Cooking the Books to Get Their Bonuses

There's been a lot of noise about the problem with vets getting appointments at VA hospitals. So here are some numbers for the VA hospitals in Minnesota, where I live:

The average wait time for a patient seeking primary care for the first time is 28 days at the Minneapolis VA Medical Center and its outpatient clinics and 25 days for the St. Cloud system, the data show. But the waits are much shorter for established patients who are already in the VA system -- three days for Minneapolis and two days for St. Cloud. Nationwide, the longest average wait for new patients seeking primary care is 145 days in Honolulu.

Waits for new patients seeking specialty care are longer -- 50 days for new patients for the Minneapolis system and 47 days for St. Cloud's, compared with four days for established patients to see specialists for Minneapolis and five for St. Cloud. The longest average wait for new patients nationwide is 145 days in Harlingen, Texas.

The Minnesota times are typical for what I experience when I make appointments to see a doctor with my private insurance. If I want to see a specialist for the first time I have to wait two or three months. But if I'm already an established patient, it only takes a few days, just like it does for vets. There's no catastrophe occurring in Minnesota.

There were similar findings in the audit for California: wait times were mostly in line with what I see in private practice. Note that some of the problem San Diego VA clinics are are operated by private contractors.

The map on this page shows the distribution of wait times across the country. There are basically 12 or 13 clinics in the country out of maybe a hundred that have long wait times; most of the country is experiencing wait times comparable to private medical practice.

So it seems like the problem at the VA isn't endemic. There are certain facilities where administrators are are committing fraud because they don't have the resources to meet the demand, but they still want to make their numbers so they can get their bonuses. These bonuses may well be the source of the problem:

According to congressional reports and VA employees, medical-center staffs nationwide were pressured to reduce waits even as backlogs grew. A carrot-and-stick approach provided cash bonuses and advancement to successful managers, but performance downgrades for failures.

In the words of whistle-blowers, that emphasis created incentives to "cook the books." 

So, it's not really a question of a generally incompetent government medical system, but the corrupting influence of money: instead of rocking the boat by complaining to upper management about resource shortages, managers lied to make sure they got their bonuses.