“It has come to our attention that in order to improve scores on assorted access measures, certain facilities have adopted use of inappropriate scheduling practices sometimes called “gaming strategies.” Example: as a way to combat Missed Opportunity rates some medical centers cancel appointments for patients not checked in 10-15 minutes prior to their scheduled appointment time. Patients are informed that it is a medical center policy that they must check in early and if they fail to do so, it is in the medical center’s right to cancel that appointment. This is not patient centered care”, according to Memorandum from the Deputy Under Secretary for Health for Operations and Management, dated April 26,2010:titled: Inappropriate Scheduling Practices.
A review of the alleged patient deaths, patient wait times and scheduling practices at the Phoenix VA Health Care System reveal that the issue of inappropriate scheduling practices was a problem back in April 2010.
In a Memorandum issued by the Deputy Secretary for Operations and Management at the time William Schoenhard stated:
“It has come to our attention that in order to improve scores on assorted access measures, certain facilities have adopted use of inappropriate scheduling practices sometimes called “gaming strategies.” Example: as a way to combat Missed Opportunity rates some medical centers cancel appointments for patients not checked in 10-15 minutes prior to their scheduled appointment time. Patients are informed that it is a medical center policy that they must check in early and if they fail to do so, it is in the medical center’s right to cancel that appointment. This is not patient centered care.
For your assistance, attached is a listing of the inappropriate scheduling practices identified by a multi-VISN workgroup charted by the Systems Redesign Office. Please be cautioned that since 2008, additional new or modified gaming strategies may have emerged, so do not consider this list a full description of all current possibilities of inappropriate scheduling practices that need to be addressed. These practices will not be tolerated.
For questions, please contact Michael Davies, MD, Director, VHA Systems Redesign (Michael.Davies@va.gov) or Karen Morris, MSW, Associate Director (Karen.Morris@va.gov).”
Note: The purpose of cancelling appointments and rescheduling appointments was to make wait times appear to be less than they actually were.
Inappropriate scheduling practices are a nationwide systemic problem, especially within the VA. The fact was that these practices concerning inappropriate scheduling practices were tolerated to such an extent that people died in the process. It was only after the deaths of numerous patients at VA Medical Center in Phoenix, Arizona that the scandal was revealed by whistleblowers.
See related article: Report: 1,700 Veterans Missing From VA Wait List in Phoenix http://time.com/126851/veterans-affairs-wait-list-report-phoenix/