WASHINGTON — Frustrated by the numerous reports of veterans unable to receive timely mental healthcare at VA facilities, legislators have called for the VA Office of the Inspector General to conduct a formal audit of wait times.

Sen. Patty Murray (D-WA)

In a letter to the VA IG, Sen. Patty Murray,  (D-WA) chairwoman of the Senate VA Committee and Sen. Richard Burr (R-NC), the committee’s ranking Republican, raised issues that have emerged in recent hearings.

Most notably, they are concerned about the contradiction between what VA staffers in the field are saying about their difficulties in getting expeditious care to veterans compared with the more optimistic tone VA officials have taken with Congress.

The senators specifically asked for an investigation of how accurately VA was tracking wait times.

“[Does] wait-time data VA collects represent an accurate depiction of veterans’ ability to access those services?” Murray and Burr wrote in their letter. “In addition, we ask that your office evaluate whether VA is accurately and completely reporting the data they collect.”

They have asked VA officials to fully cooperate with any forthcoming audit, and VA has agreed to do so.

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Long Wait Times, Short Staffing

The call for an investigation into VA wait times came after the latest Senate hearing on VA mental healthcare, in which VA provider testimony was in sharp contrast to that of VA leadership. The suggestion was that some VA schedulers were “gaming” the system to meet first-appointment requirements at the expense of quality of care for new and existing patients.

“Due to chronic short staffing at my facility and the inability to manage my patients’ appointments based on their individuals needs, I am frequently frustrated by my inability to provide care,” said Michelle Washington, PhD, coordinator of PTSD services and evidence-based psychotherapy at the Wilmington, DE, VA, who testified on behalf of the American Federation of Government Employees.

Several types of PTSD treatment are dependent not only on getting the patient into therapy as quickly as possible. but also making sure that the servicemember receives regular, usually weekly, treatment.

“But, too often I am told the patient will need to wait up to six weeks for an initial appointment,” Washington said. “Frequently the patient loses interest, or their PTSD worsens.”

Schedulers at the Wilmington VAMC are under huge pressure to make first appointments within the 14-day window set as a systemwide goal by VA headquarters. As a result, the treatment of current patients is sometimes sacrificed to meet that goal.

“They may take one of my regular PTSD patients’ appointments to fill this new patient’s appointment,” Washington said. “This hurts the effectiveness of my patient’s treatment.”

In addition, patients who have finished their courses of treatment sometimes stay on her roster for much longer than needed, due to the difficulty in making timely referrals to other VA physicians, Washington said. These patients take up slots that are desperately needed for new patients coming into the system.

One part of this problem, according to Washington, is the very low staffing of primary-care physicians assigned specifically to new veterans. Another is the lack of freedom that clinicians have in directing the course of care for each patient, either due to VA policy or to lack of resources, she said.

“As long as providers have little say in where and when to help patients, this will keep happening,” Washington told the committee.

That these staffing and scheduling issues could directly affect the efficacy of PTSD treatment was reinforced by Col. Charles Hoge (ret.), who directed the military’s research into PTSD from 2002 through 2009.

“Treatment is 70% to 80% effective for combat-related PTSD, if the veteran comes in for care and receives a sufficient number of sessions for treatment,” Hoge said. “And having coordination with primary care — having access to mental health as part of primary care — is really critical in the treatment of veterans.”