Much of the recent focus regarding the Department of Veterans Affairs has been on who will lead it. Secretary David Shulkin departed in late March amidst allegations of disagreements with the administration and improper use of public funds. Last week Admiral Ronny Jackson, a potential replacement, withdrew, leaving the troubled department without anyone permanent at the helm.
It is important but not sufficient to put forward a good candidate to lead the department. Recent initiatives making it easier to discipline poorly-performing employees or giving some veterans the choice of accessing care at private facilities will help veterans. However, the problems at the VA have persisted for many years and a solution will require a sustained effort, complete with rigorous oversight, implementation, and evaluation.
Some veterans receive first-class timely care, and many VA employees perform their jobs admirably. However, in too many areas the VA has fallen far short of its goals, with adverse consequences for too many veterans. Unfortunately, these problems have become so commonplace, and have persisted for so long, that the public risks becoming desensitized to bad news. The road to solving these problems will require an unwavering commitment.
In January 2014, it was discovered that wait times for the VA hospital in Phoenix, Arizona, were being manipulated to meet established targets. Since then, a wave of investigations has found problems with scheduling practices and wait time data across a range of facilities. Even before that, oversight bodies were skeptical of wait time data.
The timeline below details the series of investigations that have corroborated problems with wait times and scheduling practices. These shortcomings undercut other efforts to address problems at the VA, such as the Veterans Choice Program, which is not enrolling all eligible veterans.
Eliminating the widespread problems with scheduling practices, and obtaining consistent, accurate wait time data is essential for understanding how the VA is failing to meet its goals, and how effective new initiatives have been to address these shortcomings.
The timeline is only one aspect of mismanagement and poor performance as it relates to scheduling and wait times over the recent period. It does not include the many substantiated allegations of mishandling of benefits claims, fraud carried out by employees, or mishandling of finances.
While the Office of Inspector General should be commended for doing yeoman’s work to dig into areas of incompetence or malfeasance, their resources are not unlimited, and there may very well be other areas where problems remain hidden, especially since the timeline only covers investigations and reports that have occurred since 2014.
In most cases, the OIG substantiated the allegations, and in both of the new region-wide reviews, it found that wait time data was inaccurate. These new reviews encompass multiple facilities across different states within one of the 18 Veterans Integrated Service Networks.
So far, the OIG has investigated VISN 6 and 15, which contain facilities in Missouri, Kansas, Illinois, North Carolina, and Virginia. After finding inaccurate wait time data in both of these investigations, it is likely that the OIG will continue to review other regions, and it is at least plausible that those areas will have some of the same problems, and that the map of facilities with problems is only partial.
The history of investigations finding evidence of long wait times stretches back farther that. While there could be even earlier reports, in July 2005 an investigation from the Office of Inspector General warned that “scheduling procedures need to be improved to ensure accurate reporting of veterans’ waiting times and facility waiting lists.
The OIG’s Phoenix investigation lists 18 previous reports on VA patient wait times from 2005 to 2013. Most of these reports substantiate allegations of improper scheduling practices or inaccurate data, which resulted in lower quality of care or longer wait times for veterans.
The problems at the VA span multiple administrations and five different Secretaries of Veterans Affairs. While it will take leadership to help make progress, nominating a good candidate for the position is only the first step. Continued oversight, rooting out mismanagement and manipulation of wait time data, and continuing to implement the Veterans Choice Program to help veterans get more timely access to care will be vital.
Charles Hughes is a policy analyst at the Manhattan Institute. Follow him on Twitter @CharlesHHughes.
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