VA Care Is Rated Superior to That in Private Hospitals
VA Care Is Rated Superior to That in Private Hospitals
By Rob Stein
Washington Post Staff Writer
Friday, January 20, 2006; A15
The Department of Veterans Affairs medical system once epitomized poor-quality care. But after a series of changes, the system has been hailed in recent years as a model for health care reform.
Now, survey results released this week indicate that those improvements have translated into a high level of satisfaction among veterans getting treated by the rehabilitated VA.
The telephone survey, conducted in October, found inpatient care received a rating of 83 on a 100-point scale; outpatient care got a rating of 80. In comparison, a similar survey of patients receiving private care found they rated their satisfaction at 73 for inpatient care and 75 for outpatient care. The survey involved more than 200 veterans who received care at one of the VA's 154 hospitals or 875 clinics.
"We're very pleased and continue to be very proud of the work that people are doing in this vast health care system," said Veterans Affairs Secretary Jim Nicholson. "The real proof in the pudding is in the taste -- that is, 'What do the people we're taking care of think?' And they give us very good grades."
The findings mark the sixth consecutive year the VA health care system has outranked the private sector for customer satisfaction.
Nicholson attributed the high ratings to the changes in the system, such as implementation of electronic records to reduce the risk of errors.
"Our system has become not only much more efficient, but safer," Nicholson said.
The survey, known as the American Customer Satisfaction Index, has been conducted since 1994 by the National Quality Research Center at the University of Michigan business school and two consultants, the CFI Group and the Federal Consulting Group.
Peter S. Gaytan, director of veterans affairs and rehabilitation for the American Legion, said he was not surprised by the findings because the quality of VA care has been steadily improving.
"The old image of the VA warehousing veterans has changed immensely in the past 20 years," Gaytan said.
But Gaytan said many veterans have to wait months or travel long distances to get care because tight budgets have forced many facilities to cut back on service.
"The problem that the American Legion has is the accessibility to care. There are veterans waiting in line to receive care," Gaytan said. "With the veterans returning from Iraq and Afghanistan, it's our hope that they won't be turned away."
Nicholson acknowledged that some veterans do have to wait for care, but he said the waiting time has been improving and continues to improve.
"We absolutely are working on that and are making progress," he said.
Walter Sampson is vice president of a Native regional corporation -- NANA -- and clearly knows his way around bureaucracies. But even so, Sampson says, it's a struggle to get health benefits through the Veterans Administration.
He talked from the floor of the AFN convention in Anchorage to a ballroom full of people there to hear about veterans' issues. He was one of a number of silver-haired vets who spoke out.
"The last 38 years I've been trying to cut the red tape," he said. "Even though I have the resources to get to the system, I have difficulty."
Sampson served in the Army during the Vietnam War. He tried to get his best buddy counseling through the VA. But his buddy committed suicide before getting the level of help he needed, said Sampson.
"I did my share. He did his share. But we lost him."
Though the injuries resulting from Sampson's war took place long ago, the VA system still is too remote, too unresponsive for veterans who live in the remote parts of our state.
It can take months for a veteran to get enrolled for VA medical service in Anchorage.
To get treatment, veterans have to get to a VA clinic. For those living in distant villages, that means flying to Anchorage, Fairbanks or one of a handful of clinics on the road system. It might cost more than $1,000 up front to even get to a VA facility, and because of the travel, going to see a doctor can take three days.
The problems veterans face getting health care was a major topic at this year's AFN convention.
Many veterans return from combat in Iraq and Afghanistan with post-traumatic stress disorder and need mental health services. The military leadership has acknowledged that at its highest levels. But they've made too little progress.
To Sampson, the answer is as simple as it seems: "Let's go out to these villages and say, we're here to help you."
That's the way it should be. Alaska veterans should be able to get health care near where they live. It shouldn't matter if the care is related to their military careers or their lives outside the military.
They served; now they deserve service.
Instead of making long trips to VA clinics, they should be able to use the well-developed health care system built up by Native tribal organizations around the state.
The Yukon-Kuskokwim Health Corp. in the Bethel region is one example of how it could work. During a panel discussion on veterans' services, Y-K Health Corp. president Gene Peltola described the corporation's extensive network of 40 village clinics, four regional clinics, the hospital in Bethel and access to the Alaska Native Medical Center in Anchorage.
In addition, the Y-K Health Corp. contracts with a psychiatrist and psychologist in Minnesota who will hold live video counseling sessions one-on-one with patients, said Peltola.
This is the kind of help, delivered close to home, that Alaska's rural soldiers deserve. The Veterans Administration should pay for the care, even if Native health organizations provide it.
Unfortunately, the federal government hasn't yet worked out how to make that happen. While legislation passed Congress to allow rural veterans to be treated through the Indian Health Service or community-based health care facilities, the VA in Alaska says it's not clear yet that the new law can be used in Alaska.
The feds should figure out how to cut their own red tape and get it done.
BOTTOM LINE: Native health organizations have built up a network that can treat vets in the Bush. Now the government must smooth the way
Candidates agree that VA is broken, but tighter budgets may limit overhaul
By CHRIS ADAMS
Even as the country heads into an era of tighter budgets, John McCain and Barack Obama are united on giving more help to the nation's veterans and overhauling the agency that cares for them.
McCain, one of the nation's most celebrated veterans, and Obama, who never served in uniform but became an advocate for veterans issues soon after entering the U.S. Senate, generally agree that the Department of Veterans Affairs does some things well and other things quite poorly.
And while veterans issues have come into the limelight only briefly during this election, the two campaigns have sparred over how best to improve access to the VA's health care system.
"We expect whoever becomes president to take care of America's veterans," said Joe Davis, a spokesman for the Veterans of Foreign Wars, the oldest major veterans' advocacy group in the country.
The country has an estimated 24 million veterans, with World War II and Korean War veterans rapidly dying off and soldiers from Iraq and Afghanistan quickly adding to the rolls. Vietnam veterans, many now in their 60s, are the largest group and are steadily increasing the VA's health care tab.
The VA's budget has risen substantially in recent years, driven by an increasing number of veterans receiving disability payments for mental and physical injuries suffered while in the service, and by the cost of the VA's health care operations. Those two functions make up the vast majority of VA operations, although the department also funds veterans' education and insurance benefits, as well as a nationwide network of cemeteries.
When it comes to the VA's disability compensation system, the candidates and major veterans groups are in agreement: The VA system is broken.
The agency has been struggling with a backlog of claims that has hovered near 400,000 for the past few years. The time it takes to process a new claim is about 180 days, far higher than the department wants.
In addition, both candidates say that the government needs to fully fund the VA's far-flung health care system, and they both support a bill now in Congress to approve VA medical funding a year in advance to allow for smoother operations.
However, expanding veterans' access to health care is also a point on which the candidates disagree.
The VA treats 5.6 million veterans at more than 150 hospitals and more than 800 clinics scattered across all states. The system has undergone a major transformation over the past decade, boosting outpatient and preventive care in its growing network of outpatient clinics.
While the transformation has generally received favorable reviews from medical experts, there still are pockets of the country where veterans have trouble getting in for treatment. In Western states and rural areas, veterans sometimes have to drive for hours to reach the nearest clinic or hospital. In other locations, waiting times may be far longer than the VA itself considers acceptable.
McCain wants to provide a veterans care "access card," which is intended to allow veterans to access private doctors if they aren't able to get into a VA facility in a timely manner. He said it would be a supplement to VA care, not a replacement for existing programs.
The Obama campaign has criticized McCain's plan, saying it would take resources and patients out of the VA system, thus hurting the economies of scale that let the VA provide cost-effective care.
Joe Violante, the national legislative director for Disabled American Veterans, said details for McCain's plan are sketchy, but that any attempt to move patients out of the VA "concerns us because it costs more to provide care outside the system, and moving patients out undermines the critical mass that the VA needs to provide a full continuum of care."
Lang Sias, McCain's veterans director, said the plans have been distorted by Obama's campaign. The card, he said, "is an additional option, not privatization."
The other main health access issue concerns what are known as "Priority 8" veterans. Since 2003, many of those veterans haven't been allowed into the VA's health care system because they make too much money and don't have severe enough disabilities.
Obama said one of his first acts as president would be to sign an executive order allowing those veterans into the VA system. McCain believes that opening the doors to all those veterans at once could risk clogging the system. Instead, McCain wants to "aggressively increase capacity" in the system while adjusting the income tests to gradually absorb Priority 8 veterans.
The department has struggled for years to improve its disability system. In fact, the wide variation in disability payments from state to state is one thing that Obama focused on in 2005 after joining the Senate. Obama is a member of the Senate Veterans' Affairs Committee.
The VA doesn't have as many workers as it needs to process claims, said Phil Carter, the Obama campaign's veterans director. "The people there aren't staying long enough, and they are not getting good leadership," he said. "They need better management."
The claims process, he added, has become "far too adversarial," with veterans feeling they have to fight - and often wait for years - to receive benefits they are due.
Obama said he'd hire additional claims workers, revamp the training system, and bring the VA's paper claims systems into the digital age.
The McCain campaign agrees that there should be a complete review of the VA's disability system, both in the processing of claims and the guidelines for how disabilities are evaluated. "I think you need clear, predictable and understandable standards," said Sias, McCain's veterans director.
The campaign said that the VA's disability system is "tragically broken" and that "too many of our wounded veterans come home to an administrative nightmare rather than a hero's welcome."