Jim Geraghty

Beyond McDonald’s Idiotic Comment, Our System Is Still Failing Our Veterans
Quite a few people are calling for the resignation of Secretary of Veterans Affairs Bob McDonald over this remark:

During a Christian Science Monitor press event on Monday, McDonald responded ongoing attacks about how VA leaders measure patient wait times, saying the focus on specific numbers overshadows what should be the larger goal.

“What data do you get from Cleveland Clinic or Kaiser Permanente to compare with our data?” he asked. “To me, personally, the days to an appointment are really not what we should be measuring. What we should be measuring a veterans’ satisfaction.

“What really counts is how does the veteran feel about their encounter with the VA. When you go to Disney, do they measure the number of hours you wait in line? What’s important is what your satisfaction is with the experience. What I would like to move to eventually is that kind of measure.”

Yes, that’s quite stupid, on many levels –among them, Disney does measure the wait times for its rides and focuses on minimizing them to ensure happy customers. But don’t fire McDonald over this. Fire him over this report from April:

Supervisors instructed employees to falsify patient wait times at Veterans Affairs’ medical facilities in at least seven states, according to a USA TODAY analysis of more than 70 investigation reports released in recent weeks.

Overall, those reports — released after multiple inquiries and a Freedom of Information Act request — reveal for the first time specifics of widespread scheduling manipulation.

Employees at 40 VA medical facilities in 19 states and Puerto Rico regularly “zeroed out” veteran wait times, the analysis shows. In some cases, investigators found manipulation had been going on for as long as a decade. In others, it had been just a few years.

In many cases, facility leaders told investigators they clamped down the scheduling improprieties after the Phoenix scandal, but in others, investigators found they had continued unabated. The manipulation masked growing demand as new waves of veterans returned from wars in Iraq and Afghanistan and as Vietnam veterans aged and needed more health care.

When McDonald took the job, he declared, “I won’t tolerate those who stifle initiative, who seek to punish people who raise legitimate concerns, or those who lack integrity in word or deed. Trust is essential in everything we do.”

Or fire him over this obvious face-saving way of adjusting the wait-time measurement:

Released Monday, the Government Accountability Office’s review of appointment wait times for patients new to VA health care found that veterans wait three to eight weeks for medical appointments. Others could not see a primary care doctor at all because VA staff did not handle the appointments correctly, the report GAO report says.

On Monday, VA Secretary Bob McDonald said 97 percent of VA appointments are completed within 30 days, with the average wait time from three to six days.

The GAO and VA measure wait times differently, which is why there’s a discrepancy: VA starts counting from the day a scheduler returns a veteran’s call or request for an appointment, according to GAO health care issues director Debra Draper.

Draper said VA should count from the day a veteran calls to request an appointment.

The difference is crucial, Draper said, to understanding whether appointment wait times are in fact decreasing.

Subtract the VA wait-time estimate from the GAO wait-time estimate, and you conclude that some veterans are still waiting weeks just to get a response to their appointment request. I think most Americans would agree that’s a system that fails to serve its patients.

Or fire McDonald for failed implementation of the post-Shinseki reforms:

Congress and the VA came up with a fix: Veterans Choice, a $10 billion program that was supposed to give veterans a card that would let them see a non-VA doctor if they were more than 40 miles away from a VA facility or they were going to have to wait longer than 30 days for a VA provider to see them.

There was a problem, though. Congress gave the VA only 90 days to set up the system. Facing that extremely tight time frame, the VA turned to two private companies to administer the program and help veterans get an appointment with a doctor and then work with the VA to pay that doctor.

Although the idea sounds simple enough, the fix hasn’t worked out as planned. Wait times have gotten worse — not better. Compared with this time last year, there are 70,000 more appointments that took vets at least a month to be seen.

The VA says there has been a massive increase in demand for care, but it’s apparent the problem has more to do with the way Veterans Choice was set up. The program is confusing and complicated. Vets don’t understand it, doctors don’t understand it, and even VA administrators admit they can’t always figure it out.

On that last program, you can throw a little blame Congress’ way for the rushed time frame, although for obvious reasons they wanted the VA to fix this problem immediately. (Why is this so hard? The VA has a budget of $163 billion. Why can’t we just give veterans the equivalent of a credit card that can be used at any accredited medical facility?)

Wait, there’s more! Construction costs for a new VA hospital in Aurora, Colorado went $1.1 billion over the cost estimate.

Wait, there’s still more!

In his speech, [House Veterans Affairs Committee Chairman Jeff] Miller railed against a lack of accountability at the VA and an agency culture that has allowed officials to spend millions of dollars on artwork and conferences with little repercussion for the gross mismanagement of the Aurora facility.

“The (House veterans) committee recently found that the Palo Alto (Calif.) VA health care system has spent at least $6.3 million on art — on art and consulting services,” he said. “These projects include an art installation on the side of a parking garage that displays quotes by Abraham Lincoln and Eleanor Roosevelt in — wait for it — in Morse code that cost $285,000. It actually lights up.”

A stupid comment is a stupid comment; but McDonald was sent to fix problems and has failed to do so.

Read it all.