Wednesday, August 9, 2017

Review of Alleged Delay of Care and Scheduling Issues at the VAMC in West Palm Beach, FL

VA OIG received two separate anonymous complaints in October 2014 and February 2015 alleging delay of care and potential manipulation of wait-time statistics at the VA Medical Center in West Palm Beach, FL. The first complaint alleged that the VAMC and its outlying clinics were using patient cancellations to manipulate wait times. This complaint also contained allegations pertaining to unrelated human resources matters that included promotion and hiring decisions, which we did not review. The second anonymous complaint alleged that canceled cardiology appointments delayed cardiology patient care. The VAMC had a higher than average rate of clinic-canceled cardiology appointments with some patients experiencing multiple cancellations. Clinic scheduling staff canceled approximately 15 percent of cardiology appointments scheduled from October 1, 2014 through February 26, 2016. The VA national average for clinic-canceled cardiology appointments for the same period was 11 percent. These canceled appointments resulted in delayed care for many veterans, with at least 971 veterans incurring multiple cancellations. Scheduling staff incorrectly recorded wait times when rescheduling appointments. These issues occurred because the VAMC did not fully staff the cardiology clinic due to unexpected staff departures and challenges in recruiting cardiologists, and facility scheduler training and supervision were inadequate. Moreover, supervisors did not complete required scheduler audits, which inhibited the detection of scheduling errors. As a result, the VAMC understated patient wait times, delayed patient care, and did not offer eligible patients care through the Veterans Choice Program. We recommended the Director fill cardiology vacancies, provide effective training to schedulers, and perform required scheduling audits. The VAMC Director concurred with the report recommendations and provided appropriate action plans. We did not substantiate the allegation that VAMC scheduling staff manipulated wait times by scheduling appointments within wait-time goals, improperly marking them canceled by patient, and then rescheduling the appointments in the future.

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