By Lauren Sagl
WASHINGTON—Veterans Affairs clinics and hospitals in Maryland are taking a closer look at how long patients are waiting to be seen for their appointments in the wake of an investigation released by the Associated Press last month.
The data evaluates 940 clinics and hospitals in the United States and its territories from September 2014 to February 2015, right after the VA received $16.3 billion to shorten wait times.
The VA was granted this money after revelations that wait times were much longer than some VA clinics and hospitals were reporting. In the aftermath of the scandal, President Barack Obama and Congress demanded reforms and Secretary of Veterans Affairs, Eric Shinseki, resigned.
The AP report, released April 8, gauged performance based on the percentage of appointments delayed longer than 30 days, a timeliness standard the VA has set for itself.
In Maryland, the VA clinics in Glen Burnie, Cambridge and Cumberland all ranked in the nation's 100 worst VA clinics and hospitals for wait times in the AP survey, with Glen Burnie among the 50 worst clinics, delaying 8.11 percent of appointments at least 31 days. The Cambridge VA clinic and Cumberland VA clinic delayed 5.81 percent and 5.39 percent of their appointments at least 31 days, respectively.
The Greenbelt VA clinic saw the best wait times, delaying only 0.48 percent of all its appointments at least 31 days or more and not delaying a single appointment for more than 90 days during the period reviewed by the AP.
The national average for wait times of at least 31 days at VA health facilities is 2.8 percent, according to the AP.
Seven of Maryland's 14 VA clinics and hospitals saw wait times above the national average. The VA Maryland Health Care System operates five of these problematic clinics, and a total of eight clinics altogether.
"The VA Maryland Health Care System has implemented an aggressive action plan that has already started to improve all patient wait times throughout the health care system," said R. David Edwards, the organization's chief of public and community relations. "The action plan includes hiring additional primary care providers and support staff, re-introducing Saturday primary care clinic appointments and increasing clinic capacity throughout the health care system."
After the VA scandal last year, the VA Maryland Health System acknowledged that, while there were no inappropriate scheduling practices in its hospitals or clinics, it needed to take an aggressive approach to reduce wait times. One of the responses included awarding a one-year contract last August to Evergreen Health Care, a Maryland-based non-profit organization, for up to $485,000.
Through this partnership, new veterans who have to wait more than 30 days for an appointment at a VA Maryland Health Care system facility could be referred to a primary care facility run by Evergreen Health Care. However, Evergreen's four outpatient facilities, located in Baltimore City, Columbia, Greenbelt and White Marsh are not close to the Cambridge VA clinic, which is seeing some of the longest delays.
Wait times at the Southern Prince George's County VA Clinic, Fort Howard VA Clinic, Fort Meade VA Clinic and the Loch Raven VA Clinic in Baltimore were also above the national average.
At these clinics, the percentage of appointments delayed at least 31 days ranged anywhere from 4.48 percent to 3.54 percent.
According to the VA Maryland Health Care System, the Glen Burnie VA outpatient clinic is staffed by five primary care providers and various support staff. In the last six months, one provider left for another job and another retired.
These departures caused a temporary increase in wait times for patients, said Edwards. One primary care provider was hired to fill a vacancy in October 2014, while another came on board in early March, he said.
With these changes, the VA Maryland Health Care System anticipates that wait times at the Glen Burnie clinic will improve the next time data is released, Edwards added.
Rep. John Sarbanes, D-Towson, represents the area where the Glen Burnie clinic is located. A spokesperson for the congressman responded to the AP report saying, "Congressman Sarbanes is committed to providing our veterans with timely medical care. He contacted the Department of Veteran Affairs to ensure that steps are being taken to improve wait times at the Glen Burnie clinic."
Although Glen Burnie saw the highest percentage of appointments in Maryland delayed at least 31 days, delays were longer at the Cambridge VA , where 166 appointments were postponed more than 90 days, according to the AP's data.
The Maryland VA in Baltimore was the only facility to delay more appointments more than 90 days, postponing 272 appointments 90 days or more, the AP found. However, the Baltimore facility completed nearly 10 times more appointments than the Cambridge VA.
"Due to its rural location on the Eastern Shore of Maryland, the [Cambridge] clinic provides a higher portion of walk-in clinic access to allow Veteran patients to be seen by a provider for urgent issues," said Edwards.
"The clinic has walk-in appointments available every day, Monday through Friday, for Veteran patients who need to see a provider for a same-day appointment, which can have an impact on wait times for scheduled appointments," Edwards added.
Edwards also said the Cambridge VA clinic consistently receives the highest patient satisfaction scores. Additionally, the VA clinic 62 miles away in Pocomoke City, which opened in 2012, was built to absorb more patients on the Eastern Shore and to shorten wait times at the Cambridge facility.
"Continued wait times of this length are completely unacceptable, which is why I have continued to advocate for veterans to have a choice in their health care," said Rep. Andy Harris, R-Cockeysville, who represents the 1st District, where Cambridge and Pocomoke City are located. "Veterans should be able to opt out of a failed health system if they so choose."
Veterans Choice Program
Harris was referring to the Veterans Choice Program, which began in November 2014. The program allows veterans who face long delays or have to drive long distances for care to seek medical attention from a private physician.
"The choice program has had a slow start and has run into complications based on how the VA implemented the straight line rule and how it defined a VA medical facility," said Roscoe Butler, deputy director for health care, veterans affairs and rehabilitation with the American Legion.
Instead of measuring the distance from a veteran's house to a clinic with a straight line, the VA now takes into account how far a veteran must drive to get to the nearest medical facility.
According to Edwards, this change, which took effect April 24, will assist veterans on the Eastern Shore. He predicts the new policy will decrease the average wait time at the Cambridge VA clinic.
And more change could be on the way.
"Congress is now looking at amending the choice law to define a VA medical facility as a VA medical facility that can provide the care that veterans require," Butler said.
However, the AP report said many veterans still don't understand how the choice program works. Additionally, those who enroll in the program still need to get VA approval, and only some physicians participate in the program.
Between November 2014 and March 17, only 46,000 patients had made appointments through the Veterans Choice Program nationwide. The AP calls this a "drop in the bucket," considering the VA sees an average of 4.7 million appointments every month.
The Cumberland VA clinic, which delayed 5.39 percent of appointments at least 31 days, saw the third highest wait times in the state. The clinic is operated by the Martinsburg VA Medical Center in Martinsburg, W.Va.
Lauren Winebrenner, who works in the public affairs office, said she could not comment on the report because, "They [The Associated Press] altered the way the data was labeled and reported."
However, Rep. John Delaney, D-Potomac, who represents the Cumberland VA Clinic's district, acknowledged that improvements are needed.
"Dedicated men and women work at VA facilities around the country, but the report by the Associated Press is another reminder we have more work to do," said Delaney. "[Recently], I met with Maryland veterans face to face and heard their stories and this report corroborates what I've been told first-hand-we've got to reduce wait times."
The Greenbelt VA clinic, which is operated by the VA Medical Center in Washington, posted the best record in Maryland in terms of the smallest percentage of appointments delayed.
Repeated attempts to reach someone at the clinic were unsuccessful.
Rep. Steny Hoyer, D-Mechanicsville, represents the Greenbelt area. Despite the clinic's positive performance on wait times, Hoyer said he is carefully tracking the issue.
"There are more than 70,000 veterans that I represent in the 5th District and I have continued to closely monitor the unacceptable delay in accessing health care," said Hoyer. "There is more work to be done in Maryland and across the country, and I will work to ensure that Maryland veterans receive health care in a timely manner."
No plans for expansion
After expanding the Loch Raven clinic in Baltimore in 2008 and building the Pocomoke City and Fort Meade VA outpatient clinics in 2012 and 2013 respectively, the VA Maryland Health Care System has no plans to open any additional clinics.
"The Fort Meade, Loch Raven and Pocomoke City VA Outpatient Clinics were designed and constructed with the capacity to serve the growing Veteran populations well into the future in their respective regions," said Edwards.
Even though most clinics are seeing above average wait times, Edwards believes the VA Maryland Health Care System is adequately serving its veterans.
"Despite several unexpected primary care provider vacancies during the past six months, the VA Maryland Health Care System has been doing very well in reducing the wait times for patient appointments thanks to our aggressive action plan," he said.
"In addition to hiring 13 new primary care providers, with an additional nine providers in the recruitment and onboarding process," Edwards added, "the VA Maryland Health Care System has been using other resources throughout our organization and partnering with the community to effectively improve patient wait times."