Thursday, December 25, 2014
FAIRFIELD-SUISUN, CALIFORNIA
99 CENTS

Did leadership help spark vet wait-time crisis?

By
From page C4 | August 10, 2014 |

Until he resigned in May, VA Secretary Eric Shinseki led his department of more than 350,000 employees for five years by setting “bold goals” that looked impossible to achieve, but that he knew, from his Army years, could inspire better performance and, from Congress, bigger budgets.

But did a goal to cut wait times in half for patients seeking care finally put VA administrators under such pressure that many chose to manipulate performance data, compromise their integrity and even put patients at risk?

A VA physician described for me his reaction and that of colleagues when word reached them in 2011 that veterans seeking a primary care appointment or a specialty care consult were to be seen within 14 days rather than 30 days, the goal VA health care had used since 1995.

“That statement that we had to see patients within 14 days was so unbelievably unrealistic that people laughed at it,” the doctor recalled. He spoke frankly on condition that I not reveal his name or where he works.

“When I first started with VA I was told that when they put in a consult to (my specialty) – and it’s all computerized so you can see exactly the time it was placed – the goal was to see that patient within 30 days. If we were seeing 80 to 85 percent within 30 days, (bosses) were happy,” he said. “That became very difficult because the volume of patients was just overwhelming. Then, all of a sudden, we heard that 30 days had become 14 days. It wasn’t any kind of an official announcement and I’ve got to be honest: Nobody made a big deal about it. In fact, they didn’t pay any attention to it at all. It was just so stupid they might as well have told me I had to see the patient within 14 seconds. It wasn’t going to happen.”

Not everyone inside VA health care, however, could ignore the new goal as nonsense. Administrators responsible for hitting appointment timeliness marks suddenly had higher hurdles to clear or to scoot around.

Who set the new goal and for what reason?

A senior VA official made available to discuss this said the 14-day goal has been removed from all supervisor performance plans. He also said he didn’t know who made the original decision or if it was individual or a group.

When it was set, he explained, apparently there was concern about ensuring that patients who needed critical care be given “same-day access.” So someone suggested that lowering the 30-day goal, he said, would somehow incentivize staff to deliver more same-day care to critical patients.

“I think the mistake we made was to use as an average measure” a 14-day goal set per appointment, as though using it would signal “we had same-day access for people who critically required it,” this official said. “I think we just saw 30, we wanted to get closer to same day access and so they adjusted the performance measure from 30 to 14.”

That was as clear as he could explain what occurred. In retrospect, he added, another mistake was “we didn’t change the resourcing levels with the (new) resource requirement.”

In other words, the 14-day goal was set but not funded. VA health budgets still grew for identified purposes and programs, but no dollars were committed specifically to shortening patient wait times. That would have meant hiring more physicians, nurses and support staff, buying more equipment and setting up more examining rooms and operating rooms.

“That was a mistake,” this official conceded. Why no funding?

“At the time, it would have just been people thinking that setting bold goals was a good thing for an agency.”

That sounded familiar. Bold had characterized Shinseki’s leadership style. He was the secretary who promised to end veteran homelessness by 2015. He also promised by that year to end the compensation claims backlog, which he conceded he had aggravated with another bold move. Shinseki added heart disease, Parkinson’s and B-cell leukemia to the list of conditions VA would compensate for and treat as service-connected ailments if a veteran had stepped foot in Vietnam. Scientists had found an association between these ailments and defoliants such as Agent Orange used in the war.

Last summer, while Shinseki was visiting a VA claims processing site in Newark, New Jersey, I interviewed him about his ambitious goals.

“There’s a fine line between being bold and foolish,” the retired four-star general and wounded warrior said. “I think for the most part, over all the things I’ve ever done in life, (I’ve mostly been) bold and a few times foolish. I think I’m bold here.”

He said he didn’t regret setting bold objectives.

“I’ve been writing plans all my life. I never wrote a tentative plan. That’s not what you expect from a guy you want to solve a problem.”

Debra A. Draper, director for health care at the Government Accountability Office, said VA officials told GAO that they had lowered the wait time goal to 14 days because performance data by 2011 showed VA was meeting the old goal for more than 95 percent of veterans seeking care.

The trouble with that decision, Draper said, was that VA appointment data had been unreliable for years, as both by GAO and the VA’s Inspector General often reported. Yet meeting wait-time goals had been an element of VA performance contracts for administrators since at least 2000, she said.

Factors that made the data unreliable included a scheduling policy that was unclear and open to local interpretation; antiquated scheduling software; inadequate staff training and, effectively, no oversight of data reports.

Was the shift to 14 days a factor in the current scandal?

“You don’t know people’s motivations,” Draper advised. “But, yeah, going from 30 days to 14, for someone who was planning to do something nefarious or manipulative, it’s more pressure to do that.”

But Draper believes the scandal would have occurred even if VA had left the 30-day goal in place because so many veterans were complaining to Congress and to veteran groups about long waits to access care, she said.

“Whether it’s 14 or 30 days, data need to be reliable so they can really measure (and manage) to whatever the benchmark is,” Draper said.

Send comments to Military Update, P.O. Box 231111, Centreville, VA, 20120, email milupdate@aol.com or tweet @Military_Update.

LEAVE A COMMENT

Discussion | 1 comment

The Daily Republic does not necessarily condone the comments here, nor does it review every post. Read our full policy

  • Shelia WinsettAugust 10, 2014 - 10:37 pm

    I have been fighting 25 years for benefits and still my rights have been violated and the VA and Courts do nothing but stomp on me because I am pro se. They will not apply the law to me like they apply to everyone else. Just recently I had a hearing at a RO and the hearing officer was suppose to decide my case but it was decided by another person as an Acting Veterans Law Judge. He made the decision stating that I appeared before him at the hearing which was not true. He knew the law he was not suppose to make the decision in my case but did anyway because he is the knife slicer in the Department. This is wrong for I deserve my benefits and proved my case beyond a shadow of doubt. The VA will not apply the correct law to the correct facts of my case and will not apply the Alabama State Law to my case properly like it does everyone else. This is a travesty of justice and needs correcting. Will the new legislation end this nightmare of stomping on me as a widow of a Vietnam Veteran for these past 25 years?

    Reply | Report abusive comment
.

Solano News

 
Christmas Eve event features Bible, bikes

By Ryan McCarthy | From Page: A1, 3 Comments | Gallery

It’s easy to remember some Christmas memories

By Mayrene Bates | From Page: A2

 
Man’s walk for peace enters Fairfield

By Susan Hiland | From Page: A3, 17 Comments | Gallery

 
$3,500 nets Dixon man $9, he says

By Ryan McCarthy | From Page: A3, 2 Comments | Gallery

Deadline nears for BookFest authors’ contest

By Ian Thompson | From Page: A3

 
Suisun waterfront to host restaurant week

By Ian Thompson | From Page: A3

Conservancy schedules next Quail Ridge hike

By Susan Hiland | From Page: A3

 
Fairfield man wants $28,828 returned

By Ryan McCarthy | From Page: A4, 11 Comments

Fairfield police log: Dec. 21, 2014

By Susan Hiland | From Page: A12

 
Suisun City police log: Dec. 23, 2014

By Susan Hiland | From Page: A12

Suisun City police log: Dec. 22, 2014

By Susan Hiland | From Page: A12

 
Suisun City police log: Dec. 21, 2014

By Susan Hiland | From Page: A12

Fairfield police log: Dec. 23, 2014

By Susan Hiland | From Page: A12

 
Fairfield police log: Dec. 22, 2014

By Susan Hiland | From Page: A12

.

US / World

Governor issues 105 pardons, many for drug crimes

By The Associated Press | From Page: A1

 
10 years after tsunami, Indonesian family reborn

By The Associated Press | From Page: A1

Storm expected to bring Christmas snow to Sierra

By The Associated Press | From Page: A4

 
Sony broadly releases ‘The Interview’ in reversal of plans

By The Associated Press | From Page: A4

Regulations would expand coastal California sanctuaries

By The Associated Press | From Page: A4

 
Officer kills armed 18-year-old near Ferguson

By The Associated Press | From Page: A5, 7 Comments

Interrogation program mismanaged, Senate, CIA agree

By The Associated Press | From Page: A5

 
Denver shelters cite legal pot in homeless upswing

By The Associated Press | From Page: A5

After NYC deaths, a surge of support for police

By The Associated Press | From Page: A5

 
Abe takes office for 3rd term as Japan’s leader

By The Associated Press | From Page: A7

 
Russia: NATO pushed Kiev to drop nonaligned status

By The Associated Press | From Page: A7

Russia in offer to help firms with foreign debts

By T. Burt McNaughton | From Page: A7

 
NKorea outage a case study in online uncertainties

By The Associated Press | From Page: A7

 
Curfew in India state after rebels kill 63

By The Associated Press | From Page: A7

Cuba’s relations with Catholic Church hit high point

By The Associated Press | From Page: A7

 
Iraq: Suicide attack kills 24 people near Baghdad

By The Associated Press | From Page: A7

Sony tries to save face with ‘Interview’ flip-flop

By The Associated Press | From Page: A10

 
Who hacked Sony becomes Internet’s new mystery

By The Associated Press | From Page: A10

.

Opinion

 
Immunity and interrogators: a second look

By Walter Pincus | From Page: A11, 2 Comments

My grandson wants what for Christmas?

By Kelvin Wade | From Page: A11, 2 Comments

 
Letting go

By Letter to the Editor | From Page: A11, 2 Comments

.

Living

Today in History: Dec. 25, 2014

By The Associated Press | From Page: A2

 
Community Calendar: Dec. 25, 2014

By Susan Hiland | From Page: A2

Horoscopes: Dec. 25, 2014

By Holiday Mathis | From Page: A9

 
A partridge in a pear tree will cost a bit more this year

By Kathy Mitchell and Marcy Sugar | From Page: A9

.

Entertainment

TVGrid

By Daily Republic Syndicated Content | From Page: B7

 
Court denies Polanski’s motion to dismiss 1977 sex case

By The Associated Press | From Page: A10

.

Sports

 
Domestic violence at forefront of NFL in 2014

By The Associated Press | From Page: B1

Alabama’s Sims proves critics wrong with big season

By The Associated Press | From Page: B2

 
Associated Press Sports Story of the Year Winners

By The Associated Press | From Page: B2

Masters races to keep field under 100 players

By The Associated Press | From Page: B2

 
Typical NFL season: smiles for some, frowns for others

By The Associated Press | From Page: B2

NBA prepares for Christmas coming-out party

By Brian Arnold | From Page: B2

 
Titans lead Bucs for top pick in NFL draft

By The Associated Press | From Page: B2

Tyler Summitt easing into head coaching career

By The Associated Press | From Page: B2

 
Elvis Stojko, Bourne bring skating to small stage

By Brian Arnold | From Page: B2

New-Look NBA: In Milwaukee, a new hope rises

By The Associated Press | From Page: B2

 
Sharks forward John Scott suspended 4 games

By The Associated Press | From Page: B2

.

Business

Honda recalls 1,252 Crosstours over side air bags

By The Associated Press | From Page: B7

 
Applications for US jobless aid fall to 7-week low

By The Associated Press | From Page: B7

Walmart tests gift card exchange

By The Associated Press | From Page: B7

 
Unions make push to recruit protected immigrants

By The Associated Press | From Page: B7, 3 Comments

.

Obituaries

.

Comics

Beetle Bailey

By Daily Republic Syndicated Content | From Page: A8

 
Rose is Rose

By Daily Republic Syndicated Content | From Page: A8

Wizard of Id

By Daily Republic Syndicated Content | From Page: A8

 
For Better or Worse

By Daily Republic Syndicated Content | From Page: A8

Get Fuzzy

By Daily Republic Syndicated Content | From Page: A8

 
Dilbert

By Daily Republic Syndicated Content | From Page: A8

Peanuts

By Daily Republic Syndicated Content | From Page: A8

 
Garfield

By Daily Republic Syndicated Content | From Page: A8

Pickles

By Daily Republic Syndicated Content | From Page: A8

 
Frank and Ernest

By Daily Republic Syndicated Content | From Page: A8

Baldo

By Daily Republic Syndicated Content | From Page: A8

 
B.C.

By Daily Republic Syndicated Content | From Page: A8

Baby Blues

By Daily Republic Syndicated Content | From Page: A8

 
Zits

By Daily Republic Syndicated Content | From Page: A8

Sally Forth

By Daily Republic Syndicated Content | From Page: A8

 
Blondie

By Daily Republic Syndicated Content | From Page: A8

Sudoku

By Daily Republic Syndicated Content | From Page: A9

 
Crossword

By Daily Republic Syndicated Content | From Page: A9

Bridge

By Daily Republic Syndicated Content | From Page: A9

 
Cryptoquote

By Daily Republic Syndicated Content | From Page: A9

Word Sleuth

By Daily Republic Syndicated Content | From Page: A9