Annals of Internal Medicine: Understanding Veteran Wait Times

Understanding Veteran Wait Times

David Shulkin, MD

2014 was a pivotal moment for the U.S. Department of Veterans Affairs (VA). A nonstop drumbeat of media accounts reported an access crisis involving long waitlists for health care and, worse, suggested that some veterans were dying while waiting for care.

The extent of the VA’s problems, like access issues in many other health care systems, was not immediately clear. However, the VA had difficult-to-understand wait time measures, outdated scheduling software, and arbitrary and unrealistic scheduling metrics. The confluence of these problems led to allegations of secret waitlists and resulted in veterans losing trust in the VA.

In the wake of the crisis and in response to public outcry and new requirements from Congress, the VA began publicly posting wait-time data (1). Few if any other health systems had ever done this. The VA was breaking new ground. We consulted with the National Academy of Medicine and other industry and thought leaders (2). It became clear that no standards for wait times existed; the VA would have to create a new set of definitions and terminology.

To be transparent and comprehensive, the VA produced reports with many wait-time metrics. These included when veterans requested an appointment (create date), when they wanted the appointment (preferred date), and when clinicians felt the appointment
was necessary (clinically indicated date). This resulted in 22 variations of pending and completed appointments. With almost 58 million appointments a year at more than 1000 locations and a large number of descriptive statistics for each appointment, the result was a data dump in Microsoft Excel spreadsheets (3). Although accurate, these metrics had little meaning to members of Congress who were holding the department accountable, to media reporting on the VA, or to taxpayers who fund the department. Most important, the metrics meant little to veterans who rely on VA care.

I recall sitting for a radio interview and trying to interpret our online wait-time data. It became apparent to me that we had created metrics so complex that, despite my best efforts, few listeners were likely to understand what I said. I realized then that we needed a better system. We needed reports on wait times that veterans could use to make informed decisions and administrators could use to improve our system. Read full article…