Wednesday, June 11, 2014
NORTHAMPTON — Officials at the VA Central Western Massachusetts Healthcare System say staff turnover, recruiting problems and increased patient loads at its clinics are among the reasons it scored poorly in a federal audit of how long patients must wait for an appointment.
The Veterans Affairs Department’s audit released Monday looked at 731 VA hospitals and large outpatient clinics and found that the local VA healthcare system had one of the nation’s longest average wait times — 67 days for new patients trying to see a specialist and 72 days for new primary care patients.
The veteran health network fared much better when it came to mental health appointments, with an average waiting time of 27.5 days for new patients. The figure was in line with other VA facilities in New England.
The numbers represent a snapshot of patient appointments within the local VA system as of May 15. The results took local VA officials by surprise, given the positive review they spoke of receiving from the VA’s Office of the Inspector General earlier this year.
“I was not expecting us to to be as bad as we showed up in terms of some of the data,” said Roger Johnson, director of the VA Central Western Massachusetts Healthcare System. He did not dispute the recent figures, saying the wait times for veterans were “unacceptable.”
The earlier review by the OIG included the VA medical center in Leeds and four of the five clinics in the VA Central Western Massachusetts Healthcare System, which serves more than 120,000 veterans in central and western Massachusetts and has outpatients clinics in Greenfield, Pittsfield, Springfield, Fitchburg and Worcester.
“They could find nothing egregious at all to write back to their folks about,” Mike Walsh, quality manager for the local VA system, said of the earlier review.
While some local veterans in west central Massachusetts are waiting weeks and even months for appointments, others say they have no complaints about the timing of their visits to doctors — or about the care they receive.
John Bisbee, a 66-year-old Army veteran from Chesterfield, said he began receiving treatment at the VA in Leeds about three years ago for post-traumatic stress disorder and cancer. Bisbee said he’s never had problems getting appointments.
“Everybody in the Leeds facility shows compassion and love for me,” Bisbee said.
In reporting on the recent findings, the federal audit of 731 VA hospitals and facilities across the nation concluded that a complicated scheduling process resulted in “confusion among scheduling clerks and front-line supervisors in a number of locations.”
It found inconsistent scheduling processes and, in some cases, staff who reported that they were instructed by supervisors or others to enter dates different than what veterans had requested. Eight percent of VA scheduling staff said they used alternatives to official electronic wait lists or were pressured to use unofficial lists or engage in inappropriate practices to make waiting times appear more favorable.
The VA Central Western Massachusetts Healthcare System is one of 112 VA facilities nationwide — and one of only two in New England — flagged for further review and investigation. (The Brockton campus of the VA Boston Healthcare System was also flagged.) The VA is providing the list of sites requiring further review to the agency’s inspector general.
Asked Tuesday about why they believe the VA wants to review the local system further, VA officials said they weren’t sure.
“Not a clue,” Walsh said. “It was very vague as to why they were selected.”
Supply and demand
Walsh and Johnson said in interviews this week that the local healthcare system has been challenged by staff turnover and an inability to recruit specialists in areas like optometry, neurology, urology and dermatology, which has contributed to longer waits for appointments at its clinics and the Leeds medical center.
The system was down four physicians during the past year, including two physicians at its clinic in Worcester, one of whom left unexpectedly. Each doctor can carry a maximum load of about 1,350 patients, according to the VA.
“That’s pretty detrimental to our system when you take two out of the system,” said Amy J. Gaskill, a VA spokeswoman.
Gaskill said the VA has recently hired four primary care physicians, though the recruitment of physicians remains a struggle. So does recruitment for other specialty positions, including dermatology and neurology. “It’s not like we have a plethora of neurologists out there, let alone to recruit one,” Walsh said.
The VA system has three podiatrists, though one has been out on an extended leave, which also has contributed to longer patient waiting times in that area.
As it seeks to meet the VA’s goal of getting veterans with extended wait times appointments within 30 days, Walsh said staff members are working extra time. The VA is working with non-VA medical facilities such as Cooley Dickinson Hospital and Baystate Medical Center, with which it has fee-based agreements to provide care for veterans. The VA also relies on medical professions in private practice who work at the VA to provide veterans care.
“One area we are struggling with is optometry,” Gaskill said. “We are working very closely with local optometrists to bring these numbers down and get them care.”
Walsh said the VA’s Worcester clinic is its busiest, and the loss of physicians there combined with the backlog of care in specialties such as optometry has in part driven the longer average wait times for new patients enrolling in the healthcare system.
The integration of VA healthcare under the Central Western Massachusetts three years ago has added stress on the VA medical center in Leeds, Walsh noted. The Worcester clinic used to belong to and rely on the VA healthcare system in Boston for overflow and specialty care needs; the Fitchburg clinic had a similar relationship with the VA facility in Bedford and used to refer patients to Boston. Now they rely on Leeds.
“It’s kind of increased workload and capacity issues, we’re realizing at this point,” Walsh said. “It’s supply and demand. That’s the best way to put it.”
In addition, the VA Central Western Massachusetts System does not provide certain specialty care, such as cancer treatment or most surgery. As a result, it refers veterans elsewhere for such care.
Gaskill said the local VA system has made more than 500 calls to veterans who have been identified as having their desired appointments scheduled 30 days or more in an effort to get them care sooner. The work is “patient-specific” and “clinic-specific,” Walsh said.
He said the VA is allowing patients who don’t want to move up their appointments to keep their desired times even if they are beyond 30 days.
Walsh acknowledged that the VA has work to do getting a group of veterans care sooner, and Johnson on Monday said the audit provides “an opportunity to improve.”
“The data the VA put out is 100 percent correct,” said Walsh, who is the local VA’s data expert. “That being said ... you’re looking at a snapshot in time. Here’s what it looks like on May 15, 2014.”
“I would have looked at the data differently,” he continued. “When was the patient scheduled and when was he seen? That to me is more meaningful and valuable than the snapshot in time.”
Staff writer Bob Dunn contributed to this article. Dan Crowley can be reached at firstname.lastname@example.org.
U.S. Department of Veterans Affairs VA access audit and wait-time fact sheet VISN 1 June 9, 2014