Private care for vets plagued by delays, say VA inspectors

Dennis Wagner | The Arizona Republic

Inspectors for the Department of Veterans Affairs say a community-referral program designed to make private medical treatment available for veterans is plagued by delays in care, improper patient scheduling practices, cost overruns and other problems.

The findings make it clear that former military personnel who have suffered stress and medical complications because of delayed treatment in VA medical centers are now encountering the same problems when they get referred by the VA for private care.

The Patient-Centered Community Care program, known as PC3, was created to provide outside treatment for veterans when VA medical facilities are too busy or do not have needed services. Instead, the 35-page report says the program has "caused patient care delays" and "is not achieving its intended purpose to provide veterans timely access."

Those scathing conclusions are based on research at nine VA medical centers nationwide.

The new report adds to a 15-month crisis of leadership and operations at the VA caused by revelations of delayed and inappropriate medical services, mismanagement, financial problems and other problems. VA Secretary Eric Shinseki resigned amid controversy last year and interim Inspector General Richard Griffin retired under pressure this week.

BLIND SCHEDULING

According to the report, VA contractors routinely engaged in "blind scheduling" — setting up appointments without first discussing the date with patients who might not be available. Because of that practice and other issues, about 43,500 of the 106,000 doctor visits that were authorized either did not get scheduled or were never carried out.

The PC3 system is so problematic that every VA leader interviewed by inspectors had cut back or completely stopped use of the program. As a result, the report says, VA costs increased dramatically because expected savings were based on patient volume.

The inquiry was launched after an unnamed whistleblower complained about rampant failures in the system. Inspectors determined that VA staffers at every facility they visited had stopped using the medical-referral program as intended due to "pervasive dissatisfaction."

They also found that:

Contractors are not meeting timeliness requirements for patient appointments.

VA staffers fail to provide authorizations to contractors in a timely manner.

DOCTOR SHORTAGE

There is a shortage of private doctors contracted through TriWest Healthcare Alliance Corporation and Health Net Federal Services, the two companies that book private-care appointments for VA patients at an annual cost of $9.5 billion.

TriWest, which serves veterans in Arizona, said in a prepared statement, "Many of the challenges noted within the report occurred within the infancy of the program and have been refined over the past year."

"We are proud of the fact that the PC3 program was used by VA here in Phoenix to assist them in eliminating the initial backlog of more than 14,700 Veterans between April and August 2014," the company said. "Following that time, we evaluated together the opportunity for refinement and have implemented most of those changes, to include a brand new system through which we move patient information to speed service and enhance effectiveness."

The company has a $4.4 billion contract to serve as broker, booking appointments for veterans. Inspectors found the VA authorized more than 55,000 doctor visits through TriWest, but 37 percent either did not get scheduled or were never held. In many cases, patients did not even know an appointment had been booked.

The report also says TriWest took an average of 21 days to create appointments, even though it is required by contract to accomplish that task within five business days.

The inspector general did not say whether patients died or suffered medical setbacks because of delays. But in some specialized-care areas, nearly all appointment requests went unfilled.

The Phoenix VA Health Care System used a fraudulent scheduling system to track patients and their appointments, resulting in long wait times for sick veterans despite the appearance that they were getting care within recommended time frames. Some officials received bonuses based on the bogus wait times.

For instance, the report says TriWest was authorized by one VA hospital to take 192 gastroenterology patients over three months, but set appointments for only 20 of those. The patients who experienced delayed care included 57 who were symptomatic for cancer or other "potentially significant conditions." At another hospital, 94 of 150 rheumatology appointments booked by TriWest involved waits greater than 30 days.

The report says another facility reported that Health Net took an average of 146 days to return 50 unfilled-appointment authorizations for oncology patients, including nine for colonoscopies and 12 for mammographies.

Inspectors said oversight of the PC3 program has been undermined because contractors are not providing medical documentation as required and the VA does not keep a comprehensive database of patient referrals. Instead, the department relies on information provided by TriWest and Health Net, both of which "inaccurately" reported the unfilled appointments, the report said.

The report closes with a list of 10 reform recommendations and a note that the VA undersecretary for health concurs with each of them.