WSJ Video on Gaming the VA Wait List System & Targets


From the Wall St. Journal:

Read more:

The Real VA Scandal is the Long Waiting Times & Bad Management, Not Gaming by Bad Apples

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.

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Mark Graban
Mark Graban is an internationally-recognized consultant, author, and professional speaker, and podcaster with experience in healthcare, manufacturing, and startups. Mark's new book is The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation. He is also the author of Measures of Success: React Less, Lead Better, Improve More, the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, and the anthology Practicing Lean. Mark is also a Senior Advisor to the technology company KaiNexus.


  1. I believe the latest example of gaming being driven by government mandate is the emphasis on Core Measures and HCAHPS. Of course these things are important but when too much emphasis is placed on selected measures it causes top execs to demand results… so front line leaders and staff find ways to improve scores without actually improving anything. Fortunately, some healthcare systems have systematic change rooted in them but let’s not kid ourselves… The healthcare industry can also teach to the test.

    • Does the VA have to do HCAHPS like private hospitals do?

      There’s a lot of “teaching to the test” in healthcare and gaming of the numbers outside of the VA. I’ve seen articles about hospitals being punished for Ventilator-Associated Pneumonia (VAP) rates, so doctors learn to code patients as having everything BUT pneumonia. Hospitals try to pressure patients into filling out patient satisfaction surveys positively (as car dealers do). There are ways to, as you put it, improve the scores without improving anything.

      See this post:


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