In announcing the resignation of Veterans Affairs Secretary Eric Shinseki, President Barack Obama suggested his administration was never aware of the VA's massive scheduling problems, particularly those in Phoenix, Arizona.
"This issue of scheduling is one that the reporting systems inside of the [Veterans Health Administration] did not surface to the level where [Shinseki] was aware of it and we were able to see it," Obama said. "This was not something that we were hearing when I was traveling around the country — the particular issue of scheduling."
This statement is a puzzle on its own. The Government Accountability Office has been pointing to scheduling problems at the VA for years. Debra Draper, the health-care director at the GAO, has even testified in front of Congress about the problems.
1) The federal government does a terrible job overseeing local VA facilities
More than anything, the GAO has repeatedly emphasized that the federal government does a terrible job watching over local VA facilities.
One example: three of four clinics reviewed by the GAO certified themselves within compliance of scheduling policies, but none of them actually were. While the VA could, in theory, audit and punish these facilities, the GAO found that the administration rarely does.
"According to officials, [the Veteran Health Administration]'s central office does not penalize noncompliance with the certification and expects oversight to be managed locally," the 2013 report found.
This, more than any other GAO finding, speaks to what went wrong at the VA. VA officials who hid long patient wait times are culpable for their own greed — they could get pay bonuses from the VA for shorter wait times — and mismanagement. But these problems could also have been caught earlier if the federal government actually checked on these facilities.
2) The VA's scheduling technology is severely outdated
President Obama said he will keep top White House aide Robert Nabors at the VA to continue investigating what went wrong. One of Nabors's discoveries so far, according to the president, is that the scheduling technology at the VA is decades old.
"I just was talking to Rob Nabors, and he described to me … how in some of these facilities you've got computer systems for scheduling that date back to the '90s," Obama said.
But this was yet another issue prominently covered by the GAO.
"As we reported in May 2010, the VistA scheduling system is more than 25 years old and inefficient in facilitating care coordination between different sites," the 2013 report stated. "In 2000, [the Veterans Health Administration] began an initiative to modernize the scheduling system, but VA terminated the project in 2009. We also reported that VA's efforts to successfully replace the scheduling system were hindered by weaknesses in its project management processes and lack of effective oversight."
3) The scheduling policies themselves are really vague
Even if local VA officials decided to follow policies set at the federal level, that could come with a major problem: even the GAO isn't sure what the VA's scheduling policy intends.
One example is the over-complicated way the VA schedules appointments: it allows both the patient and physician to choose a desired date, with little guidance as to which date should take precedence.
"[Veterans Health Administration] central office officials responsible for developing VHA's scheduling policy and related training documents told us that the desired date is intentionally broad to account for all of the scheduling scenarios that may exist," the 2013 report stated. "However, leadership officials from the four [VA Medical Centers] we visited and their corresponding [Veteran Integrated Service Networks] reported problems with the unclear guidance on the desired date definition, and difficulties achieving consistent and correct use of the desired date by their schedulers."
Worse yet, training, which is supposed to be mandatory, is so loosely facilitated that schedulers might never get official guidance about the best practices even from their local bosses.
"[VA Medical Center] officials stressed the importance of scheduler training for ensuring correct implementation of [Veterans Health Administration]'s scheduling policy; however, certain [VA Medical Centers] did not ensure completion of the training by all staff who were required to complete it," according to the 2013 report.
The VA, for its part, has shown some awareness of these scheduling problems, and it's agreed to implement some solutions suggested by the GAO. But in a follow-up report the GAO found the agency has spent more time in the past few years looking into how to implement the policies instead of actually implementing them.
Maybe if the Obama administration was more aware of these reports, these fixes could have been implemented more quickly.