Congress probes issues hindering VA health care

Breach of trust has leaders scrambling

WASHINGTON — Doctors in the VA system see an average of 10 patients a day — about half as many as physicians in private practice — despite a wait list for appointments, and members of Congress want to know why.

VA leaders are working on an answer. They are assessing provider capacity and developing new productivity standards that take into account the time and gravity of the need for medical services, agency leaders told a congressional panel Monday night.

“The difference between this estimated capacity and our current workload represents the amount of additional care we could potentially absorb to address veterans waiting for care,” said Thomas Lynch, assistant deputy secretary for health for clinical operations.

House Veterans Affairs Chairman Jeff Miller said that work should have been done long ago and that he doesn’t know whether he can trust the department’s data after recent investigations revealed what he called a systemic lack of integrity.

“How can Congress, the American taxpayer and our nation’s veterans and their families have any confidence?” he asked. “If there were actions that VA could have taken to increase access to care for patients, why were those actions not taken long before now?”

A 2012 study the nonprofit Physicians Foundation commissioned showed that doctors who own their own practices see about 22 patients per day, and others employed in the private sector see about 18 per day.

Dr. Lynch apologized for the problems that began to come to light in Phoenix, where VA workers are accused of falsifying paperwork to conceal long wait times for appointments that sometimes exceeded a year.

“This is a breach of trust. It is irresponsible. It is indefensible. It is unacceptable,” Dr. Lynch said. He said the practices are not consistent with the VA’s values and that the agency is working to fix them.

That effort includes an assessment of provider capacity and the development of productivity standards that take into account the time and intensity of medical services. Productivity standards are being rolled out and should be fully in place by the end of September, he said.

“Ready access to care is our highest priority, and we are mobilizing our workforce accordingly,” Dr. Lynch told members of Congress. “Aligning the current demand with our ability to provide these services is part of our active work.”

He said one reason VA doctors’ case loads are low is that their patients are typically older and have more complex medical issues that require longer appointments. In some cases, facilities don’t have enough exam rooms or enough support staff to allow them to see more patients, he said.

“It’s not just about the physicians’ ability and willingness to see patients,” he testified. “Many of our facilities are 50 or 60 years old and were designed in an era where outpatient health care was not the predominant mode of health care delivered.”

Some physicians see as few as six patients per day while others see as many as 22, he said.

The hearing came as outrage over the VA’s problems intensified because of new accusations that the agency downplayed whistleblowers’ concerns about improper handling of surgical equipment, the hiring of unqualified practitioners, neglect of psychiatric patients and about violations of agency policies regarding the rescheduling of canceled appointments.

Carolyn Lerner of the U.S. Office of Special Counsel raised the concerns Monday in a letter to President Barack Obama.

Lawmakers have been trying to legislate a fix but so far have not been able to agree.

A bicameral conference committee is expected to meet today to begin writing compromise legislation that could include sweeping changes. Measures under discussion include provisions to open new VA facilities, to require the VA to pay for outside care when its own centers cannot see patients quickly enough, to end bonuses for agency employees and to make it easier for administrators to fire workers.

Lawmakers have been focused on the issue since problems in Phoenix came to light, leading to an audit that showed 57,000 veterans nationwide had been waiting more than 90 days for an appointment and some much longer. The trouble led to the resignation of VA Secretary Eric Shinseki.

Rep. Mike Coffman, R-Colorado, wants to see more administrators go, too, including Dr. Lynch.

In an angry exchange during Monday’s hearing, the congressman said Dr. Lynch doesn’t seem outraged enough about the problems or capable enough to fix them. He noted that Dr. Lynch visited the Phoenix VA four times but never spoke with the schedulers who are accused of falsifying records, with any veterans or with the key whistleblower in the VA case.

“We’re asking the same people who drove us into this ditch to figure out how to get us out of this ditch,” he said. “I don’t think it can happen. I don’t think you can do it. I think we need a new secretary of the VA that’s going to come in and is going to clean house,” Mr. Coffman said. “I don’t see you as part of the solution.”

Dr. Lynch said there are problems but insisted the VA is a good system that compares well to private health care facilities.

“We are challenged right now because of integrity. We certainly need to learn. I take this all very seriously,” he said.

Washington bureau chief Tracie Mauriello:, 703-996-9292 or on Twitter @pgPoliTweets.

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