Study examines Veterans Health Administration medical care services

by Lucy Turnipseed | 1/4/19 3:00am

Veterans around the country should give more consideration to the Veterans Health Administration’s services when choosing where to receive medical care, according to a recent study on the merits of VHA and non-VHA facilities published in the Annals of Internal Medicine at the end of 2018.

Researchers from The Dartmouth Institute for Health Policy and Clinical Practice and the White River Junction Veterans Affairs Medical Center worked on the study. TDI professor William Weeks who also teaches psychiatry and community and family medicine at the Geisel School of Medicine and Alan West ’72 from the White River Junction Veterans Affairs Medical Center were the primary authors. The study follows many recent projects on the same subject, using large, cross-section samples of patients in and outside of the VHA system to reach its findings.

“We wanted to take a closer look at local health care markets and specific health conditions because if you’re a veteran deciding where to seek treatment, what you’re really concerned with are the outcomes at your local VA,” Weeks said.

Weeks said he saw a problem with previous VHA studies, explaining that the large scale was not helpful to veterans seeking a facility in their own health care markets.

“It’s like reviews of your local Chipotle [Mexican Grill] and Chili’s [Grill and Bar] — you don’t care about their national reputations, you care about how the Chipotle [Mexican Grill] down the street is,” he said.

The study used the most recently posted, publicly available data from Hospital Compare, a consumer-oriented website that is part of Centers for Medicare and Medicaid Services. Researchers focused on 121 local health care markets that included both VA and non-VA health facility options. The study focused on the outcomes of patients with four common diseases: acute myocardial infarction, chronic obstructive pulmonary disease, heart failure and pneumonia, as well as 11 different patient safety indicators, such as death among patients with serious treatable complications after surgery. These data sets were readily available for researchers to analyze.

“Our findings suggest that, despite some recent negative reports, the VA generally provides truly excellent care,” Weeks said.

The outcome of the VA providing consistently better local care came as a surprise, he added.

VA Secretary Robert Wilkie described the conclusions of the research as “proof that the hard work and dedication of our VA employees is making a real difference in the lives of our nation’s Veterans,” which is a sentiment Weeks shared.

A study done in 2015 on the same subject, authored in part by RAND Corporation adjunct policy researcher Claire O’Hanlon, reached the same conclusion.

“We found that the VA health system performed better than or similar to other health care systems in providing safe and effective care, although there were some exceptions,” O’Hanlon said.

As its data bank, the team used MEDLINE’s cache of biomedical literature on the topic from the last decade.

“Despite problems and bad press, the VA has been doing a pretty good job,” West said. “But much better controlled studies will be needed to draw strong conclusions.”

However, the recent study did find some indications, within a few particularly positive statistics posted onto Hospital Compare by VA centers, that differences in data reporting between VA and non-VA health facilities may exist.

If reporting differences are real, the researchers suggest that VA center employees re-calculate the data submitted to Hospital Compare and closely analyze outputs in the future, so that the information consumers consult when considering where to seek health services will be more accurate.

“The VA health care system is one of the largest integrated health systems in the country, providing health care to over six million veterans annually,” O’Hanlon said.

She noted that the public should keep in mind that individuals who receive care from the VA are generally “a lot sicker” than individuals with similar demographic characteristics in the general population.

Additionally, while Wilkie lauded the progress made within the VA under the Trump administration, he disagreed with a key component of the study — that the VHA outsourcing to non-VA hospitals should be reconsidered. There is currently legislation in the works that would move the VHA further toward privatization, of which Weeks has long been a proponent. However, he warns that this move should be done carefully, with close attention paid to what actually needs to be outsourced, such as the particular services that different VHA centers cannot provide.

“The VA needs to look at what they do well and focus on that,” Weeks said.