VA hospitals do pretty darn well in a national survey

The Veterans Health Administration recently participated for the first time ever in an annual survey of hospital quality conducted by the Centers for Medicare and Medicaid Services. VA did well. The survey is known as the Hospital Consumer Assessment of Health Care Providers and Systems. Federal Drive with Tom Temin spoke about it with VA’s top medical official, Dr. Shereef Elnahal.

Interview Transcript: 

Tom Temin We started with the fact that this is not a VA survey.

Dr. Shereef Elnahal It’s actually a standard rating that is released every year by the Center for Medicare and Medicaid Services. And for the first year ever, VA medical centers are included in the same overall hospital quality ratings as the rest of American hospitals. And we’re really proud of how we scored compared to our counterparts.

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Tom Temin Yeah. How did you do? Give us the top line here.

Dr. Shereef Elnahal Absolutely. So VA medical centers overall scored a 67%, scored either four or five stars on this overall hospital quality rating out of five stars compared to less than half of our civilian sector counterparts. And that wasn’t a surprise to us. Study after study over many years has shown that VA care is at least the same, if not better, in many areas. For the first time, veterans can go to the CMS website and see us stacked against all of our civilian hospital counterparts, and we’re really proud of how we did.

Tom Temin I’m interested, though, in the statistics here, because you get a self-selecting sample of people who are going primarily to VA. They may not go to Mass General or whatever.

Dr. Shereef Elnahal It’s actually the same standard survey that anyone discharged from a hospital gets across the country. So it’s really an unbiased sample because it’s really every veteran who’s hospitalized in our system. And it’s patients overall who are discharged from civilian hospitals taking the same survey.

Tom Temin And what are some of the questions? What are some of the qualities of hospitals that are specifically in there?

Dr. Shereef Elnahal Absolutely. So one component of this rating has to do with patient experience. Again, those surveys that every veteran and civilian gets when they’re discharged is also really critical, hospital quality and patient safety metrics; things like infections that someone might get in a hospital. Other measures of patient harm. It’s also the degree to which we have to readmit veterans into our hospitals as well as in civilian hospitals, because their full set of concerns and conditions weren’t fully addressed. And so there’s other components. But the bottom line is it’s the same rating that every hospital is assessed on in the country and VA scores really well when you compare us directly.

Tom Temin Now, earlier you said this was the first time that VA facilities were included. So you don’t really have a historic baseline yet of how you’re doing over time.

Dr. Shereef Elnahal We don’t, but we do have other assessments that have compared us to include peer reviewed medical journal articles, real scientific comparisons between VA care and civilian care. And again, those overwhelmingly show that VA care is at least the same, if not better, in many areas.

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Tom Temin Were you able to identify if 67% said it was four out of five and so on? Are you able to tell almost like the FEVs scores for employees, which ones are good at the top of the game, at VA within the VA system, and which ones might need a little help?

Dr. Shereef Elnahal Yes, we can absolutely tell that. And Martinsburg, VA is one example in our region right here in the national capital region, scoring five out of five stars. 67% of our medical center score, one of the top two ratings. But of course, we do have three, two and one star medical centers as well. And for those places, we use this as an opportunity to continuously improve. That’s the spirit by which we undertake all of our quality and patient safety efforts. And so we’re going to be reaching out to those medical centers who need help and getting better while celebrating and encouraging those who scored well to continue scoring well. That’s what veterans in this country deserve.

Tom Temin And how fine grained can you understand what it is they need to improve? For example, they could have a terrific intake and people feel great about checking in, but the surgeons aren’t so good. And somebody, you know, whatever made a mistake versus ‘Geez this is really lousy’ coming in the front door. But my goodness, the doctors were great or the nurses were great.

Dr. Shereef Elnahal Yeah, well, the rating, fortunately, is very comprehensive and all of its components, all of it is transparent. Anybody can go on the CMS website and look at the components. And of course, our teams across the country are doing the same to figure out exactly what they need to work on. So for example, in the patient experience category, we can break that down by the exact questions that veterans answer to include cleanliness of the hospital environment, communication with nurses, communication with doctors, noise at night. Do veterans get to sleep when they’re hospitalized? And so we can really hone in on what we need to improve, not just for the one, to three star medical centers, but even the four and five star all have things to work on. In the spirit is, again, continuous improvement.

Tom Temin And from your standpoint as chief of medicine, basically, you know, undersecretary for health within a given hospital or center, the functions have different channels, that is to say the administrative function, that checking in and so forth, nursing medicine, how do you get them to maybe integrate with one another such that that total experience seems integrated, at least from the patient standpoint?

Dr. Shereef Elnahal Absolutely. Everybody has a part to play in making sure that we continuously improve on behalf of veterans. The accountability, of course, starts with our leaders. But where the leaders are continuously getting input and feedback and interacting directly with the front line. We see those hospitals perform better and better. And so of course, how our teams integrate and perform and work well together has everything to do with how these ratings turn out.

Tom Temin And the ratings, of course, are what people say, and when they fill out a survey, you must have internal metrics to know, you know, how long did the intake take, how many infections per 10,000 beds and this kind of thing. Can you correlate those findings with the metrics that the VA keeps internally?

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Dr. Shereef Elnahal Absolutely. We have many things that we measure that are not necessarily included in the CMS ratings, but the CMS ratings are also comprehensive. So it’s not just the surveys that veterans take after they’re hospitalized. These are also, you know, longstanding metrics that we’ve reported to CMS for some time and report to ourselves internally. And we use all of that data to improve care on behalf of veterans.

Tom Temin But overall, you’re pleased with how VA came out in this latest round of CMS studies.

Dr. Shereef Elnahal We are pleased with that and we’re trying to use it as an opportunity to gain the trust of more and more veterans, given a really important law that the President signed last year called the PACT Act, which allows us in particular to expand services and benefits to veterans exposed to toxic substances. And a really important deadline that I want every veteran to be aware of is September 30th of this year, just about a month from now. When a really critical enrollment opportunity will expire for veterans for discharge from service before October 1st, 2013, and served in one of the post Gulf War or post-9-11 conflicts. So if you’re a veteran who served in Central Command during that period of time, was discharged before October 1st, 2013, you have an opportunity to directly enroll in VA health care by going to V-A -dot-gov slash P-A-C-T or calling 1-800-my-V-A-4-1-1.

Tom Temin I know you had to get that in. And also, the fact is that you have gotten about a million applications coming through the VA side. Have they hit the hospitals yet? Have they hit the medical side yet? The ones that have been signing up for the PACT Act so far.

Dr. Shereef Elnahal They are. In fact, you mentioned more than 1 million claims have already been filed with our Veterans Benefits Administration and we’ve enrolled more than 100,000 veterans and a population that we identified as soon as the law was signed who we thought could benefit and enroll in VA health care. This is a group of folks that were not enrolled in VA health care when the law was signed, and we’ve enrolled more than 130,000 of them in the year since it was signed. And so we’re going to keep making sure we get the word out about the PACT act, about the many new opportunities to enroll and try to get as many veterans as possible to go into the new doors, into our system.

Tom Temin And by the way, getting back to the survey, you probably can also gauge or view the quality, perceived quality of institutions nearby the VA medical centers that might be part of community care. And that must be useful information to know, well, you can go there too, but you know, we’re better or whatever.

Dr. Shereef Elnahal That’s right. For the first time, because we’re included in these CMS ratings, veterans can search by region, by city, wherever they live, and they can see the ratings for VA medical centers, but also civilian hospitals and do their own comparison.

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