Health Care

Miami VA reports fewer patient delays than Florida, nation

Ronald Beasley, a veteran Army Airborne Ranger with diabetes, performs a walking test with Dr. Hermes Florez, professor of medicine with the Geriatrics Research Education and Clinical Center at the Miami Veterans Administration Healthcare System in Allapattah.
Ronald Beasley, a veteran Army Airborne Ranger with diabetes, performs a walking test with Dr. Hermes Florez, professor of medicine with the Geriatrics Research Education and Clinical Center at the Miami Veterans Administration Healthcare System in Allapattah. FOR THE MIAMI HERALD

In the eight months since Congress passed a law pumping billions of dollars into a Veterans Affairs healthcare system plagued by long patient delays and controversy, Miami veterans are seeing improvements in their wait times to see a doctor.

According to VA data released last week, about 98.6 percent of appointments completed in Miami’s VA Healthcare system during February — the most recent month for which data is available — were scheduled within 30 days of the patient’s preferred date to see a doctor.

That puts the Miami system’s facilities, which include nine sites between Key West and Deerfield Beach, slightly above the national average of 97.1 percent for February. Still, it is not possible to make a direct comparison with the data released last year because the VA now measures delays differently.

Statewide, though, veterans don‘t fare as well. Florida veterans still experience some of the longest wait times in the country, with the state placing 11th for the most wait times surpassing one month and fifth for delays longer than three months, according to VA data from September to February analyzed by the Associated Press.

The data helps measure a push to reduce wait times initiated early last year after reports surfaced that some veterans may be dying while waiting to see a doctor. The controversy sparked increased transparency and audits of the VA system — particularly after VA officials learned that agency administrators in Arizona were falsifying records to conceal the lengthy wait times — and the passage of the Veterans Access, Choice and Accountability Act in August.

The law gave the VA an additional $16.3 billion to slash delays and expand a program that would allow veterans experiencing long wait times or those who live 40 miles or more from VA facilities to get care outside the VA system.

According to data from last summer — which calculated delays based on the date appointments were made for new patients only, rather than the preferred appointment date for all veterans — about 57,000 veterans nationwide and 8,500 in Florida waited more than three months to see a doctor for the first time. Of those, the Miami VA Healthcare system acounted for 769 90-day-plus delays to new veterans last summer.

Shane Suzuki, spokesman for the Miami VA, said that the cause of delays at the time was “a combination of demand outstripping capacity and limited space in our existing sites of care.”

Now, new data reflecting all patients and based on the patient or their doctor’s preferred appointment date shows improvements in the Miami VA Healthcare system.

An average of 12 veterans a month have waited more than 90 days to see a doctor in the Miami VA Healthcare system since September, after the passage of the law — except in January, when 40 veterans waited more than three months.

The Miami VA hospital ranked 24th out of 50 VA facilities in Florida for longest wait time. Of about 192,000 appointments completed between September and February, 2,742 were completed more than a month after the patient’s preferred date and 81 were delayed more than three months, according to the Associated Press’ analysis of the data.

The Jacksonville outpatient clinic had the longest delays in the state since September, with 16,396 patients waiting more than 30 days to see a doctor and 2,006 veterans experiencing delays of more than three months.

Suzuki said all nine Miami VA facilities have implemented various measures to cut patient delays.

“The bottom line is — the numbers will reflect this — that the vast majority of our veterans are getting in for care in a very timely manner,” Suzuki said. “We are catching up from where we were and we are doing everything we can to get ahead of demand for services in South Florida.”

Part of that improvement, Suzuki said, was making use of $7.9 million in federal funds distributed to the Miami VA, which has since been used to increase staff by 7 percent — with 170 more positions to be filled — allowing for more appointment slots throughout the day, extended hours and Saturday clinics in some locations.

That’s not necessarily true in VA hospitals across the country.

About $5 billion of the law’s funds were allocated to hiring more doctors and opening new clinics nationally. But by January, only $56.4 million had been spent, according to a VA budget report for the House Committee on Veterans’ Affairs

About $10 billion of the law’s funds were meant to further develop the program that would allow veterans to get care outside the VA system. But as of January, only $438.3 million had been spent, with $300 million spent on administrative expenses to pay contractors charged with carrying out the program.

“Even as veterans confront treatment delays to this day, VA has left the vast majority of this money unspent,” Rep. Jeff Miller, R-Fla., chairman of the House Committee on Veterans’ Affairs, said in an email. “It’s well past time for the department to begin using this money the way Congress and the president intended: to get veterans the care they have earned in a timely fashion.”

But because of the change in the way the VA records appointments, — previously the VA measured wait times from the moment a clerk typed in the appointment for a new patient, but now it is measured from the preferred date established by the patient or doctor — the effects of the law and the funds spent is difficult to quantify.

The new measurement system means that about half of the all patient appointments once logged as “delayed” now meet timeliness standards, according to the Associated Press. The data does not reflect cancellations, no-shows or instances when the patient went elsewhere for care.

Robert Butler, an Iraq veteran who attends the Miami VA hospital for medical care, said he expects long waits every time he goes to the hospital.

“We come to the VA and we get pushed aside for months before we can get seen,” he said.

Butler, who suffers from post-traumatic stress disorder and has had multiple surgeries for a host of injuries sustained during combat, said the last time he saw a doctor was a year ago, before the law’s improvements. That appointment was delayed two months, he said.

His greater concern is with the Miami VA’s delays in processing paperwork that would ensure the continuation of his veteran benefits.

“They are backed up on everything, with their medical care and with everything,” Butler, 44, said.

But Ryan Foley, a legal fellow at the University of Miami Health Rights Clinic who is working on about 200 veteran cases, said his clients have not complained about long wait times at Miami’s VA facilities.

“I don’t think we’ve ever noticed a big issue with that,” Foley said. “Most have been able to get a scheduled appointment within the first 30 days.”

Suzuki also said the major complaints with the Miami facilities are with delays in the processing of benefits applications, and added that patients have chosen to stay with the VA even when their doctor’s appointments are delayed.

Only about 5 percent of patients, he said, have chosen to go outside the VA system when they are informed their appointment is scheduled more than a month after their preferred date and can get faster care elsewhere in the community free of cost.

“I think it’s a strong reflection that people know that they are going to be able to get in and that, given the choice, they seem to be choosing VA,” Suzuki said.

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This story was produced in collaboration with Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.