The VA exaggerates its achievements

A recent study disputes the claims the VA has made regarding quality. Another hit for those who support “VA for all”, or Government-run health care:

The agency has touted how quickly veterans get in for appointments, but its own inspector general found that scheduling records have been manipulated repeatedly.

The VA boasted that its customer service ratings are 10 points higher than those of private-sector hospitals, but the survey it cited shows a far smaller gap.

Top officials repeatedly have said that a pivotal health-quality study ranked the agency’s health care “higher than any other health-care system in this country.” However, the study they cited wasn’t designed to do that.

(via The Health Care Blog)

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  • Mike

    And US News and World Reports had a big issue last year how the VA should be the model for hospitals everywhere They also praised raopid response teams, even though JAMA published two articles saying there’s no evidence of improved outcomes.

    Can the media be any more disconnected from reality?

  • Anonymous

    Kevin:
    The VA has good and bad. Frankly all I have ever seen you portray is that bad. How about a little honesty. I trained in a VA, so I first-hand saw the negatives. This includes wait time for elective surgeries, the laziness and inability to fire a large minority of the support staff, the lack of options. Positives includes a computorized EMR system that is the best in the US (IMO), an excellent/cheap medication formulary that despite criticism on this blog still has the vast majority of needed meds per class (and they can get the others), often a geriatric extended care system (depending on the facility) which is often better (and less onerous to get into) than private systems, and believe it or not (where I worked) easier availability of many medical (not surgical) specialists than the corresponding medicaid system. The fact is the moron in the White House has overloaded this system given the events of the last 5 years without adequate funding. Is the system perfect…not at all. Should their employee’s be more accountable…yes. Am I a fan of “socialized health care”….no. But this is the system that has been set up for our vets. How about NOT turning the problems with the VA system into an anti “single payer”…”socialized medicine” mantra like you always do every time you post a VA story. Our vets deserve better. Not some biased agenda based on your hatred of single payer systems.

  • Elliott

    Bravo!!! I wanted to comment on this, but what I wanted to say simply sounded unonvincingly defensive to my ear. Anon 3:38 has hit the points I wanted to make perfectly. Much of what is wrong with the VA and is being revealed right now is a function of underfunding by the Republican Congress and adjustment difficulties associated with the exponential increase in the need for some services by returning Iraq vets.

  • Anonymous

    Anon:

    Kevin doesn’t really use this site to be objective or inform as much as he uses it to lobby. Hence the double standards and half-truths. If you don’t expect otherwise, you won’t be disappointed.

  • Anonymous

    Most VAs are, unfortunately for the vets, bastions for the incompetent and lazy. Just an observation from my first hand experience from both sides of the healthcare fence.

  • Anonymous

    To posters critical of Kevin: the fact that we are reading and making comments to articles here, should give you pause regarding your negative criticisms regarding bias you perceive of the blogger.

    Having been in the VA, I can say that the only real redeeming value there is EMR. With its hard to alter [although, seen it done by Information Resource Managers]electronic time stamps, somehow diminished the waste. At least now there is less duplication of tests among geographically closer VAs [still happens between VISNs]; less duplication of prescriptions [before EMR, some vets got duplicate prescriptions for their wives/partners, or multiple prescriptions from one clinic or hospital down or up the interstate for narcotics and controlled substances!] These went on unchecked because of in-place veteran advocacy by in-house patient-reps, VFW, legion, etc. that can ruin lives of chiefs-of- service, directors and doctors…
    When the records were transitioned to EMR, there were plenty of vets who grumbled and were complaining, denigrating the system.

    The VA is a wonderful place for lazy psychiatrists/psychologists who are not lazy to turf patients to primary care – the buzz service for everything, as in America’s health care. If you haven’t seen the movie Article 99 [c.1992] – go see it, you might get enlightened some…
    The VA has since received more funding, but the bureaucrats have found better ways to waste them with top heavy management who do not provide clinical care, but sit on their butts 0800-1630 with 1 hr lunch and 2×15 min smoking/coffee breaks, salaried every 2 weeks! They have great choice of healthcare and retirement to boot.
    Standards? Most of them slackers do “studies” for these. Try studies that have hypothesized, desired results, manipulated at data gathering to begin with [eg. rest at least 30 mins or longer before the blood pressure is taken for the EMR, so control is shown; its hard to check on end-pts like stoke or MI deaths as these are turfed-out to the nearest private hospital if vet is highly service-connected, or not included in studies of bigger VAs where they are not native patients to]; A1Cs are sampled more or less often to skew results to desired outcome]

    The vets who are highly satisfied are highly satisfied, because they get what they want or do not know any better…one got featured in CBS evening news, another in NBC nightly news, but what about the 98 others who did not get into the geriatric center of exellence of a nursing home?

    Does everyone feel good about paying for lifestyle meds like viagra and cialis just because the vets at one time wore a uniform, smoked and drank to their hearts now their livers preferentially put out estrogens giving them problems at getting erections and giving them boobs where there should not be? Women veterans are mostly loonies because they are to begin with; + the sexual trauma, now routinely packaged in their care!Go read the glossy mag Federal Practitioner with more studies done by PhD RNs who became so at gov’t time and moneys.

    Socialized medicine will be so, and as bad if these are the same priorities, in any place. Nobody needs to lobby against it.

  • Kevin

    The comment above was deleted for foul language.

  • Anonymous

    “They have great choice of healthcare and retirement to boot.
    Standards?”

    Good point. I wonder why these lazy beaurocrats don’t use the healthcare system they oversee? Makes you think don’t it!

  • Anonymous

    Anon 8:57
    The VA care is not perfect but where I trained the research (especially cardiac) was top notch. If you have evidence/knowledge of researcher misconduct then I suggest you notify the Office of Research Integrity. The inability to motivate/get rid of lazy staff is clearly an issue. But I also worked with dedicated attending’s/nurses every bit as good as those in private practice. As a resident (even as a med student when I trained) you could be the doc. The advantage of a resident-run institution. I am a better doc because of my VA experience. I am not minimizing the negatives. The bean counter/slacker potential there is awful (like any government institution). Most of the issues right now relate to the fact that the system is overloaded and not adequately funded (and it is not using it’s funds effectively at times. ie. employee accountability and expectation of excellence). The blame for the funding issues can be traced to the top. I am not a democrat or republican, but the present administration has clearly not budgeted (or even thought of until recently) for the influx of young and at times grievously wounded vets. That is a simple fact.

  • Anonymous

    Kevin, did you train at a VA?

  • Anonymous

    “The VA care is not perfect but where I trained the research (especially cardiac) was top notch.”

    You are correct in that there are a handful of decent (certainly not top tier but decent) VA hospitals across the country, but the overwhelming majority are train wrecks. By the way, I trained at a VA for a few months so my comment is not off the cuff.

  • Anonymous

    Why don’t the lazy beaurocrats that run the VA hospitals get their own healthcare at the VAs? I am still scratching my head!!

  • Anonymous

    The discrepency between the VA sympathizers (sp?) and the VA haters is probably due to the individual VAs. I have trained at four different VAs. Three were next to an academic center, one was a community VA. The community VA was clearly an accident waiting to happen. The three academic VAs were staffed by people who were often associated with the University. That isn’t to say that the VA nurses were a little government-minded so to speak, but the doctors in my opinion were very similar to the people across the street.

    My point is that there are really two VA systems. One that is academic minded and another that is best avoided. If I had to compare the acadmic VA I know best with the community (non-VA) hospital I know best, the academic VA hospital would come out ahead.

    A conclusion one could draw from this is that socialized medicine ala the community VAs is destined for failure. For the most part, the people there don’t have the additional drive the acadmic VA people do for quality. Another conclusion is that if you are a veteran or spouse/child of a veteran, take the time to drive to a VA that is next to a University Hospital. It is worth the extra gas and is an excellent bargain.
    b

  • Anonymous

    Office of Research Integrity = whistleblowing in strong wind; nobody hears you, unless some catastrophic event gets caught by media – epidemiological “studies” are not of this nature, usually; more similar to the shenannigans caught [finally!] by the OIG in the basic article for this blog

    Fully agree with the title “The VA exaggerates its achievement” – just be on at least one VA around [i mean at least 6 mos] a JCAHO visit, you will observe the enormous efforts exerted to windowdress the site and sights…

    Although the VA is in existence for >75 yrs, it just might implode on itself yet. It would have taken this long because of a few astute veterans who got themselves entrenched in the heirarchy, they are able to skim the cream of VA care to their advantage; for others, unfortunately they are “overqualified” for VA care – not having worn the uniform, or got so rich wearing the uniform, they are on the elite tricare tracts…
    Fortunately or not, if a single payer system patterned after the VA becomes reality, it might take just as long, longer or not before it implodes; hopefully the VA implodes first before this becomes a pattern…
    The only real redeeming value to the VA is the EMR [CPRS - not VISTA that they want to share ware, after abandoning it - what's up with that?]; but then again, the OIG still found how the clever window dressers manipulated it to their advantage…

  • Paige Hatcher

    The VA cannot be currently compared to the single payer model, when it’s funding has been repeatedly cut. If the VA has bad outcomes, lets look to the top, where the true problems lie, and not use this as an excuse to badmouth single payer.

  • ArkyDoc

    Certainly the VA has its problems. But when I worked for the VA, I could get my patients with social problems and mental health problems seen relatively quickly (often the same day if I called the psychiatrist and relayed that it was truly an emergency). In the private sector, I challenge anyone who works in a rural setting to do that for any of their Medicaid or uninsured patients. I am thankful for my interactions with VA psychiatrists who really do care for sick people (psychotic, severe PTSD, etc.) as opposed to many private sector psychiatrists who only want to see the worried well with good insurance (generally, people who are really psychiatrically ill can’t hold down a job and consequently have no insurance…)

    You need to keep in perspective that the viewpoint of harried residents during inpatient training rotations does not reflect the totality of VA care. Most VA care is now outpatient based.

    When I worked for the VA, I could generally always get my patient a specialty referral, though not always as soon as we wanted. Just as in the private sector, it was a matter of taking the time to establish professional relationships with colleagues and calling them personally – without abusing it (not everyone needs their stress test TODAY).

    Now, in the private sector, if a patient is uninsured, I know that they may NEVER be able to see any specialists, unless they are having a crisis situation, drive to a larger city tertiary care ER and are admitted.

    They also will not be able to afford many of the medications that may help. As an internist, the VA at least made my job easier by knowing that patients could get their medications. And, the emphasis on tried and true generics (and pill splitting) has been invaluable for me in trying to prescribe lower cost alternatives for my patients.

    I do agree, though, about the top-heavy bureaucracy using too many resources that should be going to patient care.

  • Anonymous

    So statistics show good quality at the VA?

    Reminds me of the line “Are you going to believe your lying eyes or what I tell you?”

    I have never found a cold dead patient with fresh vital signs charted anywhere but the VA. I have never known a patient on 1:1 suicide precautions to hang themselves while the unit staff held a fish fry anywhere but at the VA. I have never had one of my patients ge 3 weeks of IV prednisone when they were supposed to get IV penicillin anywhere but at the VA. Yes, these things could happen anywhere. But they didn’t happen anywhere. In 25 years in medicine, they only happened in the few months that I was at the VA. Do I believe their stats or my “lying eyes”.

  • Anonymous

    Anon 9:09

    - HOLY Cow! And I thought my experience with lazy mental health “professionals” and bureaucrats were bad enough…
    -almost got caught holding the ‘hot potato’ of a patient who killed herself as psychiatry continued to turf her to primary care; ‘good thing’ she shot herself after she was just discharged from their 7 day program [of what, i don't know]

    -at least I did not get PCN lost in pharmacy transcription to prednisone; i did get vehement, angry denials from a chief of pharmacy about errors…until showed him how a veteran brought me meds mailed to him for diabetes when he did not have even traces of it; but still no apologies, but scorn!

  • Anonymous

    Doesn’t the the “VA funding keeps on getting cut so how are they supposed to operate as well” argument actually show us what is going to happen with single payor/socialized medicine after a couple years of operation? Do you really think something like this would be funded correctly? If you do then you are naive.

  • Happyman

    anon 9:47 stated

    “Most of the issues right now relate to the fact that the system is overloaded and not adequately funded (and it is not using it’s funds effectively at times. ie. employee accountability and expectation of excellence).”

    During my brief stint at a VA’s hematology-oncology division, on any given day:

    1- half of the office staff (including attending physicians) were out

    2- new consults were not seen by the attending

    3- 20% of staff could be found after 4pm (3pm on fridays)

    4- a full one-quarter of patients seen in the outpatient clinics were there just to pick up meds prescribed by their private md(since the oncology drugs, being expensive, are picked up by the taxpayers even though these guys have commercial health benefits)

    I would say it’s not an issue of underfunding, but rather OVERfunding of benefits for a lazy workforce, with no performance incentive whatsoever.

    As far as the posts about errors at the VA, so true!!! As someone wise once said:

    “There’s no such thing as sick patients, only sick charts!!!”

  • Anonymous

    The VA is one of the most successful programs in history–properly understood. It only appears to be ineffective and inefficient if one is gullible enough to believe the fib that it exist to provide medical care. It does not.

    It was created to provide the large contingent of veterans of the world wars with a basis for a continued sense of dependency on and gratitude towards the federal government and thereby guarantee the founding congressmen job security.

    It was phenomenally successful in, together with the rest of the entitlement complex, creating an institutional congress with remarkable job security–so much that the re-election rates were higher than in the single party soviet union!

    Inefficiency actually contributes to the real goal. 3 lazy ineffective deadbeats on the payroll who don’t deserve to be gains the appreciation of them and the relatives whose hands they are now off. Getting the job of those three done by one competent person with a work ethic provides no poltical benefit from the “jobs for my district” point of view as that person is earning their keep and can do so elsewhere and knows it (no gratitude!).

  • Anonymous

    happy:
    as noted in your paste
    “Most of the issues right now relate to the fact that the system is overloaded and not adequately funded (and it is not using it’s funds effectively at times. ie. employee accountability and expectation of excellence).”

    The issue of lack of accountability is an issue and was addressed by the writer. A question, do you think a “brief stint” in the hem/onc clinic really qualifies you to damn the whole system? I spent three years in training there and I don’t claim to know the system completely. With my three years of experience I do know that many attendings have research days (a reason they took the job at a
    fraction of pay of private practice docs). Perhaps that is where the other docs went. Also, as a fellow/resident I regularly saw consults without the attending (at least initally). I agree with you there needs to be accountability/incentives for the staff. It is time to clear dead wood from the VA. However, your statement about cutting funds from the VA shows a gross lack of knowledge as to what is going on the the system right now. Over a
    hundred of thousand vets are coming back to the states evey year. Many, whom will use VA services. Many whom have been severely wounded (though their lives saved thanks to our excellent emergency care, moreso than in previous wars). The VA needs increased funding for these vets not decreased. There are only 4 TBI (traumatic brain injury) centers in the VA now. Given the number of vets coming back with IED-caused head injuries you propose to decrease funding? (actually plans are to increase the number of centers). I think you need to think this through happy. I don’t argue that VA money should be better spent and staff should be more accountable. But if you think that this will make the needed money magically appear…you are deluding yourself.
    PS: For every lazy doc/RN I saw at the VA (and there are plenty) I saw one that worked every bit as I do in private practice.

  • Happyman

    anon 12:27-

    i hear what you’re saying, and I don’t mean to damn to whole system. However, I do believe that the money spent on the VA woule be better spent, e.g., on giving all vets private health insurance that they can use to choose a private physician, obtain emergency care, etc., just like any other job. Of course, I realize that fighting over in iraq ISN’T like another job. But being in the military IS a job, and is voluntary. The system we have now definitely has elements of waste, costs taxpayers a fortune, and I would think it’d be a hell of a lot cheaper to give everyone aetna, or oxford, or whomever bids the lowest to the gov’t.

    And as far as TBI centers, I think all vets who suffer a TBI deserve the best of treatment, which no matter how much money is thrown at the VA system, they’d be better off at NY-Presbyterian or another large academic center.

    And you said “With my three years …(a reason they took the job at afraction of pay of private practice docs)”

    Are you kidding? the primary care attendings at the VA make well into six figures, and have the most amazing expensive benefits for LIFE. This isn’t too different from a community pcp, without all the hassles / call / managed care / etc.

    Just ask yourself this – If your brother were military and also had commercial insurance, and got injured, would you want him treated at a VA or by the same facility that treats your RICHEST patients?

    Our vets deserve the best possible care, and if that means dismantling the VA system & saving taxpayers money at the same time, i’m all for it!

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