Poor Performance Measurements

How many mental-healthcare professionals VA fields is dependent on the need and how well that need is being met. The IG report found, however, that the VA’s ability to track that is compromised.

One of the main goals of VA is for all first-time patients referred to or requesting mental-health services to receive an initial evaluation within 24 hours and a more comprehensive mental-health diagnostic and treatment planning evaluation within 14 days. The goal of the initial 24-hour evaluation is to identify patients with urgent care needs and to trigger hospitalization or immediate initiation of outpatient care.

Two of the principal measures VA uses to monitor access to mental healthcare are the percentage of patient evaluations completed within 14 days of an initial encounter and patient waiting times calculated by measuring the elapsed days from the desired date for an appointment and the actual date of the appointment.

According to VA’s FY 2011 Performance and Accountability (PAR) Report, 95% of first-time patients received a full mental-health evaluation within 14 days. However, according to the IG, this data has no real value, because VA providers did not adhere to a standardized scheduling or data-input system.

Using the same data that VA used to complete its PAR report, the IG calculated that VA completed only 49% (approximately 184,000) of its evaluations within 14 days of the veterans’ request or referral. On average, it took VA 50 days to provide patients with a full mental-health evaluation.

“Once an evaluation takes place, VA schedules them for an appointment to treat them. In FY 2011, we determined that VHA completed approximately 168,000 (64%) new patient appointments for treatment within 14 days for their desired data,” Linda Halliday, assistant IG for audits and evaluations, told legislators. “In comparison, VA’s [self-evaluation] showed that 95% received timely care.”

According to the IG report, 88% of veterans received a follow-up appointment within 14 days of their desired date. In comparison, VA’s self-evaluation reported 98% received timely care.

The actual numbers could be far worse. During their investigation, IG officials found that providers were basing desired date of care on their own schedule availability. This is in direct conflict with a VA directive to use the date the patient requests as the desired date of care.

“We reported concerns with VA calculated wait-time data in earlier audits of patient scheduling in 2005 and 2007,” Halliday said. “During both audits, we found that schedulers were inputting incorrect desired dates.”

Veterans could have waited two or three months for an appointment, but VA data could show zero-wait time, she said. “VA needs a reliable set of performance measures and consistent scheduling practices to accurately determine whether they are providing patients with timely healthcare services.”

The IG’s findings overshadowed VA’s staffing announcement and made the announcement seem, to some legislators, as an inadequate remedy for a more systemic performance measurement problem.

“It appears that VA’s response in this instance is yet another example of a federal bureaucracy providing a quick-fix, cookie-cutter solution,” said House VA Committee Chairman Jeff Miller, R-FL. “I would like to see from VA the priority that has been placed on veterans homelessness mirrored in mental healthcare.”

VA Office of the Inspector General

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