If You Think VA Wait Times Are Long, Try the Private Sector

BATTLE FOR VETERANS HEALTHCARE SG COVER (1)New blog post from The American Prospect

Congress Determined To Keep Private Sector In Vets’ Heath Care

Lawmakers on Capitol Hill mulling legislation to extend a program that lets veterans seek health care in the private sector have revived their longstanding complaints about long wait times for care at the Veterans Health Administration facilities. Veterans Affairs Secretary David Shulkin and Dr. Baligh Yehia, the agency’s assistant under secretary, appeared before the House Committee on Veterans Affairs to testify on HR  369, a bill that would allow the Veterans Access, Choice, and Accountability Act to continue past its sunset date of August 2017.

In 2014, after revelations of wait-time problems at some Veterans Health Administration (VHA) facilities, Congress created the three-year Choice program allowing eligible veterans to seek care in the private sector if they live 40 miles from a VHA facility or have to wait for more than 30 days for an appointment. The bill would let the VHA spend what remains of the initial $10 billion (about $1 billion) allocated to Choice on care in the private sector. READ MORE

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New Blogpost on VHA Performance

The American Prospect just posted this on their blog.

Report: VA Outperforms Private Sector on Key Measures

(Photo: AP/Molly Riley)

Witnesses from the Department of Veterans Affairs testify on Capitol Hill this month.

A little-noticed recent report by three leading research groups found that on critical measures, the Veterans Health Administration (VHA) consistently performs as well as and often better than private sector health-care providers. The VHA does this with patients who are sicker, older, and poorer than many of their counterparts seen in the private sector.

Among the key findings of the report, conducted by the consulting firm Grant, Thornton & McKinsey Company and by two nonprofit research companies—the RAND Corp and the MITRE Corporation—were that:

•   Postoperative morbidity was lower for VA patients compared with non-veterans receiving non-VA care.

•   Inpatient care was more or as effective in VA as in non-VA hospitals.

•   VA hospitals were more likely to follow best practices in the use of central venous catheter line infection prevention and rates of mortality declined more quickly in VA over time than in non-VA settings for specific conditions.

The report also found that veterans in nursing homes were less likely to develop pressure ulcers; that outpatients and those suffering chronic conditions got better follow-up care, and that VA health providers offered better mental health and obesity counseling and blood pressure control, particularly for African Americans. Importantly, income and educational disparities were smaller at VHA facilities in such areas as diabetes, heart disease, and cancer screenings.

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The report confirmed what many fighting for what is known as “right care”—defined as avoiding toxic, unnecessary tests, medications, and procedures—have long understood: that the VHA, contrary to its status as a GOP and media whipping boy, has been a pioneer in providing clinically appropriate care to veterans.

Elderly patients in the VHA were less likely to receive the kinds of medications that can make them sicker and sometimes even kill them, the report found. VHA patients were more likely to be spared toxic chemotherapy within 14 days of death or be admitted to an ICU 30 days before death. This was attributed to the VHA’s commitment to palliative and hospice care.

Health care quality expert Charlene Harrington, a professor emeritus the University of California at San Francisco, called the report “really impressive, particularly given the patient mix and chronic underfunding.”

The findings of the 600-page report, released in volumes one and two, might come as a surprise to the VHA’s many critics on and off Capitol Hill, including the news media. Media coverage of the VHA has focused on the negative, with little reporting on successful VHA programs. A recent USA Today cover story on performance bonuses for over 150,000 VHA employees, for example, glossed over the bigger picture and cherry picked findings of poor performance by a handful of senior executives. A follow-up editorial called for an end to all all bonuses at the VHA.

Republican members of Congress determined to privatize the VHA have similarly ignored its actual overall performance. At a November 18 hearing, House Committee on Veteran’s Affairs Chairman Chairman Jeff Miller, a Republican from Florida, declared that the VHA’s future success would not depend on continuing a record of significant accomplishment, but on “non VA providers.” Indeed Miller warned of “difficult conversations” ahead about “the purpose of the VA health-care system and what it should and feasibly can achieve.”

To be sure, the report also details a number of  ways the VHA can improve—remedying chronic shortages of primary care and specialist physicians in some areas of the country; dealing with lack of space in older VHA facilities, and repairing an aging information-technology architecture.

The report also points to variation in treatment and quality in a system that has more than 150 hospitals and almost 1,000 community outpatient clinics. Here, however, it offers an important caveat: Variation in the private sector is sometimes even more pronounced. On some measures of care recommended to achieve clinical targets, the report found that “commercial HMOs, Medicare HMOs, and Medicaid HMOs all exhibited much more variability than the VA facilities” on this measure.

Despite recent public criticism of the VA for long patient wait times, the study found the VA is actually performing well on this measure. To wit: “VA’s reported wait times for new patient primary and specialty care are shorter than wait times reported in focused studies in the private sector.” For those who live in rural areas short on VA facilities, the report added that  “expanding access to non-VA providers may help with routine or emergency room care, but not with advanced or specialized care.” Nor would veterans living in these areas have better access to teaching or academic facilities.

Significantly, most of the clinical research studies summarized in the report were conducted before Congress allocated additional funds last year to hire more doctors and nurses and other staff, thereby improving access to and quality of VHA care. In other words, there was a legitimate basis for many VHA employees getting 2014 bonuses for their individual contributions to overall institutional performance so favorably rated. Unfortunately, the VHA’s better-than-average standard of care has received little notice in the news media and Capitol Hill.

New Post on VHA and GM with more stuff

This just appeared in Beyond Chron

Public vs. Private Sector Accountability at VA, GM

by Suzanne Gordon

marry-Eric

If anyone thinks that the private sector can serve the needs of the public with more efficiency, effectiveness, and accountability better than public sector programs, they should contrast two stories of mistakes made, acknowledged and corrected  that have dominated the news over the past month.  One is the story of wait times at the Department of Veterans Health Administration  and the other is the deaths that were the result of a faulty switches and airbags in GM’s  Cobalt. There is perhaps no better recent example of the double standard with which our country deals with accountability in  the private and public sectors than the reaction to these two recent reports.

Over a month ago, a whistleblower  exposed the fact  that the Veterans Health Administration had secret lists that disguised the amount of time veterans had to wait for first appointments in VHA facilities in Phoenix, Arizona first broke.  Veterans who were supposed to be seen for an appointment 14 days after they called for one were waiting far longer.  Allegations that 40 veterans had died because of the wait times were also made.  Congressional Republicans – who have long wanted to privatize the VHA delivery of services to 8,000,000 of the nation’s vets — leaped on the story as an example of the dangers of public sector callousness and bureaucracy. Within less than a week, the Veterans Health Administration had initiated a rigorous investigation into the allegations, confirmed the wrong-doing, identified even more facilities that had longer than hoped for wait times, and two weeks after than delivered a preliminary report detailing the problem.  After another week, at the behest of Republican critics the Secretary of Veterans Affairs, Eric Shineki submitted his resignation, and a bill – brokered by Senators Bernie Sanders (I,VT) and  Senator John McCain (R-AZ) to take steps to assure that the issue of wait times was addressed. Continue reading