The director of the Central Alabama Veterans Health Care System says the local VA facilities were working on improving access, health care quality and efficiency long before a federal audit put the spotlight on the system.
The system includes the Montgomery and Tuskegee medical centers and several community-based outpatient clinics in Monroeville, Dothan, Fort Rucker, and Columbus, GA. It serves nearly 45,000 veterans.
Director James Talton says the federal audit done on the system showed the facilities not only have a staffing shortage of schedulers but the schedulers are in need of extensive training because some of the processes they used to schedule appointments were inaccurate.
According to the audit, the system has an average appointment wait time for new patients of 75 days. That was the seventh-worst nationally. The average wait time for first-time mental health patients was sixth-worst at 57 days. Other VA facilities in Alabama had shorter wait times.
But Talton says one fact that hasn't been widely reported is that the local VA system has reduced wait times for existing patients, those already in the system, by more than 50 percent. Audit results showed existing CAVHCS patients wait an average of six days for primary care appointments, seven days for specialty care appointments and 15 days for mental health appointments.
The audit also found that veterans names were placed on paper wait lists and not immediately entered into the computer system so that the system wouldn't show how long they were really waiting for care.
Talton, an Army vet who became CAVHCS director in 2012, says he was made aware this was happening in late December by an employee who came forward.
"The way we found out was a frontline employee had the courage to let me know about it," he said.
The VA completed a fact finding investigation that showed that were some paper waiting lists in use. An administrative board of investigation done by outside investigators was then done. Talton said he received their final written report in May which identified three employees responsible for the paper waiting lists.
The paper waiting lists were happening in a limited area, he said, and now, they have been eliminated and of the three executive service chiefs believed to be responsible, two have retired and the third has been demoted and placed in a role of less responsibility pending administrative action.
"A veteran whose name is on the waiting list and is not in the computer is a veteran we have no way of tracking his or her wait for care so we have no idea how long they've been waiting for care. The problem with waiting for care is not just that veterans wait. Every veteran on that waiting list is a veteran who is not getting healthcare. Not getting healthcare intuitively means that clinical outcomes and quality of lives could be affected. Which is why the VA wants all of those names on the list in the computer so we can track them and not lose them," Talton said.
The director says the names on the paper lists eventually made it into the computers but not in a timely manner and the VA is still seeing patients on the list to determine if it had an effect on their health.
Another big issue facing the VA facilities in Central Alabama, according to the director, is adequate physician staffing. There's a shortage of doctors nationally that's more pronounced in Alabama and the VA is limited in what they can pay them.
"We have a ceiling on physician salaries and we have a difficult time competing with the private sector," he added.
CAVHCS has hired new providers and opened up more appointment slots. CAVHCS is allowing vets to see non-VA health care providers and staff members are spending more time on the phone with veterans for their lab results and x-ray results so they don't have to travel to a local facility. CAVHCS is also working to reduce unnecessary appointments and create more access for veterans who need to get in for care.
"I have two jobs- taking care of veterans and taking care of those who take care of veterans. I'm committed to improving our processes here, our performance here, our outcomes here. We are looking at these issues systematically, we are cleaning them up. But I will not lie to anyone. It is not going to happen overnight," Talton said.
An investigation into scheduling practices at local VA facilities continues by the US Inspector General. The director says an in-depth look at the Central Alabama system can only help them improve.
Central Alabama VA facilities have set their own goal that by the end of the year, no veteran will wait more than 30 days for care of any kind, Talton told WSFA.
A brand new VA healthcare facility under construction right now should do a lot to alleviate congestion in existing clinics. The $40 million clinic is going up on Chantilly Parkway in East Montgomery. It's slated to open late next year. The 150,000 square foot clinic will provide out-patient services as well as specialized doctors for dentistry and eye care, for example. .
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