http://www.cnn.com/2014/05/30/us/va-bonuses-qa/index.html

Were bonuses tied to VA wait times? Here's what we know

The journey to Shinseki's resignation
It's one of the more disturbing revelations to arise from an investigation into fatal delays in care at Veterans Affairs medical centers: Employee bonuses appear to be one factor behind the manipulation of patient wait times in at least one hospital.

Two reports released this week -- one by the VA's inspector general and another by the Secretary of the Department of Veterans Affairs -- indicate in some cases wait times were manipulated to meet employee performance goals needed for bonuses.

The news has raised questions about just how widespread the practice was and who received the financial incentives.

Answers from the VA have been harder to come by.

Here's a look at what we know:

What did the reports reveal?

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At the Phoenix VA patient wait times were directly tied to VA employees' bonuses and raises. By manipulating doctor's appointments for the veterans, the wait time to see a doctor appeared to be shorter, a factor considered in VA employee bonuses and raises, according to a VA inspector general report said.

The VA secretary's audit of a number of medical centers that concluded "some front-line, middle, and senior managers felt compelled to manipulate" the scheduling process to meet performance goals established by the agency.

Who benefited?

By all indications, from the reports and congressional testimony, the practice involved high-level managers in at least the Phoenix VA medical network.

Neither report identified managers by name or position.

How much money?

There is no easy answer to this. Performance incentives are typically tied to a number of factors, and the VA has not detailed how much of a role patient wait times may have played.

Who knew about it?

There is no hard and fast answer.

The first public revelation that salary increases and bonuses may have been a factor came with the release of the agency's inspector general report.

The House Committee on Veterans Affairs also asked the question during a combative hearing this week, where Rep. Dan Benishek, R-Michigan, inquired whether there was a financial motivation to manipulate appointment schedules at the Phoenix VA.

"That is a discussion the (VA inspector general) is having," Dr. Thomas Lynch, the VA's assistant deputy undersecretary for clinical operations, said.

How widespread is the problem?

It appears the VA, itself, is still trying to answer that question, citing the ongoing inspector general's investigation. A final report is due in August.

The issue of patient wait times is not an overall performance factor ordered by the VA, Lynch recently told the House Committee on Veterans Affairs.

The factors tied to bonuses and raises are decided by each VA network, Lynch said.

But the VA also appeared to indicate in its audit that its mandate to improve wait times may have played a role.

As a result of the audit, the VA suspended financial incentives -- bonuses and salary increases -- for all Veterans Health Administration executives for the 2014 fiscal year.



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Today I finally went ahead and walked out of the health clinic I've been going to for the past 3 years.

My health is generally excellent, the only pills I take are a statin for cholesterol. However, I'm expected to show up twice a year for a blood draw. Labs, it's called, where they do a total read of my blood numbers and then continue my statin prescription.

Every single time I've ever been in there it's taken as much as an hour sitting around with the hackers and coughers, either waiting to get my blood draw done or the visit 4 days later when the labs are back. Two trips twice a year, and even after I get into an exam room, I still end up waiting at least another hour.

So this time I went to a local lab, got the blood draw done in 5 minutes and left, and today, 4 days later, I went to the clinic for my appointment. The place was strangely empty, I was the only person in the waiting room and got into an exam room within 10 minutes, a first. But then I waited. And waited. Finally, after waiting for an hour and 45 minutes, I walked out and wished them a nice day at the desk.

The assistant or whatever her position is, asked me "Oh, you're not going to wait"? That did it. I turned back to her and gave her and everyone else in that place an earful, pointing out that I felt abused, I'd been waiting for an hour and 45 minutes, the last time there I waited for 2 hours, and that's a rotten way to treat people. Etc. and so forth, I ranted a bit more and left. I don't expect to go back, there's several other health clinics in the area.

What in HELL makes these doctors think that it's okay to leave people sitting in waiting rooms for hours past their appointment times? I don't care if they had an emergency or whatever, that's their problem and they have no right to shove their lack of efficiency onto their waiting patients, most of whom are ill or they wouldn't be there.

If it was flu season and they were swamped, that's different, but it isn't and there was only one person ahead of me. I know because a nurse said so.

We should have every right to expect to see the doctor within 30 minutes of our appointment time. If they're always going to be an hour late, at least, then they can change the way they schedule to compensate for that, hire in another doctor, or learn to use their time more efficiently.

This is the same trick that auto repair shops use. Take the job in and then let it set for ages until they finally get around to it, in order to not lose the job. Schedule patients in and then let them sit and wait, while the doctor chats away with some favorite rich, high paying patient or whatever.

I'm tired to death of people who abuse their positions, whether it's cops or clinic doctors, and I'm not going to put up with it any longer. My patience has ended. From now on, they get 30 minutes grace and then I leave. If I ever get seriously ill there's a hospital nearby and quick ambulance service.

It's not a concern, AuntiE. There's a few more clinics around, this one just happens to be closest. Plus there's a hospital that also has a clinic. As for me, my blood numbers have always been in the Perfect range ever since I first started having labs done 35 years ago, other than my cholesterol, which is well within tolerances too because of the statin drug. In any case, I found that *someone* had re-upped my prescription for another year anyway prior to that clinic visit, so I won't need to get anything further done except for a flu shot this fall.

Everything gets checked with those blood tests including my prostate. I don't drink or drug, so my liver is fine. The statins, my friend, are why I'm still alive. At 59 my cholesterol went over 300 and my first angina attack dropped me to my knees. I went on Lipitor and after 2 years had no more angina. after 4 more years I was switched over to Zocor (simvastatin) and have been on it ever since. I'm 76 and healthy as a horse, and that's the only pill I take. So if the statins end up killing me someday, I consider it their right to do so. After all, the stuff gave me 17 more years of life and no end in sight yet.

Everything gets checked with those blood tests including my prostate. I don't drink or drug, so my liver is fine. The statins, my friend, are why I'm still alive. At 59 my cholesterol went over 300 and my first angina attack dropped me to my knees. I went on Lipitor and after 2 years had no more angina. after 4 more years I was switched over to Zocor (simvastatin) and have been on it ever since. I'm 76 and healthy as a horse, and that's the only pill I take. So if the statins end up killing me someday, I consider it their right to do so. After all, the stuff gave me 17 more years of life and no end in sight yet.