It's not just a backlog problem, the wide-ranging review indicated. Thirteen percent of schedulers in the facility-by-facility report on 731 hospitals and outpatient clinics reported being told by supervisors to falsify appointment schedules to make patient waits appear shorter.
The audit is the first nationwide look at the VA network in the uproar that began with reports two months ago of patients dying while awaiting appointments and of cover-ups at the Phoenix VA center. A preliminary review last month found that long patient waits and falsified records were "systemic" throughout the VA medical network, the nation's largest single health care provider serving nearly 9 million veterans.
"This behavior runs counter to our core values," the report said. "The overarching environment and culture which allowed this state of practice to take root must be confronted head-on."
Acting VA Secretary Sloan Gibson said Monday that VA officials have contacted 50,000 veterans across the country to get them off waiting lists and into clinics and are in the process of contacting 40,000 more.
The controversy forced VA Secretary Eric Shinseki to resign May 30. Shinseki took the blame for what he decried as a "lack of integrity" through the network. Legislation is being written in both the House and Senate to allow more veterans, including those enrolled in Medicare or the military's TRICARE program, to get treatment from outside providers if they can't get timely VA appointments. The proposals also would make it easier to fire senior VA regional officials and hospital administrators.
House Speaker John Boehner, R-Ohio, said the report demonstrated that Congress must act immediately.
"The fact that more than 57,000 veterans are still waiting for their first doctor appointment from the VA is a national disgrace," Boehner said.
The new audit said a 14-day agency target for waiting times was "not attainable," given poor planning and a growing demand for VA services. It called the 2011 decision by senior VA officials to set the target, and then base bonuses on meeting it, "an organizational leadership failure."
A previous inspector general's investigation into the troubled Phoenix VA Health Care System found that about 1,700 veterans in need of care were "at risk of being lost or forgotten" after being kept off an official, electronic waiting list.
The report issued Monday offers a broader picture of the overall system. The audit includes interviews with more than 3,772 employees nationwide between May 12 and June 3. Respondents at 14 sites reported having been sanctioned or punished over scheduling practices.
Wait times for new patients far exceeded the 14-day goal, the audit said. For example, the wait time for primary care screening appointment at Baltimore's VA health care center was almost 81 days. At Canandaigua, New York, it was 72 days. On the other hand, at Coatesville, Pennsylvania, it was only 17 days and in Bedford, Massachusetts just 12 days. The longest wait was in Honolulu — 145 days.
But for veterans already in the system, waits were much shorter.
For example, established patients at VA facilities in New Jersey, Connecticut and Battle Creek, Michigan, waited an average of only one day to see health care providers. The longest average wait for veterans already in the system was 30 days, in Fayetteville, North Carolina, a military-heavy region with Fort Bragg Army Base and Pope Air Force Base nearby.
Gibson, the acting VA secretary, said the department is hiring new workers at overburdened clinics and other health care facilities across the nation and is deploying mobile medical units to treat additional veterans.
The VA believes it will need $300 million over the next three months to accelerate medical care for veterans who have been waiting for appointments, a senior agency official said in a conference call with reporters. That effort would include expanding clinics' hours and paying for some veterans to see non-VA providers. The official said he could not say how many additional health providers the VA would need to improve its service.
The report said 112 — or 15 percent — of the 731 VA facilities that auditors visited will require additional investigation, because of indications that data on patients' appointment dates may have been falsified, or that workers may have been instructed to falsify lists, or other problems.
Gibson also has ordered a hiring freeze at the Washington headquarters of the Veterans Health Administration, the VA's health care arm, and at 21 regional administrative offices, except for critical positions personally approved by him.
Boehner said the House would act on legislation this week to allow veterans waiting at least a month for VA appointments to see non-VA doctors, and said the Senate should approve it, too. An emerging bipartisan compromise in the Senate is broader than that, but senators have yet to vote on it.
Associated Press writers Donna Cassata and Alan Fram contributed to this story.
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