A program designed to educate veterans on the various treatments for mental health conditions actually hindered access to medical care and contributed to the underuse of six therapists at a Georgia Veterans Affairs clinic, a Department of Veterans Affairs investigation found.
The VA's Office of Inspector General found evidence that the Hinesville VA Outpatient Clinic did not adequately manage its Choose My Therapy program, which informs patients of the different types of available care. The clinic also did not use its scheduling tools properly, leading to delays in care.
Clinic leaders said the VA's "complex scheduling process" did not reflect the therapists' patient loads accurately, but the OIG found that the clinic sidestepped the system and consultation process and used off-system spreadsheets, which are prohibited by the VA, to track patients.
The clinic used the unauthorized spreadsheets from at least 2021 through April 2023, when a new records system allowed schedulers to effectively manage consultations.
Still, the use of prohibited wait lists raised questions among investigators as to "whether patients on the spreadsheet received care as requested," according to the report released Tuesday.
The VA OIG received a complaint in November 2023 over barriers to care at the clinic, part of the Ralph H. Johnson VA Health System in Charleston, South Carolina.
The claimant questioned overall clinic mental health practices and the Choose My Therapy program, which they said acted as a barrier to care, slowing veterans' access to individual therapy.
The OIG found that the clinic did not properly handle consultations from Choose My Therapy, and veterans often did not complete the program's requirements, limiting their access to services.
The investigation also found that, while the Veterans Health Administration recommends that provider utilization rates -- a measure of how many appointment slots are filled and patient load -- not fall below 80%, most of the therapists' utilization rates at the clinic varied from 32% to 68%.
And despite what appeared as open appointments, the investigators found that patients who were supposed to be seen weekly were given three appointments across an average nine weeks. Of the 285 patients reviewed, 169, or 59%, did not continue to the third visit -- a dropout rate likely tied to delays, the investigators said.
"Delayed initiation of mental health treatment, particularly for those with complex needs, may put patients at risk for negative outcomes," they wrote.
The VA published a policy in 2017 prohibiting the use of any paper wait lists, calendars, logbooks or spreadsheets for scheduling in response to a 2014 scandal at the Phoenix VA Health Care System that involved more than 3,500 patients and contributed to the deaths of at least 20 patients, according to the OIG.
In November, more than a dozen House lawmakers raised concerns about the VA's scheduling system and processes for medical appointments following a report that former service members face difficulties getting regular mental health treatment from the department.
Reps. Marilyn Strickland, D-Wash.; Mike Waltz, R-Fla.; and others cited an Oct. 17 investigation by Military.com and feedback from constituents in a letter sent to VA Secretary Denis McDonough about canceled appointments and delays in care.
The VA did not respond to a request for comment by publication.
As a result of the investigation, the OIG made six recommendations to the clinic to improve patient care, suggesting that it ensure that therapists are treating an adequate number of patients, that scheduling staff use proper practices, that the clinic evaluate its Choose My Therapy program, and also investigate whether patients whose names were in the spreadsheets received appropriate care.
The VA largely concurred with the recommendations, adding that the veterans on the spreadsheet all received follow-up mental health care. Of 660 names, 652 were veteran patients who received care, two additional veterans were later found to qualify for health services and also received care, and six were providers or employees whose names were not categorized correctly in the database.
"The Ralph H. Johnson VA Health Care System makes patient care and safety a priority, and we appreciate the Office of the Inspector General's partnership in our continuous improvement efforts for veterans," wrote Scott Isaacks, Ralph H. Johnson VA Health System director.
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