Va Healthcare Outscores Private Sector

[Gimpy]

VA HEALTHCARE OUTSCORES PRIVATE SECTOR, AGAIN! --

CUSTOMER SATISFACTION SURVEY RANKS VA AT THE TOP -- THE CARE IS GREAT, WHEN YOU CAN GET IT, IF YOU CAN GET IT!

Once again the VA has outscored private healthcare providers in a customer satisfaction survey.

This is not surprising. The VA has some of the best and most dedicated medical staff anywhere!

Now...if we can only just get Congress & the Whitehouse to fulfill their obligation to FULLY FUND the VA Health Care System so we can remove all of those vets off the waiting lists so they can experience this great care.

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Veterans? Health Care Outscores Private Sector ? Again
January 18, 2006

WASHINGTON ? Veterans continue to be more satisfied with their health care than the average American, according to an annual report on customer satisfaction that compares the Department of Veterans Affairs (VA) health care system with private-sector health care.

The ratings came in the annual American Customer Satisfaction Index (ACSI), which ranks "customer satisfaction" with various federal programs and private-sector industries.

"Although VA has received many wonderful endorsements recently, the support of our veterans ? the people who know us best ? is the highest praise," said the Honorable R. James Nicholson, Secretary of Veterans Affairs. "This is a testament to the hard work of VA employees."

The ACSI, an independent survey of customer satisfaction within both the federal and private sectors, gave VA's inpatient care a rating of 83 on a 100-point scale. That's 10 percentage points higher than the 73 rating achieved for inpatient care by the private-sector health care industry.

VA's rating of 80 for outpatient care was five percentage points higher than the 75 rating for private-sector outpatient care and nine percentage points higher than the average satisfaction rating for all federal services.

The latest findings mark the sixth consecutive year VA?s health care system has outranked the private sector for customer satisfaction.

"VA provides world-class health care for our veterans," said Dr. Jonathan B. Perlin, VA's Under Secretary for Health. "The ACSI ratings confirm that our veterans recognize the dedicated service of VA's health care professionals."

Since 1994, the ACSI survey has been a national measurement of customer satisfaction with the quality of goods and services in the United States. ACSI produces indices of satisfaction for seven economic sectors, 41 industries, 200 private-sector companies and two types of local government services.

VA?s strong showing came after interviews with veterans who have recently used the Department?s services. The report is the product of the National Quality Research Center at the University of Michigan Business School, the CFI group, and the Federal Consulting Group.

Health care is just one of many potential benefits available to those who served in our nation?s armed forces. If you served, or know someone who did, check on eligibility for benefits and services from VA at: www.va.gov or call 1-800-827-1000.

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[BLUEHAWK]

Might one here detect some POSITIVE health care news from the VA? :yikes:

[Packo]

You know Gimp, it shore nuff be a luck of the draw. I was just reading an article where Duke University Hospital....known in the South for being of the highest petigree.....is getting it's ass sued for using hydraulic fluid to clean all the surgical instruments. Made many a patient sick. Surgeons where complaining that the instruments were a bit slippery....but the Duke officals poo-pooed it. Now turns out that drained hydraulic fluid was placed in empty instument cleaning containers that found their way to the operatin' room. Now being a TarHeel Grad....this don't surprise me, but even the finest of institutions don't guarentee perfection. I've been to some VA facilities that were top notch and some that were beyond nightmares. Same same civilian world. It's good to see the article you have posted. Don't think anyone who voted "good" ever went to Charleston SC VAMC.

Pack

[SuperScout]

The same surveyors should pay a visit to the Audie Murphy Hospital in San Antonio. Or better yet, maybe we can ask Audie himself to come back and haunt that place until it shapes up. I'd rather be treated in Piedras Negras Hospital, across the Rio Grande from Eagle Pass, TX.

[Gimpy]

During the last eight years, the VA has put its health care facilities under 21 nationwide networks, which provide more medical services to more veterans and family members than at any time during the VA?s long history.

The VA has also experienced unprecedented growth in the medical system workload over the past few years. The number of patients treated increased by 25 percent from 3.8 million in 2000 to more than 5 million in 2004. It's the 'funding' that hasn't kept pace with these increases in patient workloads.

And, the VA?s health care system now includes 157 medical centers, with at least one in each state, Puerto Rico and the District of Columbia. The VA operates more than 1,300 sites for health care including 862 ambulatory care and community-based outpatient clinics, 134 nursing homes, 42 residential rehabilitation treatment programs, 207 Veterans Centers and 88 comprehensive home-care programs. These VA health care facilities provide a broad spectrum of medical, surgical and rehabilitative care.

More than 5 million people received care in VA health care facilities in 2004. By the end of fiscal year 2004, 78 percent of all disabled and low-income veterans had enrolled with the VA for health care; 65 percent of them were treated by VA. In 2004, VA inpatient facilities treated 587,000 patients. The VA?s outpatient clinics registered nearly 54 million visits.

Now don't get me wrong, I realize that any 'system' this large and complex as the VA will certainly have isolated incidents where certain areas of their programs and/or personnel will be involved with inadequate, inappropriate or deficient care & treatment. Hell, the 'private' sector is rampant with heath care providers and hospitals or clinics that regularly fall into the category that 'fails' it's patients in many cases more frequent and if not worse than does the VA.

Which clearly indicates (to ME, and many, many experts in the field as well) that we should NOT abandon the VA system of proven heath care improvements and quality medical treatment for a 'private' care system that is copiously abounding and rife with increasing degrees of not only inefficient care, but also ill prepared and of less quality than the VAs'???

[SuperScout]

If more than 5 million veterans received care at the various VA facilities in 2004, at what cost, and then at what cost per patient? How does this cost/patient compare to the costs in the private sector? And 587,000 inpatient cases? Nationwide? I would think that a major metropolitan hospital would do at least 10% of that number, and probably at a much lower cost per patient.

What does it mean if the VA has "put its health care facilities under 21 nationwide networks, which provide more medical services to more veterans and family members than at any time during the VA?s long history." If my assumption is correct, there is a public-private sector partnership working, and if so, how does that make the VA outrank the private sector? Competing with oneself is not much of a race.

[billyguns]

So far this week I have dealt with private sector medical care as well as the VA. Both were confused and in my opinion terribly inefficient. However, in the end I did receive the medical care needed. I suppose that"s business as usual these days. And who knows, Maybe it just could be me?!?! BTW, my mail was late 3 times this week and my dog is pissed at me. Thanks for reading this meaningless post.

[Gimpy]

Originally posted by SuperScout If more than 5 million veterans received care at the various VA facilities in 2004, at what cost, and then at what cost per patient? How does this cost/patient compare to the costs in the private sector? And 587,000 inpatient cases? Nationwide? I would think that a major metropolitan hospital would do at least 10% of that number, and probably at a much lower cost per patient.

You can THINK all you want, where's YOUR 'evidence' to back it up??.....Gimp

What does it mean if the VA has "put its health care facilities under 21 nationwide networks, which provide more medical services to more veterans and family members than at any time during the VA?s long history." If my assumption is correct, there is a public-private sector partnership working, and if so, how does that make the VA outrank the private sector? Competing with oneself is not much of a race.

Well, once again, your "assumption" is WRONG!..........Gimp

Why don't YOU look it up for yourself if you're really so all-fired interested in REALLY attempting to offer anything other than criticism and condemnation all the time??

I got better things to do than to continue showing you where you are WRONG most of the time, ya know???........

But, hardheaded as I am, I will again try and 'educate' you even more in an attempt to further your ongoing accumulation of knowledge regarding the subject matter........... :re:

Did you even READ the article?

Why does it appear you're so adamantly opposed to recognize the facts that the VAs' health care system has become such a success story and worthy of our praise rather than what seems to be an attempt on your part to continually undermine and condemn it???

The article above CLEARLY states HOW this 'comparison' was made. The VA is NOT 'comparing' itself WITH itself. Nor is it evaluating itself. It is being done by one of the most reputable and noteworthy organizations in business to do just what it has, conduct investigations and surveys designed to compare various competeing services & industry.

And I quote, "Veterans continue to be more satisfied with their health care than the average American, according to an annual report on customer satisfaction that compares the Department of Veterans Affairs (VA) health care system with private-sector health care ."


"The ratings came in the annual American Customer Satisfaction Index (ACSI), which ranks "customer satisfaction" with various federal programs and private-sector industries."


"The ACSI, an independent survey of customer satisfaction within both the federal and private sectors, gave VA's inpatient care a rating of 83 on a 100-point scale. That's 10 percentage points higher than the 73 rating achieved for inpatient care by the private-sector health care industry ."


"Since 1994, the ACSI survey has been a national measurement of customer satisfaction with the quality of goods and services in the United States. ACSI produces indices of satisfaction for seven economic sectors, 41 industries, 200 private-sector companies and two types of local government services."


Since 1995, the VA and the Federal Inspector Generals Office reports that the number of patients it is treating has MORE than doubled, to about 5.2 million. During this time, these same reports state that it has trimmed its staff by about 12,000 people, opened hundreds of outpatient clinics and shifted its focus to primary care, while cutting costs per patient by about half.

"If we've proved anything . . . in the last 10 years, it is that quality is less expensive ," said Jonathan B. Perlin, the acting VA undersecretary for health.

Like I've posted on this forum before (back in August 2004), the VA's metamorphosis began in the early 1990s during the Clinton administration, when it was under attack and worried about its future. The Clinton Administration turned to Dr. Kenneth W. Kizer. A physician and former Naval Reserve officer, Kizer had earned kudos for helping restructure health services for the state of California.

Kizer was looking for a new challenge, and he certainly found one at the VA! Over the next five years as Under Secretary for VA Health Care, he and his team of aides reorganized the VA's unwieldy network of 172-plus hospitals and 132 nursing homes into 21 self-contained systems responsible for providing all patient care. The VA also shifted many specialists to its new outpatient clinics.

At the same time, the department invested heavily in computers and software. They link distant clinics to urban teaching facilities and allow VA physicians to access patient records wherever they happen to be.


These days, computers are used to measure everything at VA sites with an aim toward improving care.


Just one example............In 1990, before the Baltimore VA hospital & clinics began tracking its performance, their rates of screening for breast and cervical cancer were 50 percent and 17 percent, respectively. In 2003, they were 88 percent and 87 percent. "The computers are an effective way of driving performance," an official at the VAHC said.


By contrast, private physicians in Medicare's sprawling fee-for-service system receive little feedback from the huge federal insurance program and lag behind VA doctors on numerous quality indicators, according to half a dozen recent studies by VA and private as well as academic researchers.


Medicare officials point out that the VA has the advantage of being an integrated delivery system - - that is, a health plan in which most of the doctors are salaried employees and all care is coordinated and tracked . In Medicare, physicians work for themselves and patients are free to pick and choose their services.

Much of the increased demand from veterans for their health care services predates the current influx of Afghanistan and Iraq War veterans, and appears to coincide with the department's new reputation for quality.

A large part of that shift is the result of the investment in computers. The 75,000 physicians who are full-time, salaried doctors or affiliated with the Veterans Health Administration have access to a detailed electronic record of every patient. It includes every visit, prescription, surgery and test a patient receives. Doctors can call up prior visits, enter blood pressures and blood sugar levels, access the latest research, and tap into treatment guidelines -- all with the click of a mouse.

If a patients moves -- say, from Baltimore to San Francisco -- their record follows. If a physician in the VA's Pocomoke City, Md., outpatient clinic wants to check how his patient is faring after surgery in Baltimore, he can read the notes online. In the past, only one doctor could access a chart at a time. Now anyone can, at any time.

Industry surveys estimate that it costs the VA about $78 per patient per year to operate their electronic health record. "Roughly the equivalent of not repeating one blood test in the private sector."

I hope this information has answered at least SOME of the questions you may have regarding the subject matter. Now, will you at LEAST try and stop 'undermining' and 'berating' a system that is HELPING sick & disabled veterans a GREAT deal more than you'd like to admit???

[SuperScout]

Unwind your panties that are wadded up so tightly, and simply answer the questions, valid ones I might add, without resorting to exponential bile discharges. What does it mean if the VA is networking with other providers? Who are the networks, and are they competing with or cooperating with, the VA? Does this mean that the VA can't/won't/hasn't provided the care that veterans need, or is it more efficient to work with these networks? It's really a simply question, so try not to let it confuse you.

If the VA can treat patients at a lower cost per patient than the private sector, then whoopee, yahoo, and hotdangidy doo. It will be the first time that the private sector has been bested by a government monopoly. I'm blessed not to have to rely on the VA for the vast bulk of the minor health care I require. I don't have to travel miles and miles to sit in a filthy waiting room, to see an uncaring staff, and then to wonder why I can't see the same healthcare providers each time I make this trip.

I'm not undermining or berating the system, unless you want to call naming the filthy hospitals, uncaring staff, and other valid criticisms as berating.

[Gimpy]

Yeah, I believe that it IS 'berating' the VA health care system, for one simple reason, you NEVER have anything 'positive' to comment on regarding this 'system' and continually place comment after undermining comment about how BAD you think the 'system' is rather than taking the time to adequately investigate the 'systems' quality & effectiveness before regularly pouncing on every ill-prepared opportunity you can to condemn it.

Plain & simple.

You obviously don't even KNOW what a VISN consists of, do you?

Let me once again further your 'education' on a subject of which you apparently have NO information about (as well as it seems any concern!), using your OWN VSIN in Texas as an example, OK?

Then afterwards, I'll show you additional "educational material" which should help reduce that 'fog' of inability to comprehend you seem to be in most of the time.

Now this is gonna be a kinda long response, so put your 'readin glasses' on and sit back and relax, ok?


Veterans Intergrated Service Network 17


VISN 17: VA Heart of Texas Health Care Network

2301 East Lamar Blvd., Suite 650
Arlington , TX 76006
Phone: (817) 652-1111
Fax: (817) 385-3700


VISN 17 serves a population of 1 million veterans residing in 134 counties stretching from the Oklahoma border to the Lower Rio Grande Valley.

Most of this population is aging, increasingly disabled, lacks health insurance or is likely to be a member of an HMO if located in a large urban area.

Socioeconomic conditions of this large geographical area range from the relative affluence of urban areas such as Dallas, Austin, and San Antonio to areas of poverty and high unemployment in the largely Hispanic Rio Grande Valley.

The network and its three health care systems have numerous cooperative and joint ventures with several associated affiliates, community organizations, other federal agencies as well as DOD facilities to promote access of our patients to medical care services and to use our own excess capacity in some areas to serve the needs of the community.

This has resulted in a strong revenue generation from enhanced sharing programs. All of our systems work closely with their medical, nursing, dental, pharmacy and allied health schools to train health care professionals in areas of need.

VISN 17 is fully involved in One VA activities through educational and sharing initiatives. (Internal) The network currently consists of 7 medical centers, 58 clinic sites, 2,608 operating beds. These sites of care are organizationally aligned under three health care systems: the VA North Texas Health Care System includes medical centers in Dallas and Bonham, a large outpatient clinic in Fort Worth and numerous Community-Based Outpatient Clinics (CBOC); the VA Central Texas Health Care System includes medical centers in Temple, Waco and Marlin, a large outpatient clinic in Austin and numberous CBOC's; the South Texas Veterans Health Care System includes medical centers in San Antonio and Kerrville, large outpatient clinics in San Antonio, Corpus Christi, McAllen, Laredo and Victoria, and numerous CBOC's.

In FY 2001 the VISN 17 health care systems produced over 28,000 admissions , and 1,836,659 outpatient visits. They employ 8,239 employees and in FY 2002 had an operating budget of over $850 million. Their market share of category A users is 34% and 16.8% for all veterans. Thus the network has a very large potential to continue growth despite projected decline for the veteran population.

The expanded use of CBOCs has brought care within 30 miles or 30 minutes for more than 90% of veterans residing in our service area. The system medical facilities vary in scope and complexity from large urban centers providing state-of-the-art healthcare, education, and research, to smaller rural facilities providing primary and long-term care services.

These smaller facilities are also the social and economic focal point for the community. Network facilities also include five nursing homes, four domiciliaries, one blind rehabilitation center and two Spinal Cord Injury centers. Principle academic affiliations are with the University of Texas Southwestern School of Medicine, Texas A&M School of Medicine, the University of Texas Galveston Branch and the University of Texas Health Science Center at San Antonio.

The network supports a wide range of research activities, sharing agreements and is a Tricare provider.

Their mission is: to be a premier network that provides optimal access, scope and quality healthcare to veterans and other clients; to be recognized for excellence in medical research and the education of healthcare professionals; to demonstrate continuous improvement and innovation in service delivery that has high patient satisfaction, is cost effective and anticipates changes in technology and the health care requirements of the population served; and to be a resource for national emergencies. Vision ?Veterans? First Choice for Health Care?


Now, for MORE 'evidence' to support the 'system'!

From The Washington Monthly:


By the mid-1990s, the reputation of veterans hospitals had sunk so low that conservatives routinely used their example as a kind of reductio ad absurdum critique of any move toward ?socialized medicine.? Here, for instance, is Jarret B. Wollstein, a right-wing activist/author, railing against the Clinton health-care plan in 1994: ?To see the future of health care in America for you and your children under Clinton's plan,? Wollstein warned, ?just visit any Veterans Administration hospital . You'll find filthy conditions, shortages of everything, and treatment bordering on barbarism.?

And so it goes today. If the debate is over health-care reform, it won't be long before some free-market conservative will jump up and say that the sorry shape of the nation's veterans hospitals just proves what happens when government gets into the health-care business. (Sound familar Super?????....Gimp) And if he's a true believer, he'll then probably go on to suggest, quoting William Safire and other free marketers, that the government should just shut down the whole miserable system and provide veterans with health-care vouchers.

Yet here's a curious fact that few conservatives OR liberals know. Who do you think receives higher-quality health care. Medicare patients who are free to pick their own doctors and specialists?

Or aging veterans stuck in those presumably filthy VA hospitals with their antiquated equipment, uncaring administrators, and incompetent staff? An answer came in 2003, when the prestigious New England Journal of Medicine published a study that compared veterans health facilities on 11 measures of quality with fee-for-service Medicare. On all 11 measures, the quality of care in veterans facilities proved to be ?significantly better.?

Here's another curious fact. The Annals of Internal Medicine recently published a study that compared veterans health facilities with commercial managed-care systems in their treatment of diabetes patients . In seven out of seven measures of quality, the VA provided better care.

It gets stranger. Pushed by large employers who are eager to know what they are buying when they purchase health care for their employees, an outfit called the National Committee for Quality Assurance today ranks health-care plans on 17 different performance measures. These include how well the plans manage high blood pressure or how precisely they adhere to standard protocols of evidence-based medicine such as prescribing beta blockers for patients recovering from a heart attack. Winning NCQA's seal of approval is the gold standard in the health-care industry . And who do you suppose this year's winner is: Johns Hopkins? Mayo Clinic? Massachusetts General? Nope. In every single category, the VHA system outperforms the highest rated non-VHA hospitals.


Not convinced? Consider what vets themselves think. Sure, it's not hard to find vets who complain about difficulties in establishing eligibility. Many are outraged that the Bush administration has decided to deny previously promised health-care benefits to veterans who don't have service-related illnesses or who can't meet a strict means test. Yet these grievances are about access to the system, not about the quality of care received by those who get in. Veterans groups tenaciously defend the VHA and applaud its turnaround. ?The quality of care is outstanding,? says Peter Gayton, deputy director for veterans affairs and rehabilitation at the American Legion. In the latest independent survey, 81 percent of VHA hospital patients express satisfaction with the care they receive, compared to 77 percent of Medicare and Medicaid patients.

Outside experts agree that the VHA has become an industry leader in its safety and quality measures. Dr. Donald M. Berwick, president of the Institute for Health Care Improvement and one of the nation's top health-care quality experts, praises the VHA's information technology as ?spectacular.? The venerable Institute of Medicine notes that the VHA's ?integrated health information system, including its framework for using performance measures to improve quality, is considered one of the best in the nation.?

If this gives you cognitive dissonance, it should. The story of how and why the VHA became the benchmark for quality medicine in the United States suggests that much of what we think we know about health care and medical economics is just wrong. It's natural to believe that more competition and consumer choice in health care would lead to greater quality and lower costs, because in almost every other realm, it does.

That's why the Bush administration ?which has been promoting greater use of information technology and other quality improvement in health care?also wants to give individuals new tax-free ?health savings accounts? and high-deductible insurance plans. Together, these measures are supposed to encourage patients to do more comparison shopping and haggling with their doctors; therefore, they create more market discipline in the system.

But when it comes to health care, it's a government bureaucracy that's setting the standard for maintaining best practices while reducing costs, and it's the private sector that's lagging in quality. That unexpected reality needs examining if we're to have any hope of understanding what's wrong with America's health-care system and how to fix it. It turns out that precisely because the VHA is a big, government-run system that has nearly a lifetime relationship with its patients, it has incentives for investing in quality and keeping its patients well?incentives that are lacking in for-profit medicine.

Hitting bottom

By the mid-1990s, the veterans health-care system was in deep crisis. A quarter of its hospital beds were empty. Government audits showed that many VHA surgeons had gone a year without picking up a scalpel. The population of veterans was falling sharply, as aging World War II and Korean War vets began to pass away. At the same time, a mass migration of veterans from the Snowbelt to the Sunbelt overwhelmed hospitals in places such as Tampa with new patients, while those in places such as Pittsburgh had wards of empty beds.

Serious voices called for simply dismantling the VA system. Richard Cogan, a senior fellow at the Center on Budget and Policy Priorities in Washington, told The New York Times in 1994: ?The real question is whether there should be a veterans health care system at all.? At a time when the other health-care systems were expanding outpatient clinics, the VHA still required hospital stays for routine operations like cataract surgery. A patient couldn't even receive a pair of crutches without checking in. Its management system was so ossified and top-down that permission for such trivial expenditures as $9.82 for a computer cable had to be approved in Washington at the highest levels of the bureaucracy.

So, it may have been politics as usual that kept the floundering veterans health-care system going. Yet behind the scenes, a few key players within the VHA had begun to look at ways in which the system might heal itself. Chief among them was Kenneth W. Kizer, when in 1994, by appointment of President Bill Clinton had become the VHA's undersecretary for health, or in effect, the VAHC system's CEO.


A physician trained in emergency medicine and public health, Kizer was an outsider who immediately started upending the VHA's entrenched bureaucracy. He oversaw a radical downsizing and decentralization of management power, implemented pay-for-performance contracts with top executives, and won the right to fire incompetent doctors. He and his team also began to transform the VHA from an acute care, hospital-based system into one that put far more resources into primary care and outpatient services for the growing number of aging veterans beset by chronic conditions.

By 1998, Kizer's shake-up of the VHA's operating system was already earning him management guru status in an era in which management gurus were practically demigods. His story appeared that year in a book titled Straight from the CEO: The World's Top Business Leaders Reveal Ideas That Every Manager Can Use published by Price Waterhouse and Simon & Schuster. Yet the most dramatic transformation of the VHA didn't just involve such trendy, 1990s ideas as downsizing and reengineering. It also involved an obsession with systematically improving quality and safety that to this day is still largely lacking throughout the rest of the private health-care system.

Why care about quality?

Here's one big reason. As Lawrence P. Casalino, a professor of public health at the University of Chicago, puts it, ?The U.S. medical market as presently constituted simply does not provide a strong business case for quality.?


As the health-care crisis worsens, and as more become aware of how dangerous and unscientific most of the U.S. health-care system is, maybe we will find a way to get our minds around these strange truths.

Many Americans still believe that the U.S. health-care system is the best in the world, and that its only major problems are that it costs too much and leaves too many people uninsured. But the fact remains that Americans live shorter lives, with more disabilities, than people in countries that spend barely half as much per person on health care. Pouring more money into the current system won't change that. Nor will making the current system even more fragmented and driven by short-term profit motives. But learning from the lesson offered by the veterans health system could point the way to an all-American solution.

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Now, does THAT help your 'comprehension'?????? :cd: :cd: :cd: