The United States Department of Veterans Affairs (VA) is a cabinet-level agency which provides veterans with medical care and benefits in additional to administering national cemeteries. Currently, the Veterans Health Administration (VHA) operates over 1233 health care facilities including 168 medical centers and 1053 outpatient clinics. Nearly nine million veterans receive care through the VHA annually. The VHA is organized regionally into 18 Veterans Integrated Service Networks (VISN). VHA medical centers can be found in metropolitan areas and provide both in- and out-patient services such as surgery, critical care, mental health, orthopedics, and physical therapy. Some medical centers also offer more advanced care such as plastic surgery and organ transplantation.

In 2013, a Cable News Network (CNN) investigation revealed long wait times for appointments at some VHA medical centers and attributed some deaths to those delays. Subsequently, other media and government investigations found that some VHA medical facilities were not in compliance with VHA scheduling policies and procedures and that scheduling information was being altered to show better performance than was actually occurring. In August 2014, President Obama signed a $16 billion bill to build more VHA facilities and to hire more health care providers. Disciplinary actions, including the firing of the Secretary of Veterans Affairs, were taken to address mismanagement within the VA health care system. Despite these actions, the problem of long wait times for medical care at veterans’ facilities continues.

In this case study we examine changes in the appointment backlogs at VHA medical centers from the Mid-Atlantic (VISN 6), Southeast (VISN 7), and Sunshine (VISN 8) Health Care Networks.