On the same day an internal audit revealed 57,000 veterans had waited more than 90 days for their first medical appointments, a House Veterans' Affairs Committee hearing on the VA signaled that fixing the problems in the sprawling federal bureaucracy will be far more difficult than just upping spending or passing a single piece of legislation.
In a hearing that took a far more conciliatory and fact-finding tone than previous committee meetings on the subject, Veterans Affairs and Government Accountability Office witnesses spoke at length about the challenges in addressing medical wait times.
For one, Debra Draper of the GAO testified, 43 percent of medical consultations at the VA are closed without the veteran ever seeing a doctor, mostly due to no-shows and cancelled appointments, either by the patient or the doctor.
"Blind scheduling," as Draper called it, which simply assigns a veteran a doctor's appointment in a letter without consulting with the patient, resulted in far higher instances of veterans missing appointments than scheduling appointments over the phone.
As Chairman Jeff Miller of Florida noted, the VA has spent more than $127 million in recent years on a new system that has yet to work.
But while witnesses agreed the current scheduling system is riddled with problems and is not "veteran-centric," they said issues with wait times and access to health care for veterans extended beyond scheduling methodology.
The major issue, witnesses indicated, was that the VA health system is simply overburdened with patients. As Matkovsky said, goals at the VA were "unrealistic," and tying bonuses to performances that were unrealistic was an error.
"Not understanding the capacity of our system was a mistake," Matkovsky said.
While lawmakers are currently looking at allowing veterans to go outside of the VA system for health care if the VA can't schedule an appointment in 40 days, witnesses expressed skepticism that the problem was that simple. Draper said taking veterans out of the VA health system had a number of "potential pitfalls"; it would effectively remove tracking of veterans' wait times and health outcomes, which could turn into a method for the VA to juke the stats.
As the acting inspector general of the VA, Richard Griffin, testified, VA statistics are already flimsy. If a veteran called for a doctor's appointment and was scheduled for a consultation 120 days away — simply because that was the next available appointment — the wait time would be "scored" as zero.
That was a process, Griffin said, that needed to change.
Another, more nefarious method of deceiving the statistics, Griffin said, is for a VA official, unbeknownst to the patient, to go into the system every couple of weeks to cancel and reschedule an appointment.
"There's plenty of evidence of data manipulation," Griffin said.
Witnesses repeatedly returned to the theme of changing the culture at the VA, and lawmakers seemed genuinely interested in developing the best possible approach to fixing what a number of members characterized as a "crisis at the VA."
Largely absent from the hearing were the dramatic and heated exchanges that have typified recent meetings, partly because the witnesses were just as interested as the lawmakers in making changes to the VA. At the outset of his remarks, Matkovsky apologized for the performance of the VA, something which Dan Benishek, R-Mich., said he appreciated.
"I feel sorry for you sitting there," Benishek said, explaining that Matkovsky was there to "defend the indefensible."
It was, perhaps, Benishek who took the most indignant tone, saying he also appreciated Griffin's comment that officials needed to be fired.
Once someone is fired or criminally charged, Griffin said earlier in the hearing, "it will no longer be a game, and it will be the shot heard 'round the system."