The Department of Veterans Affairs acknowledges systemic issues of timeliness in providing veterans with health care and is committed to fixing unacceptable patient scheduling practices, a senior VA official told Congress June 23.
Dr. Thomas Lynch, assistant deputy undersecretary for health for clinical operations, Veterans Health Administration, testified before the House Veterans Affairs Committee alongside Dr. Carolyn Clancy, assistant deputy undersecretary for health for quality, safety and value, on VA’s capacity to provide care for veteran patients.
“At the outset, let me address the significant issue that has been the focus of the committee, the VA and the American public — that is the issue of wait times,” Lynch said. “No veteran should ever have to wait an unreasonable amount of time to receive the care that they have earned through their service and sacrifice.”
Lynch said America’s veterans should know they will receive the highest quality of health care from VA. “While we realize the timeliness of these services is in question,” he added, “VA acknowledges and is committed to correcting the unacceptable practices in patient scheduling.”
Lynch referred to the recent VA patient scheduling scandal as a “breach of trust.”
“It is irresponsible, it is indefensible, and is unacceptable,” he said. “I also apologize … to our veterans, their families and loved ones, members of Congress, the veteran service organizations, our employees and the American people. These practices are not consistent with our values as a department. We are working to fix the problem.”
Lynch told the panel that VA has a workforce of more than 25,000 physicians representing more than 30 specialties, and now has comprehensive information about the staffing levels at each medical center. This information, he said, includes the productivity of VA’s physician workforce, using a standard health care measure of relative value units, or RVUs.
“RVUs consider the time and the intensity of medical services delivered,” Lynch explained. “Optimizing physician productivity is critical to our ability to determine clinical capacity and mobilize our clinical assets to rapidly address unacceptable delays in services. Supporting a productive workforce requires appropriate support staff ratios, as well as the necessary capital infrastructure to ensure that the clinics run as efficiently as possible.”
Lynch noted the difference between the estimated capacity and VA’s current workload represents the amount of additional care available to address veterans waiting for care. Additionally, Lynch said, VA has accelerated the adoption of productivity standards “critical” in determining the Veterans Health Administration’s capacity and improving timely access to quality care for veterans.
“We are about a year ahead of schedule in completing action plans based on the recommendations of the [Office of the Inspector General] in late 2012,” he said.
Productivity standards, Lynch said, will be in place for all physicians in the VHA by the end of September.
“Like all of health care,” he said, “VA has transitioned to a system in which outpatient care is increasingly important, especially for the management of chronic conditions.”
Lynch also said VA has established the nation’s largest “medical home” approach to primary care in which people receive care from teams.
“In addition to face-to-face visits, they receive advice and consultation which can be provided through technology, through telephone calls, secure emails and Telehealth,” he said. “Leveraging these capabilities to deliver veteran-centric care requires investments in education, training and the ongoing evaluation to assure that services are focused on the needs and preferences of individual veterans.”
Lynch said that because the majority of U.S. physicians receive some training in a VA facility at some point, VA has invested in contemporary approaches to undergraduate and graduate training that reinforce the importance of teamwork and technological skills. The department also leverages research investments, he added, to assure that the promise of these new models achieves the goal of personalized, veteran-centric care.
The health and well-being of the men and women who have “bravely and selflessly” served the nation remains the VA’s highest priority, Lynch said.
“The work continues,” he added, “and we will not be finished until VA can assess capacity, productivity and staffing standards for all specialties and provide ready access to high quality, efficient care available to all our nation’s veterans. We must regain the trust of veterans we serve. VA leadership and our dedicated workforce are fully engaged.”