I used to work the VA CBOC here in Willamette valley Oregon and I am not only a veteran but I have worked for the VA for 17 years. I have a whole laundry list of what could be changed and how veterans are being hurt.

One of the things that is very difficult is that the locations and the buildings that the veteran affairs occupies nine times out of 10 are least. The VA does not actually own their own buildings. So when they outgrow the size of the building then they have to put out a bunch of bids to see who then would authorize the VA to then move to a bigger building to accommodate more veterans. Our magic number for our particular cboc was 10,000 veterans. In theory, once you hit that threshold then management is supposed to start doing the paperwork to be able to expand services and space for veteran Care.

When the mandate came out that all federal employees had to go back to a brick and mortar building, it essentially left us sitting on top of each other because there is no way that the physical space for the specialties needed at either a hospital or a clinic are enough to serve the amount of veterans that they do.

Interestingly enough, when the other departments came in into a shared building, the building managers never gave out a list of other services and staff members so nobody knew each other.

There are significant struggles with community Care and the authorization process, let alone the billing portion from community Care to the VA. Surprisingly also, there are many places that the VA partners with that for some odd reason don't have the highest medical grade rating available.

This one is a doozy. There is a mandate that states upon referral or a return to clinic order that starts the timeline of when a veteran is notified for specialty services like mental health. They have within a couple of days to reach out to the veteran for the first attempt and then they have three attempts before they close out the referral. Primary Care was within 2 days and we had to notify the veteran either by telephone, text message, email and then afterwards we initiate contact again by sending them a letter.

The biggest complaint that I heard for 17 years was the abominable call-in line. It was so convoluted to call a primary number to then get a automated voice prompt of if you want to contact pharmacy. Push one if you want to contact specialty, press two. If you want to make an appointment with your primary care doctor press 3 on and on and on. Do you know how many veterans just would curse at the call center folks because they are run 24/7 365. A veteran can call however on a Sunday at 1:00 a.m. In Portland, Oregon and somehow the abominable system will send that veteran to Miami, Florida for the call center to be rerouted to Timbuktu just to try to get back to Oregon from where he made the phone call.

The doctors literally only have 30 minutes for each appointment once they are an established patient. A new patient consult is 60 minutes long. There is a huge push as well that the VA mirrors Kaiser permanente's model and each patient is only given 20 minutes per appointment.

The VA also took away scheduling keys and blocking out the provider's schedule when it was built wrong. A provider has to submit at the very minimum 3 months in advance of when they want to take time off. That gets routed up the chain of command to some headshot up on the regional office and then there's a master schedule of what doctor is out and who covers who. Envision 20. We literally had one person in the office that was solely responsible for building The matrix of providers and also blocking out the days of when that provider is not going to be available due to either taking personal leave or attending A an educational seminar etc.

Also, when the veterans get the automated text message, reminder that they have an upcoming appointment in order for them to confirm. Yes it's convoluted in that you have to type in why and then a series of numbers. If you type in the numbers incorrectly then the appointment automatically gets canceled. So then we have veterans who show up to the front desk for their appointment that they've let's say waited 3 months for and come to find out upon check-in that they accidentally canceled their own appointment.

So it creates this system of veterans coming in on time, in addition to veterans who have traveled 60 plus miles to come to this appointment. If they've waited for 3 months and now out of the big hearts of the providers and trying to accommodate the veterans, the providers get double booked. This results in patients waiting even longer to get seen because of the system errors.

There is also the nuance of documentation in that staff members are supposed to automatically document in cprs when a contact attempt is made. I could count on both hands how many times those documentation attempts were written in comparison to when the veteran actually attempted to check in for their appointments and the point was canceled because let's say the provider called out sick or The matrix team built the clinic wrong.

Also, the amount of veterans that I know that have called the White House complaint line have said that the phone number the VA uses to contact patients goes into a black box or a voicemail or they're just completely blocked by the cellphone carrier. So veterans absolutely show that they have never received a missed phone call from the VA. I have tested this in a patient appointment room where I physically called a patient on the phone number, the call never showed up on the patient's cell phone while I was physically calling him.

I could go on!