By Jeff Keeling
Patients wait longer than average for some types of medical appointments at Johnson City’s Mountain Home VA hospital and affiliated clinics, but the facility is not among those flagged for further review in a national audit.
Top officials from the James H. Quillen VA Medical Center discussed the audit findings, which were released Monday, in a Tuesday news conference. Fielding numerous questions surrounding Mountain Home’s wait times for specialty care, Direc
tor Charlene Ehret and others defended Mountain Home’s quality of care, its ongoing efforts to reduce the amount of time patients wait for appointments, and its ethics.
“Keeping up with the timeliness is an everyday responsibility that we’re continually working on,” Ehret said. “Providers come and go, demand increases and decreases and we work hard to keep up with that.”
Of 141 facilities ranked on a battery of metrics, Mountain Home had the ninth-longest wait times for new specialty care patients, which was one of six categories showing average wait times. That ranking was widely reported Monday, often in headlines without reference to the fact that it was one of more than two dozen ranked factors.
In fact, Mountain Home ranked even worse (3rd and 8th worst, respectively) for the number of patients with appointments scheduled more than 120 days from a “reference date” and for the number of new patients who had been on an electronic waiting list for more than 120 days from the date of their appointment request.
Before she and others outlined some of the steps Mountain Home is taking to reduce wait times, Ehret stressed the fact that Mountain Home was not flagged for further review by the VA Inspector General’s office. The 100-plus facilities that were had findings in the audit that may have pointed to fudged numbers on waiting list data and other improprieties. The audit was initially prompted when a physician at an Arizona VA filed a complaint with the IG’s office, alleging hospital administrators were falsifying patient access records to make it appear waiting times were meeting VA performance metrics.
“We know that we give good care and we think that we have sent the right message, that honesty, integrity is important to us, that we do not want to falsify any data and we think that the report has confirmed that what you see is what you get and that there are no hidden agendas here at Mountain Home, Tennessee,” Ehret said.
In a Tuesday telephone interview with News and Neighbor, First U.S. District Congressman Phil Roe expressed concern over delayed care for veterans but relief that Mountain Home’s audit appeared clean on the ethics side.
“They used those metrics and were honest about it,” said Roe, a physician and veteran who serves on the House Veterans’ Affairs Committee. “What was really disturbing to me was that in some facilities people were manipulating those numbers to make it look like they are meeting all these benchmarks.”
Roe said he generally hears very positive comments about quality of care and service at Mountain Home. He added that a benchmark goal of two weeks for appointment wait times was unrealistic, but he didn’t excuse some of Mountain Home’s long waits.
“If you’re in the system, what I hear is pretty good,” Roe said of Mountain Home. “The problem is getting into the system.”
He said in his view Mountain Home has “made spectacular improvements” over the past three decades.
“Does that mean it can’t improve? Absolutely it can.”
Tuesday morning, Ehret explained that quickly growing demand in the Knoxville area, and high levels of demand in the specific specialties of audiology and optometry, lie behind most of Mountain Home’s struggles. She said the center has opened nine clinics since 2008 to increase access and provide care closer to veterans’ homes. A 10th clinic is set to open Monday in Campbell County, north of Knoxville, and the VA is expanding its clinic in Sevierville.
With the average Mountain Home client aged 67, she said hearing and vision services are in high demand. Both are specialties, and she said those have skewed the waiting time data somewhat for new specialty patients.
Among the steps Mountain Home is taking to address specialty and primary care backlogs, Ehret said, are the hiring of new physicians, leasing of new space in the Knoxville region, and outsourcing of care to the private healthcare sector. That occurred to the tune of $42 million last year, she said.
She added that combat veterans, women veterans and veterans with urgent clinical needs all receive priority and are seen quickly.
While Mountain Home proper has seen a fairly steady growth rate, Ehret said, “We have very severe space limitations in Knoxville and we have looked at every way of pulling patients from the Knoxville area closer to their home in Sevierville or Campbell County so that we could free up space in the Knoxville clinic for the growth that continues there.”
Dr. David Hecht, Mountain Home’s chief of staff, said the center has readjusted its “clinic profiles” and taken other measures to reduce wait times in an ongoing manner.
“We’re constantly looking across the system at where we’re growing, where we’re not growing as fast, and trying to add resources,” Hecht said.
Ultimately, Ehret said, she and the rest of her leadership team are responsible for the quality and timeliness of care veterans receive at Mountain Home and its affiliated clinics.
“We are responsible for anticipating demand and making sure that services have the resources they need to provide the quality of care that we’re so proud to provide.
“It looks as though one of the outcomes of this audit is that there are going to be additional resources for specialty care, and so we’re hoping to get a part of that.”
For his part, Roe said he expected the scrutiny of and changes at the VA to be a lengthy process. A bill that was working its way quickly through both houses of Congress appears set to offer veterans the option of seeking care outside the VA system, paid for by the VA, if they live more than 40 miles from a VA facility or if they face a prolonged wait for care.
“To get this VA (nationally) straightened out is going to be long, arduous hard work,” Roe said. “I think the work’s just now beginning, and there’s going to have to be a lot of reforms.”