Durham VA officials say steps taken to address wait times

Jul. 30, 2014 @ 05:42 PM

As a new patient at the Durham VA Medical Center, former Department of Veterans Affairs Assistant Secretary Tommy Sowers said he was told he would be mailed a card with the date of his first appointment six weeks later.

“That’s just an archaic way of scheduling,” said Sowers, who is now serving as visiting assistant professor of the practice at Duke University’s Sanford School of Public Policy. Scheduling could be better, Sowers said in an email, and he expects it to addressed by the reform bill proposed by House and Senate negotiators Monday. He also said in an interview that he wants to see innovation and greater emphasis on customers.
“The doctors and the administration -- I’ve met them, they’re my care providers -- they’re very passionate about providing the best care possible,” he said. “I think the challenge though, is they need to apply that same level of innovation inside parts of their culture.”
On Monday, House and Senate lawmakers from a conference committee announced an agreement on a bill that’s been proposed to reform the Department of Veterans Affairs, according to the Associated Press.
The bill, if approved by the House and Senate and signed by President Obama, would provide additional money to send veterans who can’t get timely visits with VA system doctors to seek outside care, to hire additional doctors, nurses and other staff, and to lease new clinics, according to the AP.
The bill also details a proposed independent review of the administrative system and management processes of the department – including workflow processes for scheduling appointments. In addition, it would dictate the launch a “technology task force” to review the department’s needs for a scheduling system and software.
It would allow for patients who have had to wait 30 or more days for an appointment with the VA to seek care from a private physician, a community health center, a Department of Defense health care facility or an Indian Health Center.
However, in an emailed in response to concern about scheduling practices, Pete Tillman, a Durham VA Medical Center spokesman, said that currently, the new-patient appointment process in Durham is for newly enrolled veterans requesting primary care to call by phone to schedule a first appointment. If the appointment cannot be made in 30 days, the veteran is offered non-VA care or an appointment at a later date.
And also to address wait-times in the nearer-term, Durham VA officials said they’ve already spent additional money to provide additional care for veterans outside the VA system and to add clinic hours.
The steps were taken as part of a system-wide “Accelerating Access to Care Initiative” launched in May following reports at medical centers in the system of long wait-times and secret patient waiting lists. Two employees at the Durham VA Medical Center were placed on administrative leave for alleged “inappropriate scheduling practices.”
As part of the initiative, the medical center in Durham received $3.1 million in June to improve access, according to an email from Tillman. As of July 23, the medical center had spent about $1.288 million of that.
They’re using some of money to extend and add some Saturday clinic hours, including in Durham, according to Sara Haigh, the Durham medical center’s associate director. Tillman said in an email that they’ve added sessions to an existing Saturday primary care clinic, and plan to begin Saturday clinics in ophthalmology in August and Saturday clinics for dermatology in late August.
“For a site like Durham where we have space constraints, the only simple way to add capacity is through extended hours,” Haigh said.
The center has also taken steps to allow more veterans to get non-VA care. Haigh said Durham VA medical center officials contacted veterans whose appointments were more than 60 days from their requested dates, and let them choose to either wait for the appointment or to get care outside of the VA system.
More than 91 percent of more than 3,400 patients contacted chose to keep their VA appointments, according to an email from Tillman.
The medical center’s total expenses for outside, non-VA health care were $24.4 million as of June. In the prior fiscal year 2013, the center’s total for non-VA care expenses was $35.5 million, which was about 7.5 percent of the medical center’s total $470.168 million budget for the fiscal year.
Generally, Haigh said, the center’s capacity now is affected by a mixture of issues, including physical space and demand.
She added that in the case of a specialty like neurosurgical care, the center is a referral site. So veterans from across the state might seek care from the center.
“We’re challenged because of the number of patients who need that kind of initial visit,” she said.
And she added that medical center patients who request services undergo a clinical review to determine the urgency of their needs.
“So the average waiting time statistics are for veterans who have had a clinical review (and) we have determined that they do not have an emergency that they could be offered a routine, new-patient visit,” she said.
According to the most recent data released July 17, the actual average wait time for new patients seeking mental health care at the Durham VA Medical Center in May was 26 days, the average for specialty care in the month was 35 days, and it was 35 days for primary care.