The Department of Veterans Affairs released an internal audit of the agency's 731 medical centers today, a response to the controversy around delays in treatment and unwise office practices revealed throughout the bureaucracy over recent weeks.

Here are some of the most important things to note from the report.



In this undated photo, the VA Medical Center Building 1 is pictured in St. Cloud, Minn. New audit data show waiting times at the two Veterans Affairs medical centers in Minnesota are considerably lower than the worst trouble spots in the VA system. The average wait time for a patient seeking primary care for the first time is 28 days at the Minneapolis VA Medical Center and 25 days at the St. Cloud center. But the waits are much shorter for established patients already in the VA system, three days at Minneapolis and two days at St. Cloud. (AP Photo/St. Cloud Times)

1. 57,000 veterans had to wait at least 90 days for their first appointment at a VA medical center.

The audit concluded that the agency's goal of getting all veterans an appointment within 14 days is unfeasible given the growing demand for medical care. Or as the VA report puts it, "Imposing this expectation on the field before ascertaining the resources required and its ensuing broad promulgation represent an organizational leadership failure." The addition of dozens of necessary syllables doesn't change the reality -- the VA shouldn't have promised it could get veterans appointments in 14 days because it never had the resources to do so.

The demand isn't that surprising when you look at America's veteran population by age.

Twenty-one percent of Americans over the age of 65 are veterans. The VA plans to publish data on wait times twice a month now and start contacting patients on wait lists to get them to the doctor as soon as possible.

2. 13 percent of VA schedulers were told by higher ups to input incorrect appointment requests to make wait times look shorter.

The audit found at least one instance of falsified records at 76 medical centers. The audit adds, "In at least 2 clinics, respondents believed someone else (not a scheduler) was routinely accessing records and changing desired dates in order to improve performance measures." At 24 medical centers, schedulers reported that they were threatened or coerced into changing the appointment requests. At two audit sites, schedulers were punished for not falsifying appointment requests. The VA announced in the report that they plan to take action against employees who falsified records.

3. The report found that the biggest barrier to getting veterans medical care was a lack of open appointment slots with approved providers.

Senate Veterans Affairs Committee Chairman Bernie Sanders (I-Vt.) and Sen. John McCain (R-Ariz.) are working on a bill that would let veterans facing long wait times go to out of network for health care providers. It would also provide about $500 million for the agency to hire additional medical personnel. Other reasons for wait times included a lack of staffers trained to schedule appointments, inadequate training of staffers and the complexities of the VA's computer scheduling system. Many schedulers are not using the computer system to track appointments -- making it nearly impossible to have an accurate system-wide account of scheduling. The report also signaled that calling veterans to remind them about upcoming appointments was something the VA was not doing enough.

4. The VA conducted 3,772 interviews to prepare the internal audit.

Each interview lasted about 45 minutes. At each of the 731 medical centers, audit teams interviewed one person in leadership, like a chief business officer, nine schedulers and one clinic manager. More than 400 staffers were dispatched across the country to conduct the audit. Because the audit was done so quickly, the VA cautions against reading the audit as gospel. They proved there's a problem with scheduling, but they can't explain why it's a problem very well yet.

For example, some of the schedulers interviewed for the audit had learned how to schedule only days before. In other words, they weren't experts in the systemic problems plaguing the VA's scheduling apparatus. Some of the employees the auditors planned to interview were afraid they would be disciplined if they revealed how much their medical center's practices differed from the national standard, and did not take part in the survey.

5. The VA has started the Accelerating Access to Care Initiative to help 100,000 veterans facing long wait times

They trained more than 900 staffers in the first big effort to increase efficiency at the agency. They will likely need to pay out some serious overtime, given how big the VA's backlog is at this point.

More oversight is going to be a big objective for the VA moving forward. The audit found that only 30 percent of staffers had their supervisor check in with them on a daily basis.