Long waits plague region's VA system
The country's largest and busiest veterans' health care network has one of the highest rates of delayed appointments and the largest number of veterans waiting three months or longer for care.
VA statistics for September 2014 through February 2015 show the North Florida/South Georgia VA Health System had nearly 525,000 completed medical appointments in a six-month span, the most of the approximately 140 VA regions in the country.
The network includes Ocala and Gainesville and stretches from The Villages to Valdosta, Georgia and from Tallahassee to Jacksonville.
The vast majority of those appointments — more than 92 percent — were completed within 30 days of what the VA dubs the “preferred date” for care.
But the percentage of appointments delayed past 30 days, some 7.6 percent, was rivaled or surpassed only by the VA systems based in Hampton, Virginia; Fayetteville, North Carolina; and Montgomery, Alabama.
With the most appointments in the country, the North Florida/South Georgia system also had the most veterans waiting months for care. From September through February, more than 2,500 appointments were delayed 91 to 120 days and close to 1,400 were delayed beyond 120 days.
The North Florida system also had a hospital and a clinic with some of the largest numbers of patients waiting for appointments. Gainesville's Malcom Randall VA Medical Center, the 21st busiest of the 150 VA hospitals, had the fifth highest number of appointments delayed 30 days or more — nearly 11,500 appointments — and the fourth most delayed past 90 days — more than 1,130.
The outpatient clinic in Jacksonville, the fourth busiest in the country, had the country's highest number of appointments pushed past 30 days and 90 days. The clinics in The Villages and Ocala, on the other hand, had only a fraction of patients waiting more than 30 days for an appointment. In The Villages, a little more than 3.5 percent of appointments were pushed past a month. In Ocala, it was a little more than 2 percent.
One year after lengthy wait times for new patients and handwritten waiting lists that violated VA guidelines drew the North Florida/South Georgia system into the national controversy over delays in patient care at the VA, senior officials with the system say that some 93 percent of appointments being completed within 30 days is a sign of progress.
“We have improved and we will continue to work to improve,” said Dr. Chona Macalindong, deputy chief of staff for the North Florida/South Georgia VA Health System. “We are not satisfied with where we are.”
Pointing to an area of progress, VA officials said a wait list for sleep disorder studies that stood at 2,000 in January 2014 — and had some veterans waiting a year — is now at 38. To tackle the list, the VA added resources and ramped up the use of referrals to private practices.
Dr. Brad Bender, the North Florida system's chief of staff, said the network paid $116.5 million last budget year — a $9 million increase from the prior year — to send veterans to private care in order to cut down on wait times.
Bender said the system sent 30,000 patients to the private sector last budget year and 18,000 so far this year. The VA is also planning an expansion of the outpatient clinic in Jacksonville, which has some of the most significant issues with wait times in the country.
“The clinic we have in Jacksonville was too small the day it opened,” said Tom Wisnieski, the North Florida/South Georgia VA Health Care System director.
Senior administrators for the North Florida/South Georgia system also point to some factors that combined with the heavy patient load to worsen wait times.
Nine percent of the veterans the system serves are new patients, about 3 percent higher than the national average. Macalindong said those new patients coming into the system typically require more appointments with a variety of doctors than established patients.
Wisnieski also noted that the North Florida/South Georgia system is, under VA criteria, considered the fifth most complex of the approximately 140 VA health systems. The VA determines that status by a series of factors that include patient population, the complexity of the system's clinical care and the level of development of research programs and educational programs such as medical residencies.
Bender also noted that waiting to get an appointment is an issue in private practice as well. But unlike the VA, those wait times aren't regularly posted on the Internet and readily available for public review.
Last year, a Dallas area physicians consulting and research firm conducted a survey that showed wait times were indeed an issue for the private sector as well. The firm Merritt Hawkins surveyed doctor's offices in 15 metro areas and found that the average wait time for a doctor's appointment ranged anywhere from 10 days to 45 days.
“Wait times are fairly standard in the private sector as well,” said Phil Miller, with Merritt Hawkins. “Basically, we have a national doctor shortage.”
Two representatives of Alachua County veterans groups — Scott Camil with Veterans for Peace and Bob Barnas with the Vietnam Veterans of America — both said they'd had positive experiences with the quality of care and getting scheduled for an appointment at the VA. Barnas said delays in a veteran getting into the VA system or in the processing of benefit claims were more significant problems.
Camil and Barnas both said getting in for an MRI exam was one exception to their smooth experiences with appointments. Camil said he can get into see his primary care doctor the next day but can wait upward of 60 days for an MRI.
“Our demand does exceed our current supply for MRIs,” Bender said.
He said the system had added staff, extended hours and used referrals to the private sector to try to address the backlog. He also said administrators had urged doctors to use less time-consuming tests such as a CT scan when appropriate.
The VA started posting statistics on wait times for appointments last summer in response to the scrutiny and controversy over sometimes lengthy delays in care. In September, the VA moved away from measuring wait times from the day that a clerk entered an appointment into the scheduling system and started measuring it from the “preferred date” for an appointment, which is either the day the veteran wants to be seen or the day his or her doctor determines to be necessary for a medical visit. The change to the “preferred date” methodology cut by nearly half the percentage of appointments delayed beyond a few days.
Wait time data for Sept. 2014 through Feb. 2015 (Of 150 VA medical centers) Malcom Randall VA Medical Center Percentage of appointments delayed at least 31 days: 5.75 percent, 13th highest out of 150 medical centers Total appointments completed: 199,548, 21st busiest Appointments delayed at least 31 days: 11,473, fifth highest Appointments delayed at least 90 days: 1,133, fourth highest Lake City VA Medical Center Percentage of appointments delayed at least 31 days: 4.59 percent, 23rd highest Completed appointments: 70,204, 108th busiest Appointments delayed at least 31 days: 3,221, 61st highest Appointments delayed more than 90 days: 363, 23rd highest