The VA is finally conducting monthly inspections at hospitals and clinics

In response to the Veterans Affairs scandal, the VA announced Wednesday that it will now direct local directors to conduct monthly in-person reviews of scheduling practices in every clinic within their jurisdiction.

“Our top priority is getting veterans off of wait lists and into clinics,” acting VA Secretary Sloan Gibson said in a statement. “We need our folks in the facilities to work directly with staff, answer all questions, and ensure our veterans receive the timely care they have earned. Veterans must trust their health-care system, and these reviews are an important step towards restoring integrity in all our scheduling activities.”

The increase in oversight gets to one of the major problems the Government Accountability Office has been pointing to for years: Even if the VA manages to set the right policies without any perverse incentives, the lack of federal oversight at local VA hospitals makes it unlikely that any policies are being properly enforced.

“Certainly, the way the system is set up, if someone wanted to go in and manipulate it, it would not be hard to do,” Debra Draper, health-care director at the GAO, said in a previous interview.

At the controversial VA hospital in Phoenix, administrators and schedulers allegedly manipulated and falsified scheduling records to continue receiving pay bonuses for seeing patients in a timely manner, even when patients were waiting on average 115 days for the primary-care appointment. If someone had been watching over the Phoenix VA facility all along, there’s a good chance the nefarious scheme could have been prevented or stopped.

Part of the problem, of course, also lies in the perverse incentive created by the VA’s wait time goals. Once local VA hospitals realized they couldn’t hit the 14-day wait time goal set by federal rules due to rising patient demand and a doctor shortage, many of them resorted to cheating on scheduling records to continue getting their pay bonuses. If the pay bonuses never created an unrealistic goal, the record falsification wouldn’t have been incentivized.

One of Gibson’s first actions after he replaced former VA Secretary Eric Shinseki was to repeal the 14-day wait time goal. The idea, as emphasized in the VA’s own audit, is to do away with the perverse incentive created by the scheduling goal.

Given that both these fixes just required a new VA leader to make regulatory changes, it’s questionable that it took a scandal to actually address such serious problems. Many veteran advocates have complained from day one that some of the problems have been known for years, but it took reports of patients dying while waiting for care for serious changes to be made.