Dismantling Republican "Myths" about VA Health Care!

[Gimpy]

Recent comments and proposals from many military veterans and politicians in the Republican party have been using misinformation and outright untruths to support their unwarranted attempts to "privatize" VA health care.

The National Committee for Quality Assurance recently published a report "The State of Health Care Quality: 2004" praising the VA's health care system. Hopefully this information will put to rest the "scare tactics" and misinformation being put forth to dismantle the Veterans Health Care Administration.


The NCQA is an independent, 501(c)(3) non-profit organization whose mission is to improve health care quality everywhere. NCQA evaluates health care in three different ways: through accreditation (a rigorous on-site review of key clinical and administrative processes); through the Health Plan Employer Data and Information Set (HEDIS? -- a tool used to measure performance in key areas like immunization and mammography screening rates); and through a comprehensive member satisfaction surve .

Below is a portion of their report.

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The VA Health CareSystem: An Unrecognized National Safety Net


Veterans who use the VA health care system have a higher level of illness than the general population, and 60 percent have no private or Medigap insurance.


ABSTRACT:


The dominance of local health care markets in conjunction with variable public funding results in a national patchwork of "safety nets" and beneficiaries in the United States rather than a uniform system.

This DataWatch describes how the recently reorganized Department of Veterans Affairs serves as a coordinated, national safety-net provider and characterizes the veterans who are not supported by the market-based system.

The role of Department of Veterans Affairs (VA) as a health care safety net is largely unrecognized. Many think of VA medical care as a benefit awarded only to veterans who are ?service-connected??that is, veterans who are disabled by illness or injury in the line of duty during military service. However, 60 percent of veterans who received VA medical care in 1992 had no private or Medigap insurance and would likely be considered the responsibility of the health care safety net.

Unfortunately, the availability of federal, state, and local government funds to subsidize the care of persons left without services varies by state and community and may not match community need. The result is a national patchwork of safety nets and beneficiaries health care system stands out as a significant, coordinated, nationwide safety net for veterans.

VA Service Networks

Organization

The VA health care system recently reorganized into twenty-two Veterans Integrated Service Networks (VISNs) on the basis of geographic referral patterns to maximize patients? access to care while improving efficiencies in service delivery.

Appropriated funds are distributed according to the VA?s new Veterans Equitable Resource Allocation capitation model that bases network funding on the volume of service-connected and low-income veterans served. Low income is defined as less than $21,610 a year for a single veteran.

VISNs offer a full continuum of care to patients within their boundaries through direct delivery or contractual agreements with other networks or providers. A typical network consists of six to ten hospitals that provide acute inpatient medical and surgical, psychiatric, and substance abuse services, along with subacute and rehabilitation services.

Each network also manages twenty to thirty freestanding outpatient clinics, nine to ten readjustment counseling centers, six to eight home-based primary care programs, five to seven VA nursing homes, one or more residential housing facilities (domiciliaries), and contracts with 140?150 community nursing homes and several state veterans? homes.

Performance measurement

VA headquarters manages the twenty-two networks by setting goals and designing strategies to maximize health care value throughout the nation. Value is defined as balanced performance of five factors: cost, access, technical quality, patient functional ability, and patient satisfaction.

Headquarters focuses on developing a standardized measurement and monitoring system that supports risk-adjusted comparative analyses among networks. Networks are held accountable for results through a newly implemented performance contract system that rewards excellent performance on clinical as well as cost outcomes. These efforts are designed to assure that high-quality care is consistently delivered by VA providers nationwide.


Veterans? Health Status And Special Care Needs


The core mission of the VA is to provide primary care, specialized care, and related medical and social support services to veterans. The VA health care system is a safety net because many of the veterans served are psychologically and economically disadvantaged and have a high disease burden.

Veterans? average scores on the Short Form 36-Item Health Survey for Veterans (SF-36V) are significantly worse (lower) than those for either the general population or the Medical Outcomes Study population.

Having scores at least ten points lower on either the physical or mental component scales has been shown to be equivalent to having approximately two additional chronic conditions, 30 percent more hospitalizations, and 20 percent more outpatient visits. Comorbidity from psychiatric illness is common among VA health care users and requires 14 percent of the VA?s total $17 billion medical care budget.

In addition, on a given day in 1996, homeless patients accounted for 13.5 percent of all admissions, 24 percent of general psychiatry admissions, and 47 percent of substance abuse admissions.


The VA also cares for small vulnerable populations for whom care is expensive but generally unprofitable in the private sector, in part because of the absence of economies of scale.


The VA?s capacity to provide this care is based on the occurrence of many of these conditions during, or as a consequence of, military service. Recently enacted veterans? health care eligibility reform legislation has reinforced the VA?s continued role as a safety-net provider for these populations. In addition to veterans with service-connected illnesses, injuries, and exposures and former prisoners of war, the VA is legislated to treat veterans with special disabilities of spinal cord dysfunction, blindness, amputation, traumatic brain injury, catastrophic disability, post-traumatic stress disorder, and serious mental illness, including substance abuse and homelessness resulting from mental illness . Low-income veterans without any of the above disabilities will be cared for to the extent that funding allows.


Conclusion

As long as local market forces dominate the health care industry and state and local funding vary, the stabilizing influence of a national safety net like the VA health care system becomes ever more important.


The VA, in the midst of its own transformation, serves part of that role by providing comprehensive services to approximately 1.7 million veterans (and with more enrolling every day ) who are not well supported by a market- based system. Also, as long as the patchwork of safety nets remains, fluctuations in the availability of one system will cause repercussions for others.

Significant changes in the VA?s safety-net function would be felt in every corner of the nation, in that any decrease in the VA?s ability to care for veterans would most likely fall to Medicare, Medicaid, or other publicly funded programs. The converse is also true. Society has made an investment in a medical care system for veterans in recognition of the continuing cost of war and national security and the special contributions that veterans have made to the nation.

The VA?s role as a national health care safety net provides an additional social benefit that is often overlooked. This role should be more widely recognized.

Veterans are increasingly satisfied by changes in the VA health system. On the American Customer Satisfaction Index,20 the VA bested the private sector's mean healthcare score of 68 on a 100-point scale, with scores of 80 for ambulatory care , 81 for inpatient care, and 83 for pharmacy services for the past 3 years . Similar improvements have been achieved in each value domain.


It also is worth emphasizing that since 1996 , improved outcomes have been achieved in each of the value domains, while simultaneously reducing the cost per patient by more than 25%. Returning to the value equation, it would seem evident that the numerator (outputs) rose while the denominator (resource inputs) dropped, signifying enhanced value.

NOTES

1. 1992 National Survey of Veterans (Washington: Department of Veterans Affairs, 1994).

2. K.W. Kizer, Vision for Change: A Plan to Restructure the Veterans Health Administration (Washington: Department of Veterans Affairs, 1995); K.W. Kizer, ?The Changing Face of the Veterans Affairs Health Care System,? Minnesota Medicine (February 1997): 24?28; and K.W. Kizer, ?Transforming the Veterans Health Care System: The ?New VA?,? Journal of the American Medical Association 275, no. 14 (1996): 1069.

3. Veterans Equitable Resource Allocation System Briefing Booklet (Washington: Department of Veterans Affairs, March 1997).

4. ?New Means Test Thresholds?1997,? VHA Directive 96-076 (20 December 1996).

5. Kizer, Vision for Change.

6. K.W. Kizer, Prescription for Change: The Guiding Principles and Strategic Objectives Underlying the Transformation of the Veterans Healthcare System (Washington: Department of Veterans Affairs, 1996).

7. J. Sunshine, interview with N.J. Wilson, ?A New Approach to Quality in VA,? Federal Practitioner (Part 1) (May 1996): 59?60, and (Part 2) (June 1996): 56?57.

8. N.J. Wilson, ?VA Performance Agreements: Changing VA Performance,? SGIM Newsletter (May 1997).

9. S. Isaacson et al., Substance Abuse Treatment: VA Programs Serve Psychologically and Economically Disadvantaged Veterans, GAO/HEHS-97-6/B-271298 (Washington: U.S. General Accounting Office, 5 November 1996).

10. N.J. Wilson and L. Kazis, ?Health Status of Veterans: Physical and Mental Component Summary Scores (SF-36V),? 1996 National Survey of Ambulatory Care Patients Executive Report (Washington: Department of Veterans Affairs, February 1997).

11. Office of the Assistant Secretary for Management, FY 1998 Budget Submission (Washington: Department of Veterans Affairs, February 1997).
12. R. Rosenheck, C. Leda, and D. Siessert, FY 1996 End-of-Year Survey of Homeless Veterans in VA Inpatient Care Programs (West Haven, Conn.: N.E. Program Evaluation Center, forthcoming).

13. The Veterans Health Care Eligibility Reform Act of 1996, Public Law 104-262 (March 1997).


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Now.......................if we can just convince Bush and the Congressional republicans to adequately FUND these programs and shut the hell up about "PRIVATIZATION"!

[Gimpy]

Evidence to support my claims!

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The Veterans Health Administration: Quality, Value, Accountability, and Information as Transforming Strategies for Patient-Centered Care


Jonathan B. Perlin, MD, PhD, MSHA; Robert M. Kolodner, MD; and Robert H. Roswell, MD


The Veterans Health Administration is the United States' largest integrated health system. Once disparaged as a bureaucracy providing mediocre care, the Department of Veterans Affairs (VA) reinvented itself during the past decade through a policy shift mandating structural and organizational change, rationalization of resource allocation, explicit measurement and accountability for quality and value, and development of an information infrastructure supporting the needs of patients, clinicians, and administrators.

Today, the VA is recognized for leadership in clinical informatics and performance improvement, cares for more patients with proportionally fewer resources, and sets national benchmarks in patient satisfaction and for 18 indicators of quality in disease prevention and treatment.
(Am J Manag Care. 2004;10(part 2):828-836)

The Veterans Health Administration (VHA), one of three administrations within the Department of Veterans Affairs (VA), is the largest integrated health system in the United States. Suffering deservedly or not during the 1980s and early 1990s from a tarnished reputation of bureaucracy, inefficiency, and mediocre care, the VA sought to reinvent itself beginning in 1995 as a model system characterized by patient-centered, high-quality, high-value healthcare.


This reinvention mandated structural and organizational changes, rationalization of resource allocation, measurement and active management of quality and value (and clear accountability for quality and value), and an information infrastructure that would increasingly support the needs of patients, clinicians, and administrators.


Although predating the US Institute of Medicine's recent recommendations for a more ideal health system, the VA's improvement using strategies remarkably similar to those enunciated in the report provides increasing evidence for the utility of the recommendations in closing the "quality chasm."


Through adoption of evidence-based practices, proactive approaches to patient safety, and use of advanced technologies (eg, a fully deployed electronic health record, bar-coded medication administration), the VA's success in improving quality, safety, and value have allowed it to emerge as an increasingly recognized leader in healthcare .2,3

[colmurph]

What are you trying to tell us Gimpy? Your int is lost somewhere in all the cut-and-paste. Aren't we doing enough for the poor vet's who are substance abusers? Are you trying to say that vets on the whole, are less intelligent than the general population? Part of your rant looks like that.

I suppose the "Vet's" who have spent the last 30 years keeping their brains soaked in alcohol or narcotics have lost some of their original grey matter.......is it service connected? Are the homeless vet's "Homeless" because of their military service, however short, or did they become homeless because they couldn't hold a job, a wife or a family because of their addictions or behaviour? Tell me Gimp....how does a guy get to have PTSD when he's never been to "See the Elephant"? It's guys like you Gimpy, who keep the old steriotype of the "Vietnam Veteran who's a whacko" alive and well. You are doing more harm to your fellow Vietnam Veterans than good with your rants.

[Gimpy]

Originally posted by colmurph It's guys like you Gimpy, who keep the old steriotype of the "Vietnam Veteran who's a whacko" alive and well. You are doing more harm to your fellow Vietnam Veterans than good with your rants.

No Smurph..........sadly, it's guys like YOU who are.

All the "proof" of that you need is in the mirror when your shaving every day!

[vetgirl]

thank god for the va!!!!!!!!!!!!!! they kept my best friend alive for the past 3 years. however ............ shame on gw bush
cut everything so i can have my war