Audit: The VA’s poor policies created perverse incentives

A new Veterans Affairs audit shows a significant number of workers have tampered with patient wait times.

Thirteen percent of staff were instructed to schedule appointments without regard to a patient’s desired date, which could indicate an attempt to falsify records.

At least one instance of the practice was detected in 64 percent of the surveyed VA facilities. The survey, however, did not determine whether these activities were intentionally fraudulent behavior.

The audit also acknowledged that the VA’s goal of seeing patients within two weeks of a desired appointment date “was simply not attainable given the ongoing challenge of finding sufficient provider slots to accommodate a growing demand for services.”

The report also criticized other complications and technicalities in the VA scheduling system, many of which have been known for years.

The report backs up the idea that what went wrong at the VA was a story of perverse incentives. The VA gave bonus payments for seeing patients in a timely manner. But when local VA officials realized they couldn’t meet the goal, they manipulated the electronic data reported to the VA to hide patients who weren’t being seen so quickly.
The audit evaluated 138 of the more than 150 VA hospitals nationwide. The rest of the VA’s expansive network will be audited in the second phase of the investigations.

In the meantime, the VA said it will reevaluate its policies to move away from a system that was clearly unrealistic in the first place.