Doctor: 14-day guideline unrealistic

link Tom Philpott

Military Update

Until he resigned in May, Veterans Affairs Secretary Eric Shinseki led his department of more than 350,000 employees for five years by setting “bold goals.” They looked impossible to achieve, but he knew, from his Army years, they inspired better performance and bigger budgets from Congress.

But did a goal to cut wait times in half for patients seeking care finally put VA administrators under such pressure that many chose to manipulate performance data, compromise their integrity and even put patients at risk?

A VA physician described for me his reaction, and that of colleagues, when word reached them in 2011 that veterans seeking a primary care appointment, or a specialty care consult, were to be seen within 14 days rather than 30 days, the goal VA health care had used since 1995.

“That statement that we had to see patients within 14 days was so unbelievably unrealistic that people laughed at it,” the doctor recalled. He spoke frankly on condition that I not reveal his name or where he works.

“When I first started with VA I was told that when they put in a consult to (my specialty) — and it’s all computerized so you can see exactly the time it was placed — the goal was to see that patient within 30 days. If we were seeing 80 to 85 percent within 30 days, (bosses) were happy,” he said.

“That became very difficult because the volume of patients was just overwhelming. Then, all of a sudden, we heard that 30 days had become 14 days. It wasn’t any kind of an official announcement. And I’ve got to be honest: Nobody made a big deal about it. In fact they didn’t pay any attention to it at all. It was just so stupid they might as well have told me I had to see the patient within 14 seconds. It wasn’t going to happen.”

Not everyone inside VA health care, however, could ignore the new goal as nonsense. Administrators responsible for hitting appointment timeliness marks suddenly had higher hurdles to clear, or to scoot around.

Who set the new goal and for what reason?

A senior VA official made available to discuss this said the 14-day goal has been removed from all supervisor performance plans. He also said he didn’t know who made the original decision, or if it was individual or a group.

When it was set, he explained, apparently there was concern about ensuring that patients who needed critical care be given “same-day access.” So someone suggested that lowering the 30-day goal, he said, would somehow incentivize staff to deliver more same-day care to critical patients.

“I think the mistake we made was to use as an average measure” a 14-day goal set per appointment, as though using it would signal “we had same-day access for people who critically required it,” this official said. “I think we just saw 30, we wanted to get closer to same day access, and so they adjusted the performance measure from 30 to 14.”

That was as clear as he could explain what occurred.

Tom Philpott can be contacted at Military Update, P.O. Box 231111, Centreville, Va. 20120-1111, or by e-mail at:

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