I received this today from our Watchdog Guardians. Ever-vigilant, they were quick to descend on Denver for a quick check of rumors about excessively long delays in VA’s newer, larger Emergency Department (ED) waiting rooms. While there, they decided to kill two birds with one stone and investigate how long it takes to get your call answered at the VAMC front desk. My guess is Linda Fournier and her OIG pals haven’t had to call the Prize Redemption Center’s 800-827-1000 number in a number of years and experience a 4+-hour wait there. Maybe someone should call the ombudsman and complain. 

Here’s the gist of the good stuff. Remember, everything’s abbreviated so hard time in the waiting room is contracted to Length Of Stay (LOS). LOS is further slotted into four-hour increments and it is hoped that the maximum wait would not exceed 1.5 LOS.  Certainly you can see one LOS sounds a shit-ton better than 4 hours of Sports Illustrated. Additionally, LODs are time-managed by the Emergency Department Integration Software (EDIS) Thus, you end up with convoluted time management using the rotation of Jupiter as a predicate:

VHA requires that EDs use Emergency Department Integration Software (EDIS). EDIS allows staff to record and track ED patients. Recorded information includes patient arrival and disposition (discharge, transfer, admission) time, and is broken down into 4-hour increments. The time elapsed from arrival to disposition is referred to as length of stay (LOS). VHA’s LOS target is for 10 percent or less of patients to have a LOS
greater than 6 hours.  For our evaluation, we used a 4-hour LOS benchmark due to the software timing features.

Software timing features. I’ll have to remember that one at my next BVA hearing. “Well, your honor, due to software timing features, my disease does not manifest itself in a normal LOS that correlates with my medical forays to the VAMC. Thus it isn’t always notated in the EDIS accurately.”

Think the below through to its logical conclusion.

VA OIG’s Hotline Division received the following allegations: the ED “needs help,” wait times exceeded 8 hours, and a patient was treated discourteously and afraid to return; and staffing issues at the Call Center caused long call waiting times and callers dropped out because they grew tired of waiting. During this review, we received an additional allegation that another ED patient was treated discourteously. We did not substantiate the allegation that the ED “needs help.” While we found some ED wait times (length of stay [LOS]) exceeded 8 hours, we determined the facility met VHA’s target of less than 10 percent of patients with a LOS over 6 hours. We did not substantiate the allegation that ED staff treated two patients discourteously, or that one of the patients was afraid to return to the ED due to alleged discourteous treatment.

Can you imagine going to an emergency room with a raging fever and waiting over 8 hours to be seen? Wait.  Even six hours?  Well, maybe at Lackland AFB’s Wilford Hall but that’s military. Obviously, both the VA and the OIG are overjoyed that the wait isn’t over 10 hours but this is disgraceful. When I last went down to American Lake VAMC in Lakewood in August, I was unprepared for the remodel. The floor area for the doctor offices and examination rooms had decreased 40% and the waiting areas had metastasized equally as much. My old friend Gloria, who had for years greeted me at the Yellow Team reception area was gone. I now had to wait in a line that did intake for the Blue, Yellow, Red, Silver Teams AND the Emergency Department. What’s more, the ED waiting room was reduced to about 10 chairs smack dab in the front entry where the new reception desk had been erected. As you enter the foyer and reception, the waiting line blocks further progress.

Setting that disturbing non-finding aside, there were complaints of long waits to talk to the VA health Nurse and others we are required to converse with before pushing “Print” and heading out to an emergency room closer to our domiciles. Remember, you are not technically allowed to seek out medical care just anywhere when VA is your go-to provider a la Obamacare. By law, you have to give them a sort of “first right of refusal” before your significant other drags your lifeless body into the car with the help of the kids. This creates another metric called the EDIS LOC or Length Of Call. When the LOC exceeds 2 LOS and no fog can be seen on the mirror under your nose, you are then legally permitted to go to an ED nearer you. This is called the EC clause for Emergent Condition. It is also the only legal leg you have to stand on if you have waited less than 1 LOC on hold.

One thing I noted in my last visit was even though my appointment was early in the morning by VA’s standards (10 AM), the LOS was already pushing out to an hour (11 AM)before I was finally face to face with the doctor. While in the waiting room, I got to meet some of our latest class of Veterans recently released to Veterans status. The VA Secretary has graciously given them two free years of medical insurance (almost free) much like the GI Bill. Unlike this free medical, the GI Bill is not fraught with 2.0 LOS pitfalls. In fact, they use a different metric measured in months instead of hours.

Most of the Vets I talked to said this was no different from being in the military and going on sick call. I remembered back and damn if they weren’t right. Remember rolling in after morning formation and sitting there waiting for the recently arrived Commander’s wife’s 3 year-old daughter to be seen first? And you with a paltry 102.5 fever? Now that I’m on Medicare and back in the land of the real medicine, I find a 10-minute wait past my designated appointment to be a piece of cake. Never again will I fall for the “Dude, you’re 100% and Priority One. You get to step to the front of the line. We can schedule you in for that heart arrhythmia in two weeks. AM or PM?”

The waiting on hold is a Monty Python skit looking for a stage to happen on:

We substantiated the allegations that Call Center understaffing caused long call waiting times and callers to abandon calls. We found 40 percent of the Call Center’s authorized registered nurse, medical support assistant, and pharmacy technician positions were vacant and determined that inadequate staffing contributed to the Call Center’s failure to meet VHA targets for caller response time and call abandonment rates. We also found
that calls were dropped due to the telephone system’s 120-line limitation, and callers who used the automated call return system did not always receive a return call. An upgrade of the phone system is not planned until FY 2016 when the facility relocates. Additional staff and an upgraded system should eliminate the 120-line limitation and reduce callback system failures.

Yes indeed. Silly Vet. Just be patient until 2016 and then we’ll be able to put 1200 of you on hold. Wait until you see the new LOH (Length On Hold) breakdown into 6-hour increments so that some calls can be carried over to the next day making the the delay appear shorter than it really is.

I have seen commercials on prime time inviting people to come work for the VAMCs. In an age of unemployment nationwide, I find it incongruous that jobs-government jobs, no less- can go begging.  These are much sought after in the VBA sector so I just assumed they received the same fervent response in the VHA. Based on this disturbing news and the rapid turnover of eight Personal Care Physicians (PCPs) in my five years with the VA medical machine, I can only surmise there is another detrimental dynamic I am unaware of that decreases the desire to seek VA employ. Apparently, it infests Denver as well.

One last observation. It seems the OIG krewe only ventures out to the Mile-High city in the winter months when the powder is about 40″ deep and the conditions on the slopes are rated “excellent”. I’m sure that’s an utter coincidence but Karaoke machine rentals also seem to spike at about these times when the OIG is in town. We report. You get to Sherlock.