The growing backlog for outside care is the latest VA problem in Atlanta in recent years. Others have included low hospital scores given by the VA and low rankings from workers and veterans. It is facing a lawsuit from a veteran’s family who discovered him covered in more than 100 fire-ant bites while under VA care. The hospital in Decatur had to close surgical suites in late 2019 and early 2020 because of contamination and safety concerns.
The national program to move more veterans to outside care started two years ago after VA hospitals across the U.S., notably in Arizona, were found to be hiding veterans’ excessively long wait times for help.
To qualify for outside help, a veteran must request approval from the local VA and meet criteria, such as the VA being unable to supply the needed primary care in 20 days, or 28 days for specialty care. Other reasons include if the veteran lives a long distance from a VA hospital, or simply if it is in the veteran’s best interest. The VA contracts with and pays Optum, a third-party provider in Georgia and some other states, for outside doctors or medical services.
The Community Care Department in each VA hospital handles the requests and is supposed to make a decision in less than 19 days, or direct the veterans back to the VA hospital. The Atlanta hospital and its satellite clinics serve about 110,000 veterans in the north half of Georgia.
A little more than a year ago, Atlanta’s Community Care Department suffered a stinging internal review which noted multiple problems, from a growing backlog to lack of staff knowledge. The VA said last fall it had hired new managers and increased staff by 180% to speed up outside referrals.
Internal VA documentation reviewed by the AJC shows the Atlanta hospital lagging VA hospitals of similar size in processing outside cases — every step from initial requests for an appointment to retrieving paperwork and tests from doctors and adding them to VA patient records.
Those unclosed cases in Atlanta climbed to more than 37,000 by May, records say. The similarly sized Gainesville, Florida VA hospital had 12,124 open cases; Houston’s had 7,315; Cleveland’s had 5,107; and Dallas’ had 4,194.
Of Atlanta’s unclosed cases, 20,566 were over 90 days old, compared with 1,661 in Dallas; 591 in Gainesville and 362 in Houston.
The VA said Optum is adding providers, and the VA is also trying to hire more service assistants, who process the requests for outside care and help veterans make appointments.
Optum said it has grown from 17,068 health-care providers in Georgia in June 2020, when it started, to 31,390. It has handled 475,900 claims in that time.
The VA said it has 63 service assistants to serve North Georgia and is trying to fill nine positions.
Many of the service assistants have been taking leave, adding to the backlog, according to one of the VA employees who spoke with the AJC.
The VA said some staff take leave but did not provide any numbers.
The story so far:
Congress opened the door two years ago for more veterans to apply for medical care outside the VA system because of backlogs of men and women waiting to see doctors. A critical internal review in January 2020 of Atlanta’s Community Care Department, which coordinates applicants and outside appointments, showed dysfunction and a growing backlog, which the VA said it was addressing. The AJC reviewed recent internal VA documents showing that veterans who have waited more than 30 days for a decision on outside appointments continues to rise and reached more than 18,000 by May.