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Hefner VA employees found to have manipulated patient wait times

SALISBURY — The VA Office of Inspector General found that the Hefner VA Medical Center’s appointment schedulers “fixed” patient appointments so that they fell within 14 days of the veteran’s desired date, according to a report released on Tuesday.

According to an investigation done by the VA Office of Inspector General from May 2014 through March 2015, investigators found that more than half of the schedulers interviewed regularly manipulated patient appointments when asked by their supervisors.

Investigators also found that the amount of appointments scheduled within the 14 days of the veteran’s desired date was part of the criteria included in some of the yearly performance appraisals the facility used for employees.

According to an administrative summary obtained by WBTV, the Department of Veterans Affairs Office of Inspector General Hotline got an anonymous complaint that management at Salisbury’s VA Medical Center was manipulating patient wait times to make it look like the facility was meeting the goal of scheduling appointments within 14 days of a veteran’s desired date.

The OIG interviewed more than 30 current and former employees and reviewed numerous records during the investigation.

In May of 2013, a VA Team of VA employees from other Veterans Integrated Service Networks interviewed employees of Salisbury’s VA to look into any scheduling problems at the facility. During a meeting that OIG investigators had with the Salisbury VA’s director, associate director, chief of staff, executive nurse, chief of Management Support, Systems Redesign coordinator, chief of Quality Management and risk manager, the director said the VA team found that a few employees at the Community Based Outpatient Clinic in Charlotte were “confused” about the desired date of the veterans and how to use the desired date when scheduling appointments. Other than that, the director said no issues were found.

One licensed practical nurse interviewed said after attending training in May of 2014, she realized her training on scheduling was wrong. She said she was previously trained to change the veteran’s desired date so that appointments would be scheduled with wait times of less than 14 days.

Another licensed practical nurse interviewed said she would tell veterans the next available appointment date and if the veteran agreed, she would enter that date as the desired date. She said her supervisor would tell her to “fix” appointments that were scheduled with wait times more than 14 days, and that the supervisor threatened to take away her scheduling abilities if she kept scheduling appointments with wait times of more than 14 days.

The report said that the nurse was told she was “argumentative” in a performance review for continuing to schedule appointment times with wait times exceeding 14 days, although the issue did not affect her overall rating on the review. She was told “it was something she needed to work on in the future,” the report said.

In a report reviewed by investigators of all appointments scheduled by staff in a two-day period in May of 2014, more than 7,500 appointments were made, “and an abnormally large number of the appointments were made with a wait time of zero days, even appointments that were made several months into the future.”

A service chief said if any appointments were scheduled in error, it was not made with “malicious intent but were probably due to confusion, such as putting in the desired date as the ‘next available date’ than the veteran had agreed to, rather than the veteran’s true desired date of his or her appointment,” the report stated.

Other management personnel stated that they did not tell schedulers to change dates to meet the 14-day wait time goal.

In the report, Kaye Green, director of the facility, stated she thought the facility’s wait times for veterans were good, but in May of 2013 she put a plan in motion to improve access for veterans for the delays that needed to be addressed after a report on patient deaths, patient wait times and scheduling practices at the Phoenix, Az., VA Health Care System was released.

Employees who scheduled appointments went through retraining in June and finished in September of 2014. Green said some employees told her that they realized they had been scheduling appointments incorrectly but did not know that they way they were doing it was incorrect.

Green also told interviewers that she thought past management teams at the facility focused on “meeting the metrics” or “hitting the numbers rather than the real intent behind the metrics,” the release stated. The current management team was working to “change the mindset” on processes, including scheduling.

“She stated goals were important, but doing the work required to reach the goal was more important,” the report stated.

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