Another day another VA visit
I saw my primary care doctor last week and he referred me to several of the specialty clinics for some follow-up stuff. I went to see one of them this morning. For a still undetermined reason, my shortness of breath is even worse of late, so it was more of a struggle for me to walk across the parking lot and throughout a good portion of the first two floors of the main hospital building at the West L.A. VA Campus. I suppose I should be grateful I didn't have to deal with the temporary triage area of the Emergency Room.
When I got to the clinic reception area, pulling an oxygen tank on wheels behind me and very out of breath, the sign said, "please stand behind the kiosk until you are called to the window." I stood there waiting while one of the clerks showed the other how to handle something in the computer. Five full minutes passed before the clerk who had been receiving instruction was ready and called me to the window. The other clerk told him, "don't help him until you finish that, to make sure you don't have to go back and do it all over gain." Another couple of minutes passed and then that other clerk summoned me to the window. It took her all of 30 seconds to check me in and tell me to have a seat. Seven minutes of standing and struggling to breathe seems excessive.
I was early for my appointment. I still had to wait for 40 minutes beyond the scheduled appointment time before I was seen. The disconnect isn't with the quality of the care provided. The specialist I saw was personable, thorough and obviously concerned with my medical issues. He provided excellent care, clear and cogent instructions and I was thoroughly satisfied with the quality of care. If I were writing a review of the place, he'd get the maximum number of stars.
The administration of that care is the problem. We can fault Congress for not providing enough funding, the Executive Branch for inadequate management and the protections of the Civil Service system in keeping employees who don't do the work and cannot be fired; but there is another issue to be explored.
The first symptom is found in that parking lot. Every single parking space marked as "Handicapped Only" was occupied. That is a lot of spaces. The parking lot entry is now controlled by a guard to ensure that no employees and only properly cleared visitors can park in that lot between 6 a.m. and 3 p.m. The lot was still almost completely full on a mid-week morning.
There are 170 VA Medical Centers and 1,061 outpatient clinics in the VA Health System. There are over 9 million veterans enrolled in the VA Health System. I am not typical in terms of number of visits given my multiple medical issues, but so far in 2018 I've been to the VA for non emergent care nine times. Since every veteran should get at least one checkup annually and there are a lot of us getting care on a more frequent basis; assume for a moment that we average two visits to a VA facility each year.
Over 18 million appointments (not counting emergent and urgent care visits) divided by 1,231 facilities is over 14,600 appointments per facility annually. The West LA VA campus is big. Lots of buildings. Lots of people.
This isn't offered as proof of anything except there are a lot of appointments to manage. The proof is in the scandals of waits veterans experience to get care. I watched a man in the waiting room this morning waiting patiently for his name to be called. After he'd been there for well over an hour waiting, he had to go to the desk and reschedule. He had to be somewhere. Jammed parking lots, jammed waiting rooms and reports about how administrators are gaming the system to earn performance bonuses they aren't entitled too are signs that the system's capacity isn't sufficient to provide every veteran with the excellent care the system can and does provide.
* * *
The VA Mission Act, which went from the Senate to Trump's desk last week, is not the answer. One of its provisions is to allow the VA to contract with a chain of care clinics to serve a segment of those more than 9 million of us enrolled in the VA Health System.
Medicare is a government funded system where the care is provided by non-government providers. The rate of errors in claims processed by Medicare is far higher than the rate of private insurers. I see nothing to indicate the same would not be the case if the VA allows veterans to go to private care providers without pre-authorization. Some will milk the system.
The VA needs to invest in infrastructure and administration first and foremost to make the most efficient use of its present capacity.
When I got to the clinic reception area, pulling an oxygen tank on wheels behind me and very out of breath, the sign said, "please stand behind the kiosk until you are called to the window." I stood there waiting while one of the clerks showed the other how to handle something in the computer. Five full minutes passed before the clerk who had been receiving instruction was ready and called me to the window. The other clerk told him, "don't help him until you finish that, to make sure you don't have to go back and do it all over gain." Another couple of minutes passed and then that other clerk summoned me to the window. It took her all of 30 seconds to check me in and tell me to have a seat. Seven minutes of standing and struggling to breathe seems excessive.
I was early for my appointment. I still had to wait for 40 minutes beyond the scheduled appointment time before I was seen. The disconnect isn't with the quality of the care provided. The specialist I saw was personable, thorough and obviously concerned with my medical issues. He provided excellent care, clear and cogent instructions and I was thoroughly satisfied with the quality of care. If I were writing a review of the place, he'd get the maximum number of stars.
The administration of that care is the problem. We can fault Congress for not providing enough funding, the Executive Branch for inadequate management and the protections of the Civil Service system in keeping employees who don't do the work and cannot be fired; but there is another issue to be explored.
The first symptom is found in that parking lot. Every single parking space marked as "Handicapped Only" was occupied. That is a lot of spaces. The parking lot entry is now controlled by a guard to ensure that no employees and only properly cleared visitors can park in that lot between 6 a.m. and 3 p.m. The lot was still almost completely full on a mid-week morning.
There are 170 VA Medical Centers and 1,061 outpatient clinics in the VA Health System. There are over 9 million veterans enrolled in the VA Health System. I am not typical in terms of number of visits given my multiple medical issues, but so far in 2018 I've been to the VA for non emergent care nine times. Since every veteran should get at least one checkup annually and there are a lot of us getting care on a more frequent basis; assume for a moment that we average two visits to a VA facility each year.
Over 18 million appointments (not counting emergent and urgent care visits) divided by 1,231 facilities is over 14,600 appointments per facility annually. The West LA VA campus is big. Lots of buildings. Lots of people.
This isn't offered as proof of anything except there are a lot of appointments to manage. The proof is in the scandals of waits veterans experience to get care. I watched a man in the waiting room this morning waiting patiently for his name to be called. After he'd been there for well over an hour waiting, he had to go to the desk and reschedule. He had to be somewhere. Jammed parking lots, jammed waiting rooms and reports about how administrators are gaming the system to earn performance bonuses they aren't entitled too are signs that the system's capacity isn't sufficient to provide every veteran with the excellent care the system can and does provide.
* * *
The VA Mission Act, which went from the Senate to Trump's desk last week, is not the answer. One of its provisions is to allow the VA to contract with a chain of care clinics to serve a segment of those more than 9 million of us enrolled in the VA Health System.
Medicare is a government funded system where the care is provided by non-government providers. The rate of errors in claims processed by Medicare is far higher than the rate of private insurers. I see nothing to indicate the same would not be the case if the VA allows veterans to go to private care providers without pre-authorization. Some will milk the system.
The VA needs to invest in infrastructure and administration first and foremost to make the most efficient use of its present capacity.
posted by me at 2:46 PM
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