Quality care for vets more important than wait times, says VA secretary

Veterans Affairs Secretary Robert McDonald says wait times aren't the best measure of whether care at VA hospitals is improving. Satisfaction matters more. 

Monitor Breakfast

“From crisis comes opportunity,” says Veterans Affairs Secretary Robert McDonald. “The deeper the crisis, the bigger the changes that can be made.”

Secretary McDonald has had the opportunity to test that theory. A West Point graduate and former chairman and CEO of Procter and Gamble, McDonald was nominated by President Obama to run the VA in wake of a 2014 scandal at its Phoenix hospital. Critics charged that as many as 40 patients died as a result of waiting for treatment in Phoenix and that some VA employees there falsified records on how long patients actually waited.  

At a Monitor-hosted breakfast with reporters in the lead up to Memorial Day, the secretary was questioned about why the VA does not publicly report when veterans first ask for an appointment, known as the “create date.” The information can be used to calculate how long vets had to wait for an appointment.    

“The days to an appointment is really not what we should be measuring. What we should be measuring is the veteran’s satisfaction,” McDonald said. “What really counts is how does the veteran feel about their encounter with the VA? When you go to Disney, do they measure the number of hours you wait in line? What is important is, what is your satisfaction with the experience.”  

The secretary added, “what I would like to move to actually is that kind of measure. We are in the process of creating that kind of measure, validating that kind of measure.”

The reference to Disney theme parks prompted House Speaker Paul Ryan (R) of Wisconsin to respond to McDonald’s breakfast comments with a tweet: “This is not make-believe, Mr. Secretary. Veterans have died waiting in those lines.”

Secretary McDonald was also asked about a recent column in Roll Call newspaper, suggesting that Hillary Clinton should consider him as her running mate. Columnist Jonathan Allen argued that McDonald “trumps [Donald] Trump’s business-world experience” and “took on the thankless task of reshaping the broken bureaucracy of the VA….”

McDonald responded, “The way I look at all these things is just as I looked at when the White House contacted me about this job. I went to West Point. My life’s mission has been to help improve the lives of others and if I am asked to serve I certainly will consider it.” 

With the Obama administration coming to end in January 2017, McDonald is trying to deliver on what he calls 12 “breakthrough priorities” before the end of this year, including improving the experience veterans have dealing with the VA, increasing access to health care, developing a simplified appeals process, and reducing veterans homelessness.  

The secretary cited gains in a variety of areas. In the past 12 months, the VA completed 1.6 million more appointments than in the previous year. Average wait times are now five days for primary care, six days for specialty care, and three days for mental health care, he said.

But McDonald admits that those average wait times are not the experience for vets in all of its facilities. “There are tails at the end of that distribution and some of those tails are what we are trying to deal with.” For example, he said, veterans have been part of the general movement of the population to the South, and the VA needs to build facilities there. 

He added that “we know we have an issue getting people in. We know that and we are working hard on it.”

The VA is a massive management challenge.  It runs the largest integrated health care system in the US. It operates 1,200 health care facilities, has 350,000 employees, including 25,000 physicians who serve nine million patients. If it were a business weighed in the Fortune 500 rankings, McDonald said, it would rank sixth. 

When asked what issues would confront his successor, McDonald noted that, “one of the things we have committed to here is same-day resolution of a medical issue for any veteran…. It may not solve the issue, but we will get them the help they need that same day. We already do that at about 25 percent of our facilities.”     

A second issue his successor will face is the need to “get the appeals backlog down,” McDonald said. There currently are 440,000 appeals of VA benefits decisions pending. “In order to get that backlog down, there is only one thing we can do and that is pass legislation that changes the 80 year-old law that governs appeals,” he said. The law currently allows vets to file unlimited amendments to their claims.