Hospital Official: VA 'Games' Patient Schedules|by Bryant Jordan

Department of Veterans Affairs officials came under fire in a Senate hearing Wednesday over the long wait times for vets who need mental health services, though a senior official denied VA hospitals are “gaming the system” to make it appear the situation is improving.

Senate Veterans Affairs Committee Chairwoman Sen. Patty Murray, a Washington Democrat, pushed the issue after a VA hospital coordinator testified that vets were waiting a month or longer to be treated for post-traumatic stress, even though VA officials have said new patients are getting in within two weeks.

“Veterans in need of new and established patient appointments usually have to wait far longer than 14 days -- and often as long as two months -- before they can begin evidence-based trauma-focused treatments,” said Michelle Washington, coordinator of PTSD services at a VA hospital in Wilmington, Del. “Often, after such a delay, patients have lost the motivation for treatment and therefore cannot benefit from these highly effective treatments.”

Washington, who appeared as a representative for the American Federation of Government Employees, which represents more than 200,000 VA workers, told the lawmakers she feared retaliation by VA management for appearing at the hearing.

“Nonetheless, I took the risk of testifying today because of the importance of speaking out about the growing barriers to providing mental health care to my patients,” she said. “Like my colleagues, I work at the VA because of an intense dedication to serving this unique patient population, and their service-connected mental health conditions.”

Veterans advocates say delays in mental health care are especially destructive at a time when veteran suicides are on the rise, and when the population of veterans will only grow after the wars in Iraq and Afghanistan.

Paul Rieckhoff, head of Iraq and Afghanistan Veterans of America, told lawmakers in May that veteran suicide “is out of control. It’s [at] epidemic proportions right now.”

The VA has estimated that veterans account for about 20 percent of the roughly 30,000 suicides every year in the U.S.

The VA on Wednesday released data showing the number of vets seeking mental health care rose by more than 300,000 in recent years, to the point that the VA is now trying to provide psychological services to more than 1.2 million vets.

Murray and other lawmakers credited the VA with providing excellent care to vets in the system. The problem is that too many veterans are not getting in the door, they said.

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Washington, who also relayed testimony from employees at other VA locations, outlined several ways that managers or supervisors manipulate appointment scheduling. In one example, clerks were told to label an appointment a “cancel” if the patient did not arrive within one minute of their scheduled time. When VA clerks don’t comply, they can be disciplined, Washington said.

Murray later asked Mary Schohn, director of mental health operations for the Veterans Health Administration, if she believed “that facilities are gaming the system and not fully recording wait times” for treatment.

“VHA does not condone gaming of any sort,” Schohn said. “I am not aware of particular facilities doing anything of the kind, and if I were, I would act immediately upon finding that out.”

Schohn said the VA is now auditing all its locations to make sure that patient schedule manipulation isn’t happening.

She also said the VA has a new performance contract that will hold its leadership accountable in a number of areas. One way is that it will track the percentage of new mental health patients who have had a full assessment and then started treatment within 14 days of seeking an appointment.

The contract also requires that Iraq and Afghan vets newly diagnosed with PTSD receive at least eight psychotherapy sessions within a single 14-week period; that patients discharged from a facility get a follow-up appointment by a mental health professional within seven days; and that any patient deemed at high risk for suicide must get four visits within 30 days.

North Carolina Sen. Richard Burr, a Republican, called it “unacceptable” that veterans were not getting timely access to the care they needed, and criticized the VA for what he said was a string of reviews and surveys and policy papers. The providers want to be able to do their jobs, he said.

“They’re focused on outcome and you’re focused on process,” Burr said.

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