Gaming The System

Legislators were particularly disturbed by one practice at the Wilmington VAMC, revealed by Washington. She said a veteran’s first appointment is frequently used only to gather background information and often involves little to no discussion about possible courses of treatment.

Richard Burr

“They may get in within that 14-day window, but it’s just for consultation and getting background information,” Washington said. “A first appointment can be a month to six weeks, easily.” 

When VA leaders testified later in the hearing, Murray asked them to respond to Washington’s testimony. “Do you think facilities are gaming the system and not fully reporting wait times?” Murray asked Mary Schohn, VA director of mental health operations.

“VHA does not condone gaming of any sort. I am not aware of particular facilities doing anything of the kind, and if I were I would react immediately,” Schohn said. “We are engaged in auditing to ensure that’s not happening.”

Having a background-gathering session count as a patient’s first appointment to fulfill VA regulations is not how the VA policy is written, Schohn added. “I don’t know about Wilmington, but that’s something I certainly want to follow up on. That’s not the expectation of how services are to be delivered.”

Despite that, the problem of long wait times and lack of physician resources is not limited to a few VAMCs. In July, Murray requested that VA survey their frontline mental-health professionals about whether they have sufficient resources to get veterans into treatment.

VA did so and found that nearly 40% of providers said they cannot schedule an appointment in their own clinic within that 14-day window, and 70% said they did not have adequate staff or space to meet the needs of veterans.

According to an IG report published earlier this year, only 16% of VA facilities visited by IG investigators met their staffing requirements for mental healthcare.

At a committee hearing in May, Antonette Zeiss, PhD, VA’s mental health chief, testified that VA had enough mental healthcare resources to serve its patient population. At this recent hearing, Murray asked Zeiss if she had a different answer.

“I believe we have unprecedented resources, and we’ve gotten them out to the field and we’ve hired and enormous number of staff,” Zeiss said. “And at the time, I believed they were adequate, if used in the most effective ways possible.”

VA is continuing to see an increase in mental-health patients, partially due to increased outreach by the agency, Zeiss said. The department will “aggressively follow all the data” to ensure they have effective predictions of how much funding and staffing is needed.

Legislators questioned whether policy at the top level will have a big enough impact on the needs of specific facilities.

“According to wait-time data provided by VA, veterans at the Spokane VA in my home state wait an average of 21 days for an appointment with a psychiatrist, with the maximum wait time being 87 days. I’ve been told that all of the psychiatrists in Spokane are booked solid for several months,” Murray told Schohn. “I’m very disturbed on the disconnect between providers and your testimony on the wait time issue.”