The VA and Nostradougus

va

When the first hint of a controversy hit the VA in Phoenix on April 30 (a month ago), I wrote a blog entry entitled “What Makes Us Falsify?”.  Here is what I said then:

Today’s healthcare system pushes people to falsify. In the never-ending quest to fulfill unproven metrics and quality indicators, the pressure mounts for people to do stupid things.

Remember, at that time, NO ONE was linking the wait times and deaths to PFP other than me.  In fact, I have been screaming out this crap for YEARS!!  Now a NYT article comes out and I guess I not alone anymore.  The article talks about how the primary care shortage is at the core of the issue.  Duh. You think?   Then it goes on to say these points:

  • At the heart of the falsified data in Phoenix, and possibly many other veterans hospitals, is an acute shortage of doctors, particularly primary care ones, to handle a patient population swelled both by aging veterans from the Vietnam War and younger ones who served in Iraq and Afghanistan, according to congressional officials, Veterans Affairs doctors and medical industry experts.
  • The inspector general’s report also pointed to another factor that may explain why hospital officials in Phoenix and elsewhere might have falsified wait-time data: pressures to excel in the annual performance reviews used to determine raises, bonuses, promotions and other benefits. Instituted widely 20 years ago to increase accountability for weak employees as well as reward strong ones, those reviews and their attendant benefits may have become perverse incentives for manipulating wait-time data, some lawmakers and experts say.
  • “Yes, it is gaming the system a bit,” one employee at the Veterans Affairs medical center in Cheyenne, Wyo., explained in an email to colleagues. “But you have to know the rules of the game you are playing, and when we exceed the 14-day measure, the front office gets very upset.”
  • In Jackson, Dr. Hollenbeck reported that hospital administrators created “ghost clinics” in which veterans were assigned to nonexistent primary care clinics to make it appear that they were receiving timely care.
  • And in Albuquerque, an employee at the veterans center said some doctors were shocked when they received a memo a few months ago stating that 20 percent of physician “performance pay” would be doled out only to doctors who found a way to limit patient follow-up visits to an average of two a year — a tactic to reduce waiting times by persuading veterans to make fewer appointments.

How perverse and disgusting is this?  And remember, quality indicators are unproven.  As the bureaucrats feign that they are aghast at the situation, they continue to push for PFP, metrics and other crap behind the scenes.  To me, that is as disgusting as what happened at the VA. I saw this coming 10 years ago (because I am Nostradougus) and I was right.  It will only get worse.

 

 

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  8 comments for “The VA and Nostradougus

  1. Bridget Reidy
    June 8, 2014 at 7:20 am

    How about that ubiquitous falsification, the ROS, especially the “complete” ROS? As best I can tell it was part of academic medicine only as rather poor way to make sure we were thinking of the whole body, until some academian who’d been relying on underlings to do it for them for decades persuaded Medicare to use it to see how complex or thorough any visit was. Pretty soon even people on salary were using it for colds, after they noticed it was one of the few parts of the rules for complex visit billing that the auditors could understand, and EMR vendors used it to sell programs that sucked away one’s time and made it almost impossible to do or document a real complex visit, as a way to bill more complex visits. My guess is falsification was virtually unheard of until it was virtually forced on us this way. From there it was easy to glide down the slippery slope. How many of us are really willing or lose our jobs for honesty?

    • Doug Farrago
      June 8, 2014 at 8:20 am

      Agree 100%. I do a bit about it in my talks. ROS = garbage

  2. Chris Rhody D.O.
    June 5, 2014 at 1:44 pm

    They will use this to justify independent practice for non physicians.

  3. June 1, 2014 at 9:56 am

    Incredibly good video, JRDO! The magic of management is the magic of Penn & Teller. Doctors are like the skeptic, who says – that’s a brilliant illusion they’re doing up on stage, but it can’t happen in reality. Managers are the ones who want to be entertained by magic – they insist that with the willing suspension of disbelief, all things are possible. Volunteering for ignorant gullibility to plan things that are impossible – this is the recipe for disaster.

  4. JRDO
    May 31, 2014 at 7:26 pm

    This is what happens when the managers are not experts.
    I think there are some parallels here for when the administrators are not patient care givers.

    • MACF
      June 5, 2014 at 8:52 am

      Nothing like working at VA EDs to be a direct witness of the System flaws. From patients who report being kicked out from their primary care clinics unders the explanation of being a “no show” once (something not heard in the “real world”), to others requiring to be transfused while waiting for their colonoscopy appointments.
      This is not new, and I bet that the same polititians that are now acting so disgusted, knew about it from their constituents letters for a long time and did nothing.
      The fact that the whistle blower who denounced the issues in Phoenix awaited to his retirement before talking speaks of itself.
      The only solution is to shut down the System and allow our veterans to seek good quality medical care at their local facilities.

  5. May 31, 2014 at 10:11 am

    “In fact, I have been screaming out this crap for YEARS!!” One of the traps laid down for rational persons in the current system is that the wicked problem, whatever it is, stems from a lack of understanding on the part of good, decent and rational people.
    The pretense offered – which did not hold up in the Nuremberg Trials – is that the perpetrators did not understand the gravity of the situation. They were not responsible for its entirety – they were only following orders, and if they only had more information, their innate humanity, logic and reason would have revolted within them, in such a way to cause them to do the right thing in the crimes for which they were being tried.
    The courts saw this as a lie, and frequently executed those who stand upon these claims.
    The fundamental ethical lapse underneath, and in the fine article “What Makes Us Falsify?” from April 30, is the deliberate willingness and desire to commit evil, and deny that one has done so. Such humans are not human – they are the shells of human beings. Unfortunately, they represent the vast majority of our culture and population.
    This capacity is open to us all, to commit voluntary evil; it comes from the ability to make ethical choices, a capacity we cannot stand down from, no matter what we do.
    It is not only a problem in Albuquerque, nor the VA system, nor government itself – it is a corruption of society. Societies that are building and thriving, live in an ethical system; those that are deteriorating and dying live in an ethical vacuum. The sociological history of so many recorded cultures and civilizations show that this happens at the end.
    Systemic evil, like “Schroedinger’s Cat,” lives in an inchoate state, not recognized until it is named. It seems to be neither good nor evil, until the system collapses, and the determination is made that there is an “evil.” Of course, everyone has known that in their conscience from the beginning. Everyone just shudders and goes about their own business, commits their own contribution to sustaining the evil in the system.
    Then when it collapses, everyone howls – but not out of conscience, but out of the fear that their own guilt, their own collusion and permissiveness in evil, will be laid at their own doorstep.
    The easiest way of finding evil in our society is pointing out where it is NOT. That is easier, but in today’s American Healthcare, might come up empty.
    The outcome is the needless suffering and death of innocent human beings. That is the gravity of the charge. The only people who can make credible claims to virtue are those who can say, “In fact, I have been screaming out this crap for YEARS!!” That action may not change the system; it torments those who are pretty much shells of human beings. Perhaps one will be saved today, over here; another, next week, over there. We cannot save the rest.

  6. Pat
    May 31, 2014 at 6:41 am

    I really don’t understand why everyone is so upset. Any vet, or med student who has done rotations in a VA hospital (I’m both) knows the charms of lazy, entitled staff members and overbooked clinics. Sure there are a lot of decent VA employees, but even they are subsumed in an unwieldy bureaucracy whose natural byproduct will always be corruption.

    This is a systemic rot that has been decades in the making, so I really don’t understand all the new outrage. As we move inexorably toward nationalized health care, this is good practice for what we can expect.

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