The VA Is a Quality Leader, Contrary to Many People’s Assumptions

If you believe that the largest integrated health care system in America, Veterans Health Administration, lags in health care delivery, you are misled and misinformed.

VHA — the national health care system operated by the U.S. Department of Veterans Affairs — serves over 9 million of our nation’s heroes, enrolled in more than 1,700 locations. This system employs more than 320,000 providers and staff (including 3,500 researchers and 3 Nobel laureates) and receives tireless support from hundreds of organizations and more than 76,000 volunteers.

Roughly 70% of physicians in the U.S. have trained in the system (widely known as the VA), which continues this legacy by training more than 125,000 trainees each year, collaborating with 1,800 academic institutions.

There is no other health care system in America, and quite possibly the world, doing what the VA does every day, in regard to education, research, patient safety, quality, and overall whole health management. And with the system’s transformation efforts over the past year, all VA medical centers and more than 99% of the more than 1,000 community-based outpatient clinics now provide same-day services to address urgent care medical and mental health needs.

Better Wait Times

Here’s a fact: the VA has shorter wait times than the private sector as a whole. According to a national survey of physician appointment wait times in 2017, the time for new patients to get appointments in the private sector increased, on average, by 30% since 2014. In contrast, during the same time frame — following the wait-time scandal at Phoenix VA hospitals — time to see a doctor within VA facilities nationally has improved significantly.

In the private sector, the average wait time is 32 days in midsized markets and 24.1 days in large metro markets, according to the 2017 survey. Meanwhile, at VA facilities, the average wait time for new patients to see primary care physicians is 21.8 days, as of September 2017. For all other specialties highlighted in the private-sector survey, such as cardiology, dermatology, orthopedics, and gynecology, the comparable wait times at VA facilities are significantly better. In fact, across all specialties offered by the VA, average wait time for new patients is 20.3 days, and even less for mental health visits.

Improved Quality

The VA is on a trajectory of rapid improvement across all areas of the health care landscape. The first-of-its-kind Health Care Improvement Center is an innovative program that monitors, identifies, and fixes in real time the vulnerabilities and risks in facilities to ensure patient safety. The Access and Quality in VA Healthcare website, which has received more than 40 million hits since its launch in April 2017, allows veterans to look up wait times and quality of VA facilities and compare them to private-sector hospitals in their community. The VA recently deployed an “anywhere to anywhere” telehealth program that makes care available to veterans with access challenges, especially in rural communities. The VA deployed an Opioid Safety Initiative Toolkit to address the nationwide addiction epidemic, which affects veterans disproportionately. The VA invested millions in the recently launched LUKE Arm, the world’s most advanced upper arm prosthesis, which brings a functionality never experienced before by an amputee.

The VA also recently announced the selection of an electronic health records (EHR) system that is seamlessly interoperable with the Department of Defense platform and allows the health system to better support transitioning service members, especially around managing mental health conditions and suicide risk. Suicide prevention remains the topmost clinical priority, where there is now a comprehensive and holistic approach to managing veterans at risk proactively. In addition, as of July 2017, the mental health benefit has also been expanded to cover veterans with Other Than Honorable discharges, where there is higher prevalence of mental health conditions. All this while modernizing the organization into a more agile, flexible, adaptable, transparent, accountable system that is the engine for change in care delivery today and into the future.

Greater Accountability

As with any large organization, especially one remaking itself, there are heartaches and challenges to overcome. It is not easy to overhaul a complex system that has operated in a certain way for so long, driven by legacy decisions on resources, operations, and organizational decision-making. In some cases, outdated policies or regulations hinder advancement.

Although much good has been accomplished, every step taken by VHA is scrutinized. The organization is often in reactive or defense mode, rather than heralded for so many forward-looking decisions and new standards of excellence achieved for the health of our country. When problems do arise, they often are specific to a location or individual, not widespread across the system. It is not acceptable to judge an entire system, especially one the size of Veterans Health Administration, on the actions of a few or issues in a small fraction of facilities.

Also, the VA typically reports significantly more than the private sector, and has requirements for reporting even the smallest of things. This is a double-edged sword. An example is the VA’s EHR selection. The decision was met with backlash — internally from those reluctant to relinquish an antiquated, non-uniform system, and externally from parties who did not understand the advancements in care and cost savings that this system will provide. The benefits include interoperability across the system and within community providers, creating the possibility of seamless care for millions of veterans and transitioning service members. For the first time, the VA will have a longitudinal view of a veteran’s health history, including military service with occupational history, key social determinants of care, and insights from the world’s largest genomic database, via the Million Veteran Program. The new EHR will be invaluable for more accurate diagnoses, changing the clinical course of disease, breakthrough research, and ultimately saving and extending lives.

The VA is rightfully accountable to the public, taxpayers, Congress, and most importantly to veterans. Thus, it is paramount that these stakeholders are not misled by opinion and do not assume the worst. Many of the advancements described have been made recently. In many respects, the VA is transforming from not only being the largest integrated health care system in America, but also into becoming America’s greatest health care system. It is a system worth celebrating, cherishing . . . and saving.