access to health care for America's veterans.

Both the Dupont VA Healthcare Center in St. Matthews and the Fort Knox VA Healthcare Center at Ireland Army Community Hospital are named in an audit report released Monday.

The parent facility for both clinics is Louisville's Robley Rex VA Medical Center which has not been flagged for further review and is not among the VA facilities under investigation by the Office of Inspector General, according to a VA spokeswoman in Louisville.

Yet the wait time statistics for both clinics are included in the overall numbers for the Louisville hospital.

A WHAS11 review of the audit found that of about 57,000 patients across America who have been waiting more than 90 days for an appointment at a VA facility, 595 of them are in the Louisville VA system.

Auditors found the Robley Rex VA Medical Center scheduled 98 percent of all appointments within 30 days.  The Lexington VA Medical Center scheduled 97 percent of first time patients within 30 days.

"Any instance of suspected willful misconduct is being reported promptly to the VA Office of Inspector General (OIG)," the report states.  "Where the OIG chooses not to immediately investigate, Veterans Health Administration leadership will launch either a fact finding or formal administrative investigation. Where misconduct is confirmed, appropriate personnel actions will promptly be pursued."

The report stresses that the reviews are a preliminary step as the Veterans Administration determines the extent of scheduling or access problems at specific facilities.

Primary care, mental health and some ancillary health services are provided at Community Based Outpatient Clinics (CBOC), according to a V-A spokeswoman.  The Dupont Clinic provides healthcare services for approximately 5,500 Veterans, and the Fort Knox facility provides services for approximately 5100 Veterans.

According to the audit, the "initial assessment of sites requiring further review is based on a review of qualitative responses by front-line staff to questions and comments contained in site audit report."

Major findings in the audit include:

* about 57,000 patients have been waiting more than three months for an appointment.

* more than 63-thousand patients have been enrolled in the system for at least ten years but have never been seen by a doctor.

* a complicated scheduling process resulted in confusion among scheduling clerks and front-line supervisors in a number of locations. 

* a 14 day wait-time performance target for new appointments was not only inconsistently deployed throughout the health care system but was not attainable given growing demand for services and lack of planning for resource requirements.

* Overall, 13% of scheduling staff interviewed indicated they received instruction (from supervisors or others) to enter a date different than what the Veteran had requested in the appointment scheduling system.  

* 8% of scheduling staff indicated they used alternatives to the official Electronic Wait List (EWL).  In some cases, pressures were placed on schedulers to utilize unofficial lists or engage in inappropriate practices in order to make waiting times appear more favorable.   

The report concludes that such practices are widespread enough to require VA to re-examine its entire Performance Management system and, in particular, whether current measures and targets for access are realistic or sufficient.   

The WHAS11 review of the audit's findings revealed a wide disparity in the wait times for new patients versus established patients:

To see a primary care provider at a facility operated by the Louisville VA, established patients wait about three days while new patients wait an average of 26 days.

Established patients at the Robley Rex VA Medical Center wait an average of just under four days to see a specialist, while it takes about 51 days for new patients to see a specialist.

The wait times for louisville area veterans to see a mental health specialist are also split, about two days for established patients and about a twenty day wait for new patients.

A bipartisan bill moving through Congress would give veterans who live more than 40 miles away the option of going to a non-VA facility.

"I'm very optimistic that we're finally going to get some serious action here to improve the VA dramatically," Senate Minority Leader Mitch McConnell (R-Kentucky) told WHAS11 on Friday, "which will be important not only to the older veterans but the younger people coming back from recent wars who have been particularly frustrated by it all."