Report Summary

Title: Review of Alleged Wait-Time Manipulation at VHA's Southern Arizona VA Health Care System
Report Number: 14-02890-72 Download
Issue Date: 11/9/2016
City/State: Tucson, AZ
VA Office: Veterans Health Administration (VHA)
Report Author: Office of Audits and Evaluations
Report Type: Audit
Release Type: Unrestricted

The Office of Special Counsel (OSC) referred allegations concerning the Southern Arizona VA Health Care System (SAVAHCS) Ocotillo Primary Care Clinic to the VA Secretary in October 2014. These allegations were brought to the OSC by a former SAVAHCS employee who served in the Ocotillo Clinic. The complainant alleged that: Managers improperly directed scheduling staff to “zero out” patient wait times; Ocotillo Clinic physicians were awarded bonuses based in part on wait times; The complainant was excluded from a meeting with the hospital director; The failure to adhere to agency scheduling directives endangered veterans’ health. The VA Office of Inspector General substantiated the OSC complainant’s allegation that managers improperly directed scheduling staff to zero out patient wait times at the Ocotillo Clinic in violation of the agency’s scheduling directive. Review of scheduling data showed 76 percent of appointments in the Ocotillo Clinic had a zero-day wait time from December 2013 through August 2014. According to the Primary Care Nursing Supervisor, as well as several of her nursing staff, SAVAHCS scheduler training taught methods that violated VA’s national scheduling policy.

We partially substantiated that, in FY 2013, physicians were awarded bonuses based, to some extent, on appointment availability, including the percentage of patients scheduled within 14 days of their requested date. We found no evidence that Ocotillo Clinic physician performance pay in FY 2014, FY 2015, or FY 2016 was based on wait-time performance.

We did not substantiate that the complainant had been excluded from a meeting with the hospital director because the complainant criticized scheduling procedures. Our review of patient care records found one patient who experienced a delay in care that led to a poor outcome. However, we determined that the poor outcome resulted from a lack of communication regarding the need for medical intervention, and not from SAVAHCS’s failure to adhere to agency scheduling directives. We recommended that the VA Southwest Health Care Network Director: Review the training records of all SAVAHCS schedulers to ensure their training is compliant with Veterans Health Administration’s (VHA) scheduling policy; Ensure that SAVAHCS schedulers comply with current VHA policy regarding scheduling policies and practices. The Director of VISN 22 concurred with our findings and recommendations, and submitted acceptable corrective action plans. We will follow up on the recommendations to ensure full implementation of all corrective actions.

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