The VA and Nostradougus


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.



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