WSJ Video on Gaming the VA Wait List System & Targets
From the Wall St. Journal:
You can also read about the four “schemes” in the VA Inspector General’s report (PDF)
Scheduling Scheme #1
Schedulers go into the scheduling program, find an open appointment, ask the veteran if that appointment would be acceptable, back out of the scheduling program, and enter the open appointment date as the veteran’s desired date of care. This makes the wait time of an established patient 0 days.
Scheduling Scheme #2
Schedulers at several locations described a process using the Clinic Appointment Availability Report (or similar report) to identify individual schedulers whose appointments exceeded the 14-day goal. Scheduling supervisors told schedulers to review these reports and “fix” any appointments greater than 14 days. Schedulers say they were instructed to reschedule the appointments for less than 14 days. At one location, a scheduler told us each supervisor was provided a list of schedulers who exceeded the 14-day goal. To keep their names off the supervisor’s list, schedulers automatically changed the desired date to the next available appointment, thereby, showing no wait time.
Scheduling Scheme #3
Staff at two VA medical facilities deleted consults without full consideration of impact to patients. The first facility deleted pending consults in excess of 90 days without adequate reviews by clinical staff. Schedulers working at the second facility cancelled provider consults without review by clinical staff.
Scheduling Scheme #4
Multiple schedulers described to us a process they use that essentially “overwrites” appointments to reduce the reported waiting times. Schedulers make a new appointment on top of an existing appointment of the same date and time. This cancels the existing appointment but does not record a cancelled appointment. This action allows the scheduler to overwrite the prior Desired Date and appointment Create Date with a new Desired Date. This adjusts the Create Date to the current date of entry and the Desired Date to the date of the appointment, thus reducing the reported wait time.