Blog

Blog’s Focus

I imagine there are dozens of blogs out there concerning Veterans Affairs or the VA. Not too many of them, however, are written by a fellow who recently worked there and who also gets his health care from the VA. I worked for Pharmacy Customer Care, a call center operation that is run by the Health Resource Center, headquartered in Topeka, KS. (People who regularly follow VA news may be aware that the HRC’s director was fired this past April, about two months ago, for sending “sexually-charged” instant messages to a female VA employee in North Carolina.) Pharmacy Customer Care takes calls for VA medical center pharmacies up and down the East Coast from Maine to Florida, Texas, and Louisiana. I left just before PCC started taking calls for Puerto Rico. PCC has three call centers located in Waco, Texas; Topeka, Kansas; and Black Hills, South Dakota. This outfit has a significant impact on a bunch of veterans, and it is growing. Meanwhile, most veterans, even some who use it if they’re not paying close attention, don’t even know it exists. This blog will follow major VA stories for sure, but I will also follow Pharmacy Customer Care, or PCC, in this blog, as well, simply because I know it well and can provide plenty of useful information to my readers. On to the next post!

Advertisements

A Veterans Affairs Scandal Closer to Home

One likes to believe that all those VA scandals were committed by the bureaucrats at someone else’s Veteran’s Affairs Medical Center, but this one has hit a little too close to home for that wish. Over about 10 years, veterans in the work program at the VA in Temple, Texas, made nearly 50 complaints about abuse from supervisors and suspected criminal behavior, but–wouldn’t you know it?–VA administrators didn’t do a blessed thing about it. Maybe that was because, according to the story, those in the work program claimed to have mowed the lawn and done other work for high-level officials. Oh, yeah! The VA loves its veterans.  Please see “Investigation Finds Corruption, Intimidation at VA Temple Campus.”

An excerpt:

Other complaints hinted at possible crimes; VA equipment like lawnmowers and expensive tools regularly disappeared. Veterans said assignments sometimes took them off the sprawling VA campus in Temple and to the homes of high-ranking VA officials, where they said they were ordered to work.

Yet even as the complaints piled up, administrators took no action.

I don’t know why I’m surprised. VAMC Temple, the flagship of the Central Texas Health Care System, was implicated in the 2014 appointment waiting list scandal, and now this.

 

HRC Needs to Accommodate Housebound Vets

I recently wrote this letter to Senator Isakson:

9/25/2017

The Honorable Johnny Isakson, Chairman
U. S. Senate Committee on Veterans’ Affairs
131 Russell Senate Office Building
Washington DC 20510

Dear Senator Isakson:

I am deeply concerned about an issue at the VA’s Health Resource Center, headquartered in Topeka, KS, but before discussing that issue with you, I’d like to thank you for the Veterans Appeals Improvement and Modernization Act of 2017. This bill, which you introduced, should go a long way toward reducing the backlog the VA has amassed regarding veterans’ appeals. It was sorely needed. Thanks for pushing that legislation through.

The issue I am concerned about regarding the Health Resource Center, or HRC, concerns disabled or housebound veterans unable to meet the insensitive demands of the bureaucrats who are supposed to be looking out for them. Specifically, when veterans who are out of medication call the HRC’s telephone call center business line, Pharmacy Customer Care, the situation is governed by a knowledge base article, KB 12234: Emergency Supply of Medication. Provided the medication meets certain criteria, under normal circumstances the PCC contact representative, the person answering veterans’ calls, sends an emergency refill notification to the appropriate VAMC’s pharmacy. Unfortunately, a number of pharmacies have opted out of the normal procedure and, instead, require that veterans appear at the pharmacy when they run out of an urgent medication. While that can pose a problem for veterans who have jobs anyway, it is especially problematic for veterans too sick or disabled to get to the pharmacy or for those veterans, often the elderly, without transportation. These veterans are just caught in the middle and left to suffer. HRC management does not appear too concerned about the situation.

A former HRC and PCC employee myself, I have raised this concern before. In fact, even after I left the VA on June 2, 2017, I communicated with management about this and other issues. When I requested a copy of KB 12234 on June 28, 2017, via the Freedom of Information Act, management did make a slight, inadequate change to the policy after they received my request. The change reads, “If caller’s situation requires further action not covered in this article, you may contact the Assist Line for guidance.” That change is a small step in the right direction but hardly covers this situation.

To be clear, this is not a “once-in-a-while” problem. When I was taking calls, and I did so for about five years, I regularly got calls from veterans belonging to VA medical centers that did not recognize the HRC’s emergency refill procedure, and they could NOT physically go to the pharmacy to take care of the problem. They were just out of luck. All we could do was order the medication via the regular process and let the normal, unrushed delivery process occur.

The small change management made is simply too vague, and this situation occurs frequently enough to be addressed specifically. Furthermore, HRC call center culture is one of “don’t bother the pharmacies.” That is ingrained there. Their vague modification will not change how these veterans will be treated in most cases, particularly since all calls are strictly timed and contact representatives must meet prohibitive length-of-call guidelines, guidelines that work against real customer service except in the most routine of calls. Calling the Assist Line adds several minutes to calls, sometimes many minutes. Most contact representatives just won’t do it because it will result in longer talk times, and longer talk times will cost them their next bonus, even their jobs. Intensive, deliberate training focused on housebound vets would likely help, but I doubt that’s taking place, either. The small change HRC management made to KB 12234 gives them plausible deniability, but little else.

These reluctant bureaucrats could fix the problem with just a few new lines to KB 12234:

Transfer callers to the Assist Line for subsequent transfer to VAMC pharmacies when:

  1. Veterans receive their medications from a VAMC pharmacy that does not recognize emergency refill electronic referrals, and
  2. IF the pharmacy accepted emergency refill referrals, the medication would qualify for such a referral, and
  3. Veterans are unable to physically go to the pharmacy due to a disability or medical condition or a lack of transportation.

The solution is that simple. When VA pharmacies require that veterans actually appear at their customer service windows for urgent medication, allowing housebound veterans to speak directly to pharmacy staff via telephone would simply be the logical substitute for an in-person visit. They cannot meet the stringent requirements of an indifferent bureaucracy. It is the right thing to do.

In view of the turmoil surrounding the HRC now, I’m not sure that doing the right thing is paramount in decision-makers’ minds. The HRC director himself, Robert Downs, was fired in April after being caught sending sexually charged instant messages. He lasted about five months after being hired while under investigation for those inappropriate messages, an investigation Matt Eitutis, the fellow who hired him, knew about, according to news reports. The HRC has had to make do with an acting director. Matt Eitutis, himself, the former acting executive director of Member Services, the immediate superior of the HRC director, and notably a former HRC director, as well, has been reassigned for allegedly looking out for himself rather than veterans. Mr. Eitutis and three of his subordinates are under investigation at the time of this writing. At least one high-level HRC official has filed discrimination and other complaints against Eitutis. Then there’s the recent Hot Springs call center scandal, a call center that one whistleblower called “more ruse than reality.” I think veterans’ welfare is taking a backseat to all the drama now. Someone, however, needs to take care of the homebound veterans that KB 12234 has bypassed. I hope you have time to look into this. If you need more documentation, I have plenty of it.

Thanks for your time, Senator, and, once again, thanks for the legislation that actually does something to lessen the VA’s lengthy appeals process.

Sincerely,

 

George W. Reamy

cc: HRC

Who says, “Wait just a sec”?

Bureaucrats. What a great, generally unaccountable bunch. When those in charge at the Veterans Affairs Medical Center in Phoenix said to hide appointments, everybody fell right in line. Nobody publicly objected, and self-interest, whether that interest was keeping a job or getting a bonus, ruled the day. Veterans died. It turned out that VA medical centers all over the country were doing much the same thing, and everybody was busily falling into line, right down to the low-level employees at the desks talking to veterans and ostensibly making their appointments.  No wonder people fell in line. I don’t think a soul went to jail for falsifying official government records or hazarding veterans’ health. Veterans died waiting on their appointments. No real consequences? No real sweat! Sweet!

Now we have the VHA’s Atlanta-based Health Eligibility Center saga. It seems the VA was about 800,000 health care applications behind, and according to Scott Davis, an Atlanta whistle-blower, the solution was a plan to toss out around 500,000 of them and claim everyone was all caught up. Oh, did I mention that about 300,000 veterans died waiting to hear if they were eligible for VA care? Between purging those 500,000 and the 300,000 who passed away, that 800,000 backlog would have gone up in smoke. Thank goodness for courageous people like Davis, and it does take courage to stand up to powerful people who control one’s livelihood. How many of the 500,000 still-living veterans would have died if their applications had been purged?

The VA is now conducting an internal investigation. I suspect the rectitude of the information coming out of that whistle Scott Davis keeps blowing is why the bigwigs around this latest scandal have all been reassigned. We’ll see how the investigation turns out, and we’ll see who gets their jobs back and who doesn’t.

I doubt Angel Lawrence, the director of the HEC in Atlanta will get hers back. She has also been accused of sending racially-charged messages. You have to hand it to VHA Member Services division head Matt Eitutis. He can sure hire some great directors. The guy he hired to head the Health Resource Center got canned in April for sending sexually-charged instant messages to a female VA employee, and now this director gets caught sending racially-charged messages. Oh yeah. This guy can pick ’em!

If the allegations turn out to be true, and VA officials acted in their own best interests rather than veterans’, the scary part for me will be the long line of officials up and down the chain who fell in line to execute the plan. Other than our courageous whistle-blower, who said, “Wait just a sec”?”

 

Veterans Crisis Line Still in Crisis

Embed from Getty Images

I. just. don’t. understand. Really, I don’t. How can we, the people, pay these Veterans Affairs bureaucrats six-figure salaries for such two-bit performance? Last year, Matt Eitutis, a VA bureaucrat who led the VA’s Health Resource Center to a whopping 26% call abandonment rate (when callers in queue finally hang up when no one takes their calls), was appointed to rescue the Veterans Crisis Line. (See “New VA Hotline Chief Has a History of Dropped Calls from Veterans,” USA Today, 3/4/2016.) About a year after that article, the VA’s Inspector General issued a report dated 3/20/2017 that found some alarming deficiencies, not to mention that Veteran’s Crisis Line management had still not successfully addressed recommendations in a previous February 2016 report issued by the IG. Some of the more disturbing findings of the 2017 IG report appear below. My comments appear in brackets:

  • The Suicide Prevention Office leads suicide prevention efforts for VHA and coordinates and disseminates evidence-based findings related to suicide prevention. The Director of the VHA Suicide Prevention Office stated that the Acting Director of the VCL informed her that she had no authority over the VCL. We found limited communication between the VHA Suicide Prevention Office and VHA Member Services about suicide prevention and the VCL. [So administrative people at Member Services, led by Eitutis, weren’t listening so well to the clinical people, the people who actually know how to save lives.]
  • We were also informed during interviews that Member Services leaders did not heed warnings from VCL clinical staff who predicted obstacles to achieving proposed operational targets in the intended timeline (such as inadequate staffing and training resources). Lack of formal planning and inaccurate forecasting resulted in more than 16,000 hours of Canandaigua FTE (full–time equivalent) employees being temporarily redirected to the Atlanta Call Center for training and operations. This led to an increase in the number of calls that rolled over to backup centers and delays in the development and implementation of VCL processes, policies, and procedures. [No surprise here, given the first bullet in this list.]
  • VCL leaders defined the success of the call center partly in terms of suicide reduction. However, the VCL had no process in place for routinely obtaining or reviewing data on serious outcomes, such as attempted or completed suicides by veterans who made contact with the VCL prior to the event. By not reviewing serious adverse outcomes, VCL QM managers missed opportunities for quality improvement. [They weren’t even bothering to look if they were actually preventing suicides.]
  • We found that VCL leadership had not established expectations or targets for queued call times or thresholds for taking action on queue times. A veteran could be queued for 30 minutes, for example, and that wait time might not be reflected in hold time data; however, the result of the delay is the same, whether the veteran was in a queue or on hold. [They weren’t counting queue times. A bureaucrat will always find a way to look good somehow.]
  • The QM [quality monitoring] staff had not been provided with training in the skills needed to provide leadership to promote quality and safety of care, leading to deficiencies in the QM program.
  • We made seven recommendations in a previously published report, Healthcare Inspection–Veterans Crisis Line Caller Response and Quality Assurance Concerns Canandaigua, New York (Report No. 14-03540-123, February 11, 2016). VHA concurred with the recommendations and agreed to a completion deadline of September 30, 2016. We consider all prior recommendations to remain open as of the publication of this report. [This report’s date is 3/20/2017. Here’s one of the findings from that report: “We substantiated the OSC complainant’s allegations that SSAs [Social Service Assistants] were allowed to coordinate emergency rescue responses independently after the end of a 2-week training period, without supervision, and regardless of performance or final evaluation.”]

Every one of the action items from an IG report in February 2016 was STILL open as of the March 2017 report, over a year later and six months after the initial deadline for taking care of those deficiencies. And we pay these VA big-shots six figures? Go figure!

Press 1, Press 2, Get the ol’ Switcharoo: Post #2

Embed from Getty Images

While I was working for the VA Health Resource Center’s Pharmacy Customer Care call center in Waco (two others are in Topeka, KS, and Black Hills, SD), I spoke to more than a few veterans who were bent out of shape at having gotten me rather than their local VA pharmacy. I can understand why they would feel like victims of a bait and switch operation. Just look at the image below, a screenshot of the telephone directory entry for the Central Texas System pharmacies, with locations in Temple, Waco, and Austin:

Temple Pharmacy 170615

Just looking at the entry would tend to make veterans believe they were about to call the Central Texas VA System pharmacy or at least one of them. The physical location adjacent to the telephone number would lead me to that conclusion. Certainly, I would not suspect I was about to be routed to a call center that takes calls from VA pharmacies up and down the East Coast, Texas, and Louisiana.

My confidence that I was about to get my local pharmacy wouldn’t change when I called the main number (254-778-4811) and just used the menu rather than the extension. (Many vets and their families don’t bother with looking up any numbers in the VA’s online directory. They just call the facility’s main number and work their way through the telephone menu.) If I opted to use the menu, and after getting through all the howdy-doody material always loaded at the front of the interactive voice recordings, the recording would begin offering me menu choices. Temple’s says, “For pharmacy, press 1.” Then, if I press one, the recording says to press 1 to use the auto refill line or “to speak to a pharmacy representative, press 2.” There’s nothing–nothing–that would lead me to believe that I’m about to get a national call center that handles dozens of pharmacies’ calls. Finally, when I press 2, I begin to smell a bait and switch when the PCC recording says, “Thank you for calling the Department of Veterans Affairs Pharmacy Customer Care Center.” That’s still nice and vague, though. Temple’s pharmacy is also part of the Department of Veterans Affairs, and  the moniker “Pharmacy Customer Care” could apply to a local pharmacy just as well as a national one. Some veterans catch on right away and flat-out ask if they’re speaking to a rep from their local pharmacy or to some guy at a call center somewhere. Others don’t catch on for quite a while. I’ve had veterans ask me about it, sounding absolutely surprised when they found out they were talking to a national call center. I’d look at their call histories, however, and see they’d called several, if not many times already, apparently assuming they were talking to their local people. Nope.

Nobody likes being fooled, particularly when they suspect that the place at which they’ve ended up is just a little less capable than their own pharmacies. Considering that PCC cannot make decisions for or commit local pharmacies to any course of action in non-routine situations, those suspicions are correct. PCC is a middle-man, a go-between. For routine requests and medication needs, that’s fine. Things percolate right along, and the certified and licensed professionals at local VA pharmacies can concentrate on other matters rather than routine ones. When situations are not so routine, things can get a little dicey with a middle-man in the way (see the discussion here). Local VA medical centers like Temple should be more explicit when they provide options in their interactive voice recordings, and Pharmacy Customer Care should identify itself as a national call center. Furthermore, PCC should have a streamlined process to get veterans to their local pharmacies on their first call about a non-routine issue anytime veterans request it–even when call center employees would rather not–a streamlined process that both the veteran and contact reps know about and can actually use.

Porn-Watching VA Employee Fuels Congressional Action

Embed from Getty Images

Congress is acting to get rid of guys like this more quickly. The latest atrocity involves a VA employee watching porn while a veteran waited for services. It just keeps getting worse. See the 4/4/2017 Military.com article titled “Porn Viewing VA Employee Highlights Need for Firing Authority.” With any luck, this guy is already gone. And this from the same VA medical center that brought us this last year: “Hundreds of Appointment Wait Times Manipulated at Texas VA Facilities, Watchdog Finds,” Fox News, 6/21/2016. The folks at the Michael DeBakey VA Medical Center must be very proud.

 

Want “Everything” Refilled?

Indisputably, the VA Health Resource Center’s business line Pharmacy Customer Care, PCC, a call center that answers the phones for a bunch of VA pharmacies, can be a good deal for veterans and their family members calling for medication. Talking to a person is generally a whole easier than dealing with, for example, an automated refill line that makes you punch in presciptions numbers for the meds you need. You just tell a person that you want your Atenolol and Simvastatin and–PRESTO!!! With PCC contact reps’ being timed, however, it can get a little tricky if you get a contact rep more concerned about his time than the veterans whose calls he’s answering. Sadly enough, you’re likely to run into one sooner or later since not only contact reps’ bonuses but their jobs also depend on their average handle times. You can take charge of the call, however, and make sure you get the service you earned.

Embed from Getty Images

To be sure, the PCC contact representative is going to answer the phone and start driving the conversation. They’re going to get the information they need to look up your files, figure out what you need, and get you off the phone as quickly as possible in most instances. That’s not necessarily a bad thing because you probably don’t want to stay on the line chatting with someone you don’t particularly know anyhow, and lots of other vets are waiting in queue for their turns. A contact rep simply concerned about helping you quickly but still helping you fully before going on to the next caller will likely do a fine job for you and what you’re calling about. It’s the contact rep who’s trying to protect his average handle time at your expense that you have to watch out for.

If all you’re calling about is a couple of meds, you simply tell the contact rep you need those two meds and let him go to work for you. He will tell you if it has refills, if it needs to be renewed, or if some other action needs to be taken like being removed from a “hold” status. No sweat. Let’s say, though, you’ve got a bunch of medications, and you want them all taken care of, every one of them, so you’ll get them in the mail in a week or week and a half or so. MAKE SURE your contact rep (1) refills all active medications that have a refill, and then (2) takes renewal action for anything that didn’t refill, whether that medication has expired or just run out of refills. Either way, your VA doctor will have to write new prescriptions for you. (Some pharmacies require PCC to transfer callers to their VAMC primary care team, a renewal line, or the VAMC’s own call center when they need a new prescription.) Don’t let your contact rep just say, “OK, I’ve refilled everything.” Make him call out each and every medication that he refilled, and THEN tell you each and every medication that did not refill and needs renewal action so you can tell him the meds for which you want him to ask the doctor to write a new prescription. It’s a two-step process: first, refills and, second, renewals. If the contact rep is overly worried about his average handle time, you’re likely to hear an ever-so-subtle change in his tone of voice, but you just hang right in there and make him do his job. Good contact reps won’t mind a bit. Who cares what the bad ones think, eh?

 

What? Didn’t Know?

Embed from Getty Images

I was doing some research not long ago and ran across an article that’s over a year old, but it said something that piqued my interest. The March 4, 2016, USA Today article was titled “New VA Hotline Chief Has a History of Dropped Calls from Veterans.” The article discusses, among other things, the abysmal abandonment rate, when callers get tired of waiting on someone to answer and just hang up, for the VA’s suicide hotline. The thrust of the article is that the guy selected to run the hotline, Matt Eitutis, didn’t have such a great abandonment rate while he was running the Health Resource Center. In fact, the HRC in 2015 had an abandonment rate of 26%. That’s waaaaay above acceptable standards for call centers. Accordingly, people were questioning Eitutis’s selection to run the hotline. Here’s that interesting excerpt:

“It shows that Mr. Eitutis’ office has a history of dropping calls from veterans,” said Davis, who works in the VA’s national enrollment center, which falls under Member Services. “I don’t know how someone can look at the performance of that operation and say, ‘This is a guy we should give a promotion to.'”

 

But Gibson, who did not dispute the accuracy of the data, said that before Eitutis was placed in charge of the Health Resource Center and its phone banks, the VA wasn’t even sure how many calls it was missing.

Of course, the first paragraph of the quoted text above deals with the complaint. The second paragraph is the Deputy Secretary for the Department of Veterans Affairs Sloan Gibson’s defense of his choice of Eitutis–at least part of his defense, and the only part I’m really interested in. Please allow me to repeat that part: “[B]efore Eitutis was placed in charge of the Health Resource Center and its phone banks, the VA wasn’t even sure how many calls it was missing.

Whoa! Not sure? Really? As my regular readers may be aware, I was formerly an employee of one of the Health  Resource Center’s business lines, Pharmacy Customer Care, a call center operation that takes the calls for pharmacies at dozens of VA medical centers along the East Coast, Louisiana, and Texas. It establishes an official relationship with these VAMCs via a memorandum of understanding. These MOUs specify that Pharmacy Customer Care will meet certain minimum performance standards, and, I do believe, the abandonment rate was one of them. I’m going to get my hands on one of those MOUs and see what that threshold was, assuming it was one of the criteria. If Deputy Secretary Sloan was right, then the Health Resource Center and, by extension, Pharmacy Customer Care, didn’t know what its abandonment rate was until Eitutis got there and made some changes. The 2016 article said he’d been running the Health Resource Center for the past two years, so that would mean that no one knew the abandonment rate until sometime in 2014, possibly later. If the abandonment rate wasn’t in the MOU criteria prior to Eitutis’s arrival, OK.  If it was in the criteria then, what abandonment rate was the HRC telling client VAMCs? According to Sloan, they didn’t even know what it was.

Muy interesante, eh?

 

 

 

So You’re out of an Important Medication?

Embed from Getty Images

So you’ve lost your medication or otherwise run out or almost run out (i.e., have less than a 4-day supply), need to get more quickly, and you’re enrolled at one of the VA medical centers (see the sidebar after clicking on the “READ MORE” link below if you’re still on the main page) that have contracted with Pharmacy Customer Care, PCC, to answer their pharmacies’ calls.  The first thing you need to realize is that PCC does NOT want you calling your VA pharmacy directly. Nope. No way. (Exception: VAMC Big Spring patients. Big Spring demands that PCC put its patients through to the pharmacy when they want to speak with pharmacy staff.) Apparently, your VA pharmacy doesn’t want you calling it directly either because it contracted with PCC to answer its calls. So here you are without your medication, and you’ve probably got to deal with a call center, an entity that doesn’t stock a single medication, not even aspirin.

Maybe you can just short-circuit the whole problem and just go to your pharmacy and let the staff there know what’s going on, although I hear there are a few VA medical center pharmacies out there that are trying to tell veterans they can’t just appear and get service. If you try going in and that happens, you should write a whole bunch of people, starting with that VA medical center’s director, your congress representative and senators, and maybe even the VA Inspector General. A letter to the editor addressed to your local paper wouldn’t hurt anything either. Shine the light nice and bright! Most VA pharmacies let you walk in and let ’em know what’s up, though. Good on them. The people staffing those pharmacies still remember whom they serve.

If driving over to the pharmacy is not an option, and your VAMC contracts with PCC, then you’re no doubt going to have to deal with a call center and its time-consuming processes. When you call, you’re likely to be put on hold automatically until a contact rep can get to you. Stay on the line. You’ve got to get some help. (Mondays and days after holidays are really bad times to call. You’re likely to wait a while, but if you need your medication. . . .) When a contact rep finally answers, you’ll hear something along these lines: “Welcome to Pharmacy Customer Care. My name is Johnny. Am I speaking to the veteran?” Say you are the veteran, or, if not, say who you are and your relationship to the veteran, and then before going on, get that contact rep’s name and write it down if you didn’t get it when Johnny answered the phone. That greeting sometimes comes out rapid-fire.  (Always have a pen and paper handy when you call, by the way.) People are just a little more responsive when you’ve gotten their names. Your PCC contact rep is going to ask for more information from you (full name, full Social Security number or VA member ID, date of birth, and the VA facility in which you’re enrolled–which usually comes out “which VA do you get your meds from” or something close to it). Once ol’ Johnny gets you pulled up in his system, he’ll want you to tell him what you need. Right off the bat, let him know you’re out of medication, which one it is, and why you’re out: you lost it; you forgot to order it on time; your doctor told you take more than the instructions say; it was stolen, you ordered it, but it never came in the mail, etc.

The PCC contact rep’s action will depend on which VA you’re enrolled at, which medication you’re out of, and why you’re out. Normally, they’ll send what’s called an emergency refill referral. Some VA medical centers, notably San Antonio, Bay Pines, and Gainesville, as of when I left last week, don’t recognize PCC’s emergency refill alerts and your only option is to go to the pharmacy. Good luck trying to call San Antonio’s, Bay Pines’s or Gainesville’s pharmacy to discuss the situation with the pharmacy staff, however, because PCC is taking their calls now, and PCC contact reps don’t have pharmacies’ numbers precisely because management doesn’t want you getting through to your own pharmacy. Maybe–maybe–the VAMC’s operator will put you through, but maybe not. Some have been trained NOT to put veterans through to local VA pharmacies and shoot callers over to PCC instead. PCC puts veterans from these VAMCs in a tight spot. PCC can’t send a referral because these three VA’s have opted out of the emergency refill process, these veterans can’t call their pharmacies, and PCC contact reps can’t transfer them to their pharmacies because they don’t have the number, either, since management withholds it from them.  In an ideal world, they can go to their pharmacies, but the problem is that this isn’t an ideal world. Some veterans are so disabled that they can’t leave the house. Some don’t have transportation. Some live so far away it’s just impractical. Elderly veterans have their own set of problems. Some people just can’t make it to the pharmacy. What to do? Well, if it’s something important enough and they’re getting sick, there’s always the emergency call, 9-1-1. They can also show up at an emergency room somewhere, but they may have to pay for their costly visit. Some veterans on fixed incomes don’t have that option, either. Not too long ago, I complained to PCC management and the VA inspector general about PCC’s cutting vets off from their pharmacies, and management countered that lead contact representatives, supervisors of a sort, could always put veterans through to their pharmacies. Oh, really? I worked there 5 years and never saw that in response to a first call from a veteran; however, if you find yourself cut off from your pharmacy and the contact rep can’t send a referral, demand to speak to a supervisor. That’ll get you a lead contact rep. Hold PCC bureaucrats to their claim and demand that the lead contact rep, the supervisor, transfer you into your pharmacy and see if it gets you anywhere. I hope it does. Truly. You didn’t serve your country only to be stymied by a layer of bureaucracy.

Which med you’re out of is also important. PCC contact reps have two lists of meds that they’re not supposed to send a referral for. One list has non-critical or over-the-counter items like aspirin, diapers, Omeprazole, and others. The other list has all the narcotics and controlled medications. If you’re out of one of those medications, PCC contact reps will order your refill or take action for a renewal (a new prescription needed because the med has expired or is out of refills), but you’re going to get stuck waiting.

Even why you’re out will affect how contact reps respond to your cry for help. If you’ve been taking more than the instructions call for, whether you did that on your own or because the doctor told you to start taking more, your contact rep is going to transfer you to your primary care team–period. No referral. I guess if you’ve been taking more medication than the instructions say to take, then the doctor needs to know about it. If the doctor told you to take more, then the good doc needs to write you a new prescription so you don’t run out early with every refill.  One way as the other, your PCC contact rep has to consider a bunch of factors before taking action.

Now, if your situation clears all the hurdles and ol’ Johnny, the contact rep, can actually send an emergency refill referral, he should verify your telephone number because the referral asks your pharmacy to call you and discuss the situation. That’s the good news. The bad news is that your pharmacy has one full business day to call and sometimes doesn’t call then. One full business day works out to be 24 hours Monday through Thursday, but if you call on a Friday, you may have to wait until sometime on Monday for that call. Heaven help you if it’s a long weekend. If you don’t get a call within one business day, call PCC again and ask whoever answers the phone (there’s a couple of hundred reps or more, so getting the original Johnny again is a long shot) what the pharmacy said in response to the referral Johnny sent because pharmacies answer PCC in writing. PCC doesn’t monitor referrals for timely responses, however; YOU must call back if no one from your pharmacy calls you. If the pharmacy responded, Johnny II, the guy you’re talking to on your second call, will tell you what it said and should check, as applicable, to make sure any action is reflected in his computerized system, currently VistA. If the action is reflected, great. Game over, assuming you’re happy with what the pharmacy is doing. If the action isn’t reflected in VistA, little Johnny II should offer to escalate your referral; that is, raise the priority to URGENT and send another referral. Then you get to go through the one full business day wait again, and if no one from the pharmacy calls you again, then you call back PCC again. Johnny III, the guy taking your third call, will check to see if the pharmacy responded and if VistA reflects appropriate action. If it doesn’t, tell Johnny III that you want your situation escalated yet again. This time, with you holding on the line, Johnny III will contact a lead contact rep, routinely called a “senior,” who will tell Johnny III what to do from there. Sometimes, the lead contact rep wants you transferred over to her; sometimes, she says she’ll make some calls and send an e-mail or two and call you herself when the situation is resolved; sometimes, she tells Johnny III to transfer you over to your primary care team or something along those lines. If the pharmacy is unresponsive, and you have to go through the whole escalation rigmarole, things could take around 3 days, give or take, assuming no weekend or long weekend is involved, and you call back on the stroke of exactly one business day later, and that’s just to find out what the pharmacy is going to do. It’ll take more time to actually DO something, as well. You could be awhile getting your medication. Of course, most callers don’t have to go through part or all of the escalation process. (Callers from some VA medical centers are a lot luckier than others.) If the pharmacy actually calls you in response to the very first referral, that pharmacy rep could tell you to come in and get some more medication right then, and, assuming you can actually come in, you’ll have your medication that afternoon. They could also decide to stick it in the mail, and your fate rests with the postman and where they mail it from, the pharmacy or a CMOP (Central Mail-Out Processing center).

If you run out of medication for whatever reason, and you’re not in a huge, gotta-have-it-right-now hurry, call the PCC. You’ll eventually get what you need and probably a little faster than you would otherwise. If you have the option to go in, and it’s absolutely critical, I’d go to the pharmacy and let someone at the VAMC know what’s going on.

Timing Calls & Minute Mischief

Embed from Getty Images

Probably the biggest factor in dealing with PCC call center people is realizing that they are being timed relentlessly via their telephony system, AVAYA. Even if they get up to use the bathroom, they are timed. Relentlessly. That profoundly affects how you and other veterans are treated on calls. As soon as a call comes in, AVAYA displays how long that call is taking to the contact rep. If the contact rep has to transfer a caller to a primary care team (remember, contact reps don’t have pharmacy numbers) to, say, make an appointment, AVAYA times how long the caller is on hold. Once the contact rep gets the caller over to someone who can make the appointment, AVAYA times how long it takes for the contact rep to finish any other action, like an electronic notification, called a referral, done after the call. Only after all documentation is complete, which may be as simple as completing the service request, which merely documents the fact that a call was made, is the contact rep able to select the option on AVAYA signaling she’s ready for the next call, and it all begins again. Of course, there’s no blame to attach to AVAYA; it’s just a yardstick. Management sets the requirements contact reps must measure up to. It kind of reminds me of my second-grade teacher’s yardstick. Just like management uses AVAYA, she’d measure things with it. Much like management uses AVAYA, once in a while, she’d hit me with it, too.

When I left last week, a 5-minute and 28 second average handle time was the key to getting an end-of-year bonus or not getting one: 5:28. Contact reps have to be rated exceptional to get a bonus, and to be rated exceptional, they have to be under 5:28. If they’re at or over that mark but below about 6:30 or so, then they’re merely “fully successful,” and lose out on their bonus. If they talk more than a time hovering around (I forget exactly, so I could be off by several seconds but not much) 6 minutes and 30 seconds, they can forget their bonuses, are rated unsuccessful, and could lose their jobs if they keep it up for a while. Oh, they get rated on other aspects of performance, too, like making a mistake on a monitored call or getting an electronic referral to a pharmacy kicked back (called a rework), but the really difficult bar to clear is average handle time. Contact reps, whether they’ll admit it or not, think about how long calls are taking all day long, whether they are simply trying to stay employed or stay eligible for the annual bonus. (It’s not a lot: around $700, give or take, for a kid slugging it out in the call center trenches. Still, that kid in the trenches doesn’t make a lot. $700 is a lot of money.) That average handle time drives a lot of behavior, some of it not so good.

On the upside, PCC’s relentless measuring of contact rep performance ensures that you’re going to get on and off the phone pretty doggone quickly, all things being equal. When you call, your contact rep isn’t going to waste much time discussing the Super Bowl with you. She’s going to get your information, get what you need, and get off the phone fast. That’s fine as long as what you’re after is fairly routine and conducive to this type of treatment. If you just need a couple of refills, maybe a renewal if something has expired, or you need to know if that doctor finally wrote that new prescription, you’re in good shape. Contact reps will give you that info, thank you for the call, and move on to the next one. You’re happy because you got what you needed, and the contact rep is happy because she had a call that will contribute to a good average handle time.

On the downside, if you’re calling about something that will take 6 or 7 minutes or more (Heaven help you both), you’ll have to hope that you’ve got yourself a competent, relatively secure contact rep who’s not overly concerned about her average handle time. Everybody gets these long calls (20 minutes, anyone?), and secure, confident contact reps depend on the law of averages to keep them on the path to their bonuses. Heck, I once got a call that took close to an hour after wrap-up time after the call was factored in. Then there are the contact reps who will cut corners to keep their times low. Let’s go through a few scenarios.

Scenario 1: A veteran’s son calls and wants to know if his father’s blood pressure medication, his Metoprolol or Lisinopril, has been mailed yet. The son is NOT on the VA contact list, a list of people to whom contact reps can talk about the specifics of information in the veteran’s files. Good contact rep: Asks if the veteran is present, asks the veteran some security questions, gets permission to (1) speak to the son about what’s in his records, and (2) add the son to the list of VA contacts so the next time he calls, the PCC rep can speak to him freely. Contact rep concerned about time: Asks if the veteran is present and gets permission to speak to the son. This contact rep won’t bother with adding anyone to the VA contact list. It will lengthen the call significantly. The next time the son calls, he’ll go through the same thing until he gets a contact rep that will do his job.

Scenario 2: A veteran calls up and wants the contact rep to “refill everything.” Many callers don’t know the difference between a refill, usually every prescription has several loaded, and a renewal, when the med expires or is out of refills, and it’s time for the doc to write a new prescription for the same med. Good contact rep action: A good contact rep will do things in two stages. First, she’ll refill everything that has a refill. Second, she’ll go over the medications that didn’t refill, because they’re expired or out of refills, with the caller and offer to take action, whether she can request them herself or has to transfer the caller to a renewal line. (Pittsburgh, White River, West Palm Beach, Dallas, Albany, Manchester, Northampton, and San Antonio all require a transfer to a renewal line.) Contact rep concerned about time: This guy will refill everything with a refill and tell the veteran that he’s done, never mentioning the ones that didn’t refill. The veteran will figure everything is, indeed, taken care of and get frustrated, eventually, when some of his meds never arrive and has to call back. Meanwhile, that contact rep saved a bunch of time because renewals, asking that a new prescription be written, can be time-consuming if the VA medical center doesn’t require a transfer so its people can do it themselves.

Scenario 3: A veteran with a severe mental problem (e.g., onset dementia, severe anxiety, PTSD, traumatic brain injury) calls about anything. Contact reps will likely not be aware of the specific circumstances for each caller. Good contact rep action: asks at the end of the call if the veteran needs anything else, sometimes even suggesting an action or two, aware that some callers need a little help or at least the extra few seconds to think about what they need. Contact rep concerned about time: He’ll do exactly what the veteran asked for and no more, even when he sees a problem, thank the veteran, and hang up. The veteran will have to call back once something else occurs to her.

Average handle time drives a bunch of behavior, and management passively abides this behavior. They love their statistics. You need to be aware of this and insist–insist–that you get everything you need with each call. If you think that a contact rep is in a race with the clock and you’re the one losing the race, ask to speak to a supervisor. Mounting minutes can add mounting mischief to a call.