Before Privatizing the VA, Publicize It

Leah BinderThe Veterans Affairs (VA) hospital scandal has policymakers calling for VA Secretary Eric Shinseki’s head, and this week they got it, when President Obama accepted the Secretary’s resignation.

Some policymakers are also calling for privatizing VA hospitals, allowing them to be owned and operated by the same entities that own and operate the hospitals the rest of us use. This idea assumes the hospital community as a whole performs better than the VA, and the sad truth is we don’t have any evidence of that.

We know that on average, other hospitals are not doing a great job. Upwards of 500 people each  day die from preventable errors in American hospitals, one in 20 admitted patients will get an infection, and one in four inpatients suffer some form of harm unrelated to the reason they went  to the hospital in the first place.

Evidence suggests waiting lists like the VA’s may be common, as well.

So how does the VA compare? We don’t know. We don’t have much data publicly available to begin with, and we have virtually nothing that compares VA hospitals with other American hospitals.

To be clear, data is being collected—it’s just not typically available to humble souls like you and me and the rest of the American citizenry. Hospitals get accredited to receive Medicare and Medicaid payments, but accreditation reports are not made public by hospital. Health plans collect claims data, but most of that is never released to the public. The Centers  for Disease Control,  the Centers for Medicare and Medicaid Services, and other federal agencies collect reams of data, but much of it is not made public,  either.

This dearth of information is why employers and other purchasers of health care formed my organization (The Leapfrog Group), to ask hospitals to report on data they can’t get anywhere else. Their support means it’s free for hospitals to publicly report and free for consumers to access information about hospitals in their community. But only about a third of hospitals participate.

The Bush Administration tried to improve public reporting when they launched a website called “Hospital Compare” and required hospitals receiving Medicare payments to publicly report on a handful of important safety measures. Most of us think it’s obvious that hospitals should reveal problems like infection rates for the enormous amount of Medicare money they receive, but in fact, this was a bold policy breakthrough.

The Bush rule is bold, but for unconvincing and arcane bureaucratic reasons thousands of hospitals are exempt from it—including all VA hospitals. Other exempt hospitals include cancer hospitals, children’s hospitals, critical access hospitals and (weirdly) all hospitals in the State of Maryland.

The Obama administration maintained all those exemptions, including for VA hospitals. In fairness, though, VA hospitals have been transparent by reporting their own set of measures and making that available to the public for free. But the measures they report are not the same ones reported by general hospitals, which means comparisons are limited.

So before we jump to privatize VA hospitals, let’s publicize them. We need to know how they are doing in comparison to private sector hospitals—and vice versa. That means ending the exemptions that give the VA (and thousands of other hospitals) a pass from common-sense rules on public reporting. Sunshine is the best disinfectant, and it’s time to shine a light on VA hospitals—and every other hospital to which Americans entrust their lives.

Leah Binder is the CEO of The Leapfrog Group, a voluntary program aimed at mobilizing employer purchasing power to alert America’s health industry that big leaps in health care safety, quality and customer value will be recognized and rewarded.

She blogs regularly at Forbes, where this piece appeared.

26 replies »

  1. Sunshine is indeed the best disinfectant. I might also rejigger the ratings system (as the article proposes) but focus on outcomes. for instance, how many people who have access to the system die in the catchment areas without having accessed the system in the X months before their deaths? It is way harder to game outcomes measures, though I’m sure — like in the old Mad Magazine Spy vs Spy — they’ll find a way.

  2. No, Joel.

    Advocating for the patient at the bedside is the responsibility of a doctor. It is the competent individual that decides his quality of life with or without his agents. Your personal thoughts on this issue at the bedside except for giving advice are inconsequential.

    Advocating for social policy is something done away from the bedside. That is where one’s thoughts might considered.

    Payment becomes the issue and that is why the government should not be so closely involved. We have seen what happens when governments determine who deserves to live and who deserves to die. The most vivid example was the Nazi’s during WW2. We have to remember that just prior to that time America was the leader in the eugenics movement.

    The alternative to government is that the patient must have significant involvement in the costs of care and insurance. There are many ways of doing this without too great an impact on the healthcare marketplace. Our destruction of the marketplace of healthcare is very much a part of what appears to be your frustration with 90 year olds that might usefully live for another 10 years and might have the ability to pay the price of an extended lifespan.

  3. Then you completely reject your earlier statement and recognize the patient’s right to control his own destiny. Your former statement seemed to be advocating death panels that you blamed on the extreme right.

  4. If the patient is of sound mind his/her wishes MUST be respected first- but to include professional assisted relief from unbearable sufferring

  5. Per Allan’s reply above, perhaps the problem starts with why people think quality of life is just defined by one person. Frankly, I completely agree with Dr Lippin’s comment above per “Stop saving lives that have zero chance of any quality of life” as from neonatal units to trauma centers to ICUs treating 90 year old people, this society can’t handle death,and especially on someone else’s dime expects the full court press even after vitals are flat lined for minutes.

    It is fascinating and perverse simultaneously how all the Obamacare supporters think that a government controlled health care system will be sensitive to individual situations. I really think there is a combination of incredulous naivete, profound ignorance, and new depths to entitlement and dependency brewing in America.

    I know because I see it every, single, day, in the offices I work in the past 5 or more years that precedes this legislative assault on health care.

    I forget who was the woman who would write here in the past that “everything to health care is infinite”. Yeah, the problem is it was her infinite cluelessness and false hope to say this over and over.

    Quality of life includes equally those who are impacted by the patients seeking care to improve this “quality of life”. People demanding full court presses to be kept alive and given the illusion they will return home to their preexisting lifestyles need to look their significant others and other family/friends directly in the eye when asking such supports patients wlll HAVE to rely on perhaps daily for weeks, months, years. These patients have to do some soul searching to realize if that is fair to disrupt other peoples’ lives to have the probable illusion the patient’s life is of full quality.

    Example A is dementia as handled in America as of today.

    Does that answer the question silently?

  6. You really believe a board not the individual of sound mind is entitled to provide the answer?

    Doctor, at the bedside your responsibility is to the competent patient.

  7. ANS- a board of ethical professionals including family members- if the individual is of sound mind the individual should be included of course- The extreme right calls these “death panels” – I call them quality if life and quality of death panels

  8. This is a rhetorical response not meant to be answered, rather meant to be silently thought about.

    Who determines the quality of life of an individual? The individual or a third party?

  9. “I could care less what you offer in many of the debates at these threads anyway.”

    Which is why you feel compelled to keep responding.

    A “bully”? For making comments on a BLOG? Grow a dermal layer.

  10. You are a bully and a jerk, typical to insult people directly and then when called on it or just insulted back, you cry “foul”.

    Frankly, others have called you on it, and yet here we are today with another round. But, I’ll give you this, I do need help, from other colleagues to rise up and stop this BS assault by profit mongerers and frank cost containment that disregards standards of care.

    So, you are right and wrong. Just ignore me, I could care less what you offer in many of the debates at these threads anyway.

  11. You can dish it out but you can’t take any pushback, ‘eh? Your routinely come here and petulantly blast away at everyone, like no one has any worthy views or skills at all. Poignant.

  12. Here is my agrresive plan to begin to fix the VA HealthCare system. We don’t need more hospitals and doctors

    – it begins with improved recruiting health standards- many current recruits (@1 in 5) are unhealthy long before they are recruited

    – improved medical triage on the battlefield .Stop saving lives that have zero chance of any quality of life

    – convince ALL Vets that more is not always better in medicine – it isn’t – often treatments actually harm

    – all above said have zero tolerance for excessive delays and fraud but don ‘t over promise what you can’t deliver

    Dr. Rick Lippin

  13. Bureaucracy of monolithic proportions never leads to advancement nor improvements in interventions, as it just becomes a feeding ground for the nefarious and devious. What, the numbers of sites in the VA system preventing care is now at 40 some different locations, so when is the magic number reached to show what is an indictment of the system, not just aberrant hospitals sporadic across the country?

    I think the denial and rationalization of what profit mongering does to the health care system is endemic here. Both sad and disgusting. But, it is what immature defenses do, keep the characterologically impaired in power and manipulate with ease.

    Oh, and the Bergdahl matter will just sweep this issue under the rug, where the Democraps want it, and later so will the Repugnocants as well. Congress will do it’s job, what an oxymoronic statement that is!!!

    Maybe they’ll schedule his follow up appt in the States in 2 weeks, but, per who’s watch is that time frame being measured?

  14. You are so funny, but thank god this site only has print, visuals at the end of the day won’t be appreciated by all, if you get the point to the adage of “you’re so funny but looks aren’t everything”.

    By the way, Bobby G, your retorts are troll behavior, why the Authors of THCB don’t finally put you in your place is beyond me. Don’t like what I say or preach, fine. Just ignore it, I do fine doing exactly that with your comments elsewhere.

  15. Chris if the VA doctors the waiting list they can also doctor the records. Waiting times can mean a death sentence for many diseases. There have been many problems with the VA so one has to be careful about the way these things are evaluated. Waiting times alone demonstrate the processes necessary for good care are likely not present.

  16. Peter, the Vets are entitled to certain benefits. For some reason, likely in order to make their numbers, at least some VA’s require treatment at the VA even though it can be done elsewhere more conveniently. Medication benefits are generally the benefits that most often create the problem.

    Many patients prefer to use Medicare for what they perceive to be quicker and better care. Based upon what I have seen that, in most cases, is a very good decision. The VA could see them once to check that the medications are appropriate, but that is not good enough and thus there is duplication of services.

    Example one VA used to require the monthly pro time to be done at the VA or else they would not prescribe the medication. Why did the patient have to travel so far? Why did he have to be subjected to duplicate screening. When that same patient required cardiac evaluation and surgery the process was dangerously long. Under Medicare the patient could have been diagnosed, operated on and already home before the first test from the VA was available. Long delays in certain cardiac problems can lead to death before the workup is completed.

  17. I think it’s a mistake to lump every VA facility together as being “bad”, after all there are good and bad private institutions as well. That said, we do need to look at the culture of the VA system in general and how to prevent manipulation of data and neglect of patients.
    What is clear through all of this as I’ve said before, is that having some type of insurance plan does not equate to access for care. The downfall of any health care system is the abiltiy of that system to accomodate the sick and injured. Apparently the VA is having this difficulty, and I fear even under the ACA the private sector will have the same problem.

  18. “Yes, and according to some that is where the mandate for ObamaCare (GovernmentCare) began.”

    Yes, lower wait times by reducing financial access to care.

  19. Allan, no one forces vets into the VA. They can use the private system if they wish.

  20. Publicize what, that bureaucracy screws up health care?! Let me let you all in on a little secret that most of you should have figured out about what, 20 years ago now, that letting people who don’t spend one minute in the exam room who set policy are only focused on one thing, cost and profit, and that has nothing to do with care.

    But, let’s have this disgusting situation be pontificated about for another few months or more before reality sets in and the vets finally tell every one in Congress and inside the VA system the truth, and that is simple this:

    People who defend this country from risk and harm deserve good and consistent care, and those who just want to get bonuses and keep their job while NOT doing their job, well, those cretins who put honest and responsible people at risk, they can go to hell, as AC/DC is singing as I write this post, being a profit mongering a-hole deserves a “highway to hell!”

    The VA scandal as coming out is beyond disgusting, it is a condemnation of what politicians do to health care. And Obamacare, PPACA, whatever the hell you want to call this monstrosity that are Federal intrusions into public care, it will be logarithmic to what the VA is today.

    But, you all here want to pontificate and just minimize what is happening to the people who depend on health care. Hey, there are wallets and purses to fill, oh, and people to get better, that is secondary, eh???

  21. “Evidence suggests waiting lists like the VA’s may be common, as well.”

    Do we have waiting lists for hospitals that last for years? If one hospital is full cannot a patient go to another?

    “The longest wait to see a doctor was in Boston where the average wait was 45.5 days to schedule an appointment with a family physician…”

    Yes, and according to some that is where the mandate for ObamaCare (GovernmentCare) began.

    “So before we jump to privatize VA hospitals,”

    I don’t conclude that we should or should not privatize the VA, but one has to look at the demographics and take note that many people on Medicare get duplicate services for non battlefield injuries and this duplicate care is promoted by the VA. That is costly, wasteful and increases the waiting list for others. There are other groups that could also be treated privately or semi privately. The VA could compensate all of these people at lower cost for reasons exclusive of the question whether or not private is less expensive than the VA.

  22. “So before we jump to privatize VA hospitals, let’s publicize them.”

    While privatizing everything in sight remains the GOP wet dream (right on down to selling the National Park system — can you say “Bald Eagle McNuggets”?), there will be no “jumping” to do this, notwithstanding all the pundit bloviating of late in the wake of the VA CusterFluck. It will take a Republican President concomitant with veto-proof GOP control of Congress. I rather doubt all of that will happen.

    I agree with your core point. Transparency. Dispassionate, credible analysis.