Performance-and-bonus-driven managers manipulating data seem to be at the heart of the unfolding scandal at the Department of Veterans’ Affairs according to various reports, but after five years in the driver's seat of the agency, President Barack Obama accepted the resignation of Secretary Eric K. Shinseki yesterday.
Those cash rewards apparently went to the worst performing hospitals, reports Stephen Moore for InvestorsBusinessDaily. Moore writes:
"As far as mismanagement, the problem of 'performance' bonuses at the VA appears to have been systemic. An Open the Books investigation has found that 'one in five employees at the Phoenix VA received bonuses in 2013, with some receiving extra pay of $5,000 or more. The total bonus payouts were $337,885.'"
Leaving numerous American veterans to suffer without care, sometimes alone and in incredible agony, managers and their various "scheduling schemes" (the phrase used officially) are identified in the official interim report of the Inspector General.
In fact, four "scheduling schemes" have been identified in the report. To quote:
"Schedulers go into the scheduling program, find an open appointment, ask the veteran if that appointment would be acceptable, back out of the scheduling program, and enter the open appointment date as the veteran’s desired date of care. This makes the wait time of an established patient 0 days."
"Schedulers at several locations described a process using the Clinic Appointment Availability Report (or similar report) to identify individual schedulers whose appointments exceeded the 14-day goal. Scheduling supervisors told schedulers to review these reports and 'fix' any appointments greater than 14 days. Schedulers say they were instructed to reschedule the appointments for less than 14 days. Atone location, a scheduler told us each supervisor was provided a list of schedulers who exceeded the 14-day goal. To keep their names off the supervisor’s list, schedulers automatically changed the desired date to the next available appointment, thereby, showing no wait time."
"Staff at two VA medical facilities deleted consults without full consideration of impact to patients. The first facility deleted pending consults in excess of 90 days without adequate reviews by clinical staff. Schedulers working at the second facility cancelled provider consults without review by clinical staff."
"Multiple schedulers described to us a process they use that essentially 'overwrites' appointments to reduce the reported waiting times. Schedulers make a new appointment on top of an existing appointment of the same date and time. This cancels the existing appointment but does not record a cancelled appointment. This action allows the scheduler to overwrite the prior Desired Date and appointment Create Date with a new Desired Date. This adjusts the Create Date to the current date of entry and the Desired Date to the date of the appointment, thus reducing the reported wait time."
A previous plea was made to President Obama by Rep. Jeff Miller, Chairman of the House Committee on Veterans’ Affairs, as seen in the Examiner, to "safeguard evidence of possible wrongdoing at local VA facilities so VA employees who may have allowed patients to fall through the cracks will be properly held to account."
Miller said then that he believes this is "the biggest health care scandal" in the VA's history, adding that "... by the department’s own count at least 23 veterans are dead due to recent delays in VA care."
Multiple media outlets carried the apologies from Shinseki for the scandal in which VA employees are reported to have conspired to hide the months-long wait times that American veterans faced when seeking care throughout the veteran's hospital system. The newly-resigned Secretary led the department for five years, and at least two writers for the WashingtonPost described him as seeming "dumbfounded." The writers also quote President Barack Obama as going "out of his way" to define Shinseki, a former Army general who lost half of his right foot to an exploding mine in Vietnam, as "a person of integrity."
Nevertheless, many may find the IG's interim report released this week to be eye-opening:
"To date, we have ongoing or scheduled work at 42 VA medical facilities and have identified instances of manipulation of VA data that distort the legitimacy of reported waiting times."
The IG report also included this bit of help:
"We will provide VA with the list of the 1,700 veterans we identified as not being on any wait list so that VA can mitigate any further access delays to health care services, and deliver higher quality of health care."