Actions taken to improve health care in Phoenix

VA Acting Secretary: We Have Taken Recommended Actions to Improve Patient Care in Phoenix

Acting Secretary of Veterans Affairs Sloan D. Gibson today told members of the House Veterans’ Affairs Committee that the Department of Veterans Affairs (VA) has taken action on the four recommendations made in the Interim Report of the Office of Inspector General for the Phoenix VA Health Care System. The final report of the IG has not been published.

“We have taken actions on all of the recommendations in the Inspector General’s interim report on Phoenix which was released in May,” Gibson said. “The Inspector General confirmed we have systemic issues when it comes to patient scheduling and access, and we are working to address this serious issue.  We have identified Veterans on wait lists at Phoenix, including those identified by the IG in their interim report, and have reached out to immediately begin scheduling appointments.  We have reviewed wait lists nationwide, including the New Enrollee Appointment Request (NEAR) list, and not only are we reaching out to contact those Veterans to get them into clinics, but we have posted the information online so Veterans can review our progress.

Acting Secretary Gibson visited the VA health care system in Phoenix on June 5 as the first of his 13 medical center visits in the past seven weeks.

Below is the text of Office of the Inspector General’s (OIG) four interim recommendations, along with the actions VA has taken to implement each:                                                                

First, OIG “recommend the VA Secretary take immediate action to review and provide appropriate health care to the 1,700 veterans we identified as not being on any existing wait list.”  In response:

• VA announced on June 4 that the Department had reached out to all Phoenix, Arizona-based Veterans identified by the IG as not being on any wait list to immediately begin scheduling appointments for all Veterans requesting care.
• Of those Veterans identified by the IG, 1,035 Veterans requested and were scheduled for medical appointments.
• As of July 18, 2014, 844 of the 1,035 Veterans have completed those appointments or have an active future appointment; with the initial appointment being offered within 30 days.  Any appointment scheduled more than 30 days in the future is the result of the provider’s clinical judgment or the Veterans preference to get an appointment at a later date.  
• As of July 18, 2014, 191 of the 1,035 Veterans did not show up for or canceled their appointment prior to the scheduled time. The Phoenix VA Health Care System will reach out to these Veterans again to ensure their health care needs have been addressed.
• Of the remaining 665 Veterans, all have been contacted, and either indicated they didn't want an appointment or did not respond to multiple phone calls and a certified letter offering an opportunity to schedule an appointment. 

Second, OIG “recommend the VA Secretary review all existing wait lists at the Phoenix Health Care System to identify veterans who may be at greatest risk because of a delay in the delivery of health care (for example, those veterans who would be new patients to a specialty clinic) and provide the appropriate medical care.”  In response:

• Acting Secretary Gibson initiated a review of all wait lists at the Phoenix VA Health Care System.
• As part of the review, VA reached out to more than 5,000 Veterans in Phoenix to coordinate the acceleration of their care.  The 1,700 Veterans identified by the OIG are a subset of those 5,000 Veterans.
• Those Veterans included all individuals on the Phoenix VA Health Care System’s New Enrollees Appointment Request List (NEAR), Electronic Wait List (EWL) and patients who were waiting greater than 90 days to receive a scheduled appointment.
• Once contact had been made, Phoenix staff scheduled Veterans for appointments based on the Veterans’ preference for the timing of their appointments as well as appropriate clinical need.
• Clinical staff attempted to accommodate all needed appointments at the Phoenix VA Health Care System.  Where capacity did not exist to provide timely appointments, staff referred patients to non-VA community care in order to provide all Veterans timely access to care.   
• Since May 15, VA has scheduled 2,300 appointments at the Phoenix VA Health Care System and made 2,713 referrals for appointments to community providers through non-VA care.

Third, OIG “recommend the VA Secretary initiate a nationwide review of veterans on wait lists to ensure that veterans are seen in an appropriate time, given their clinical condition.”  In addition, on May 21, 2014, former Secretary Shinseki directed the Veterans Health Administration leadership to personally review their processes to ensure VA is doing everything possible to schedule Veteran patients for timely appointments.  In response:

• VA health care facilities nationwide continuously monitor clinic capacity in an effort to maximize VA’s ability to provide Veterans timely appointments given their clinical conditions.
• Where VA cannot increase capacity, VA is increasing the use of care in the community through non-VA medical care.
• Approximately 200,000 new VA appointments nationwide were scheduled for Veterans between May 15 and June 15, 2014.
• Additionally, nearly 40,000 individual Veterans have received referrals for their care to private providers in the community in order for Veterans to receive needed care as quickly as possible.
• Each of VA’s facilities continuously reaches out to Veterans waiting greater than 90 days for care to coordinate the acceleration of their care.
• Facility clinical staff continuously evaluate Veterans currently waiting for care to determine if the timing of their appointment is medically appropriate given their individual clinical conditions.

Fourth, OIG “recommend the VA Secretary direct the Health Eligibility Center to run a nationwide New Enrollee Appointment Request report by facility of all newly enrolled veterans and direct facility leadership to ensure all veterans have received appropriate care or are shown on the facility’s electronic waiting list.”  In response:

• The Health Eligibility Center, in connection with the Veterans Health Administration Support Services Center, developed a report to identify those individuals currently waiting on the New Enrollee Appointment Request (NEAR) List. 
• As of May 15, 2014, approximately 64,000 Veterans were currently pending on the NEAR list. 
• As of July 15, 2014, approximately 2,100 individuals remained on the NEAR list. 
• A preliminary analysis of the 61,900 Veterans removed from the NEAR list shows:

• 20 percent cancelled their request for an appointment
• 11 percent scheduled an appointment
• 2 percent were placed on the Electronic Wait List
• 7 percent requested and were referred to other VA services
• 7 percent were in the early stages of eligibility and verification
• 52 percent are still in process

• Of the 52 percent in process, VA has made several attempts to contact those Veterans by phone.  After verifying mailing addresses, VA sent certified letters to every Veteran who could not be reached by phone. 

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