Cincinnati VA Explains Access Audit Results

In mid-May, the VA mandated a national review of access and scheduling based on allegations that there were inappropriate scheduling practices and that some VA facilities might be manipulating access data. The report only summarizes only system-wide audit findings.

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“Since our audit visit we have worked hard to bring ourselves into 100 percent compliance with all VA scheduling requirements,” said Cincinnati VA Medical Center Director Linda Smith.

Cincinnati, OH (PRWEB) July 31, 2014

In mid-May, the VA mandated a national review of access and scheduling based on allegations that there were inappropriate scheduling practices and that some VA facilities might be manipulating access data. The VA access audit team inspected the Cincinnati VA Medical Center in May and the Community Based Outpatient Clinics in early June. The audit was not intended as a formal investigation of individual staff or managers. On July 29, the Access Audit Report was released by VA Central Office. It summarizes only system-wide audit findings.

The Access Audit Report found that VA’s current scheduling policy is “overly-complicated” and “resulted in a high potential to create confusion among scheduling clerks and front-line supervisors.” The report also cautioned against an over-interpretation of any of the findings since sampling sizes were small and not all schedulers elected to participate.

While we are not aware of any evidence of manipulation of access data at the Cincinnati VAMC, the audit team found that some clinics at the Cincinnati VAMC were not fully complying with the VA directive on scheduling. Our own audits have not found evidence of any deliberate manipulation of scheduling by either supervisors or schedulers.

The current scheduling directive requires that facilities place Veterans on an Electronic Waiting List if they cannot be seen within 90 days for new patient or 120 days for established patients. Under VA’s new Accelerating Access to Care Initiative, facilities have been directed to contact Veterans waiting longer than 30 days and provide them with the option to be rescheduled sooner if VA capacity exists, keep their scheduled appointment or be referred to non-VA providers in the community.

At the Cincinnati VAMC, the average wait time for new patients in Primary Care was 53 days in May and improved to 45 days in July. Many of the Primary Care clinics have access within 30 days. In the specialty clinics, Veterans on average were seen within 43 days in May and access improved to 39 days in July. In many of the specialty clinics, we also have access within 30 days.

We are working toward a goal of seeing all new Veterans within 30 days and have taken a number of actions, many before the scheduling audit in May, to improve access to care for Veterans. These actions include building larger replacement clinics in Florence, KY and Georgetown, OH (both projects were approved by VA) and adding an additional primary care team at our main hospital. In the interim, we have run Saturday clinics, extended operating hours and hired additional specialty care providers. With additional funding from VA and Congress, we plan to add more primary care teams. Currently, most new Veterans are receiving appointments in primary care within 30 days, a measure that is better than in many community clinics. We are continually recruiting for more Primary Care providers.

The scheduling and access reviews confirmed what we already knew: that there were a small number of procedural clinics that had backlogs due to space and/or staffing issues. These included access issues for cataract surgery, total joint replacements, sleep studies and routine and screening colonoscopies. We had already been addressing the staffing and space needs since before the audit. With $4 million in new funding from VA, we have sent routine colonoscopies, cataract surgeries, total joint procedures and sleep studies to providers in the community while we expand our internal capacity. These funds are addressing any Veteran waiting more than 30 days for the procedures. VA staff are working with both the Veteran and provider to arrange referrals for 800 procedures this month, up from 300 earlier this year.

Construction projects are also improving access. In May of this year, the new GI procedure area was opened at a cost of $3.8 million. Its eleven private prep and recovery rooms and five procedure areas will allow for a dramatic increase in our ability to meet demand for colonoscopies and other procedures. Space is under construction for an additional eight exam room suite for Medical specialty clinics that will be open in September. Reorganization of several functions in another area will increase exam room capacity for specialties such as Dermatology, Urology and Orthopedics. A project creating a new Center for Sleep Studies was recently awarded and construction will begin in August.

“Since our audit visit we have worked hard to bring ourselves into 100 percent compliance with all VA scheduling requirements,” said Cincinnati VA Medical Center Director Linda Smith. “Training refresher sessions with question and answer sessions were held for the 400 employees who schedule. A medical center audit team was established to visit each clinic. Monthly reports are given to medical center leadership so follow up can occur to correct any scheduling issues. A HELP line was established that allows schedulers to ask questions anonymously and answers are provided to a mailgroup of all schedulers. Finally, I have personally visited the clinics in the hospital and at the Community Based Outpatient Clinics to observe the scheduling process and assure we address any issues.”

The Cincinnati VAMC takes any whistleblower allegations seriously and will comply with the Office of Inspector General and the VA to remedy inappropriate practices or mismanagement. We are not aware of the details of the whistleblower allegation from an unknown individual that was reported in the Access Audit findings and will take appropriate action once those details are known.