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Unrealistic goal a disaster

Don’t take the scheduling abuses making headlines now at Veterans Affairs medical centers as an indictment of the VA system as a whole. Millions of veterans receive quality care in these hospitals every day.
But the life-or-death nature of some scheduling decisions and the nation’s responsibility to care for its veterans justify the attention brought to the issue in recent weeks. Some 40 veterans died waiting for appointments at the Phoenix Veterans Affairs Health Care System, many of whom were placed on a secret waiting list. That revelation brought forward others. So far, such gross abuses have not surfaced in Salisbury. But administrators systemwide are talking openly about the need for more physicians, more efficiencies and a more reasonable scheduling goal for seeing patients than 14 days.
A comprehensive national review found more than 57,000 new VA patients had been waiting more than 90 days for an initial medical appointment — at a time when the system required such patients be seen within 14 days. The 14-day rule was not realistic, as Salisbury VA director Kaye Green said in a recent interview. But 90 days is not an acceptable alternative.
The audit report said Salisbury’s average wait time for new patients was 28.83 days — double the goal but much better than many of its peers. The average wait at the Fayetteville VA was more than 83 days, the highest in the state and warranting a visit last week from the Acting Secretary of Veterans Affairs Sloan D. Gibson. “I’m here today to say that no veteran should ever have to wait for the care they have earned through their service and sacrifice,” Gibson said.
Before the current scandal, it has been suggested by some that the VA health care system should be opened to all. Phillip Longman wrote a book along those lines, “Best Care Anywhere: Why VA Health Care Would Work Better for Everyone,” first published in 2007. Critics are scoffing that notion now, pointing to the VA’s scheduling troubles as a sign of things to come under the Affordable Care Act. As Longman noted in his book, the VA has a mixed reputation because “its mistakes tend to become national news” — even though medical errors are less common within the VA than in other settings.
You can blame the disastrous 14-day goal for pressuring personnel at some hospitals to find dishonest ways around it. As bad news sometimes goes, though, the scandal could lead to much-needed scrutiny and improvements, such as increasing the number of physicians in the system and paying for more veterans to see doctors outside the system. As more and more veterans enter the system, this flexibility will be important. It would be good to see the VA’s successes make national news, too.

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