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AARP: VETTING THE VA -- VA medical care ranks
among
the world’s best. But the system is dogged by
red tape,
disrepair. Older vets worry that the influx of
veterans
from Iraq could crimp benefits.
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http://www.aarp.org/bulletin/
yourhealth/vetting_va.html
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Vetting the VA
VA medical care ranks among the world’s best.
But the system is dogged by red tape, disrepair.
Older vets worry that the influx of veterans from Iraq could crimp
benefits.
By Douglas Waller
The report in February sparked outrage. The revelation that soldiers
recovering from wounds inflicted in Iraq and Afghanistan were housed in
squalid outpatient facilities at Washington's Walter Reed Army Medical
Center also exposed a divide in the care of the nation's veterans.
Beyond the debacle at Walter Reed, which is run by the Defense
Department, are the problems veterans face once they leave active duty
and try to enter the health system run by the Veterans Affairs
Department. That agency has come under fire for tightening eligibility
rules that deny care to hundreds of thousands of vets and for long
delays in processing disability claims. In March a VA review found more
than 1,000 maintenance problems—such as leaky roofs, peeling paint and
insect infestations—at its 1,400 hospitals, clinics and nursing homes.
And last year the agency reported a laptop had disappeared with the
personal information of millions of vets.
On the other side of the divide is top medical care—especially for older
vets—that VA Secretary Jim Nicholson calls "the gold standard" in U.S.
medicine. Outside studies also suggest that VA care exceeds anything
found in the private sector.
Consider:
* A 2004 RAND Corp. report found that in 294 categories of care—many of
them for ailments like diabetes and heart disease—VA hospitals
outperformed private facilities.
* With 51 percent of its patients 65 or older, the VA has pioneered
research in geriatric care. In 2006 the journal Medical Care reported
that Boston University and the VA reviewed 1 million records from 1999
to 2004 and found that males 65-plus who received VA care had about a 40
percent decreased risk of death compared with those enrolled in Medicare
Advantage's private health plans or HMOs.
* The VA's cost per patient has remained steady for the past 10 years,
at about $5,000, while the consumer price index for medical care—what
families pay in the private sector for care—has jumped about 40 percent.
VA prescription drug costs are also lower.
* Veterans are happier with their care than patients in the private
sector. In the University of Michigan's 2006 American Customer
Satisfaction Index, a survey of patients, VA hospitals scored 84 out of
100—10 percent higher than the score for private hospitals. The VA
program is largely free except for small copayments from higher-income
patients.
* The VA is the largest integrated health care system in the United
States, with electronic records of all its patients, so anywhere a
person is treated, the doctor has his or her complete medical history.
Frank Walter Smith, 83, one of several Washington-area vets interviewed
by the AARP Bulletin, is a World War II vet who defused unexploded bombs
in the Army. While he's disgusted by the Walter Reed scandal—"the
government should be ashamed of it"—Smith says he's been "quite
satisfied" with the VA medical care he's received. "On the whole, they
do very well. I haven't seen anything like paint falling off the walls
or mold on the ceilings."
Joseph Violante, national legislative director for the Disabled American
Veterans (DAV), calls the VA medical system "excellent." But he
acknowledges that restrictions on access have kept out hundreds of
thousands of veterans who'd prefer VA care over private plans. [See
sidebar, "Who's Eligible?"]
Moreover, groups like the DAV and American Legion fear that older vets
from earlier wars might see their care scaled back because of the influx
of wounded Iraq and Afghanistan vets.
The VA hospitals "aren't falling short yet," says Peter Gaytan, director
of veterans affairs and rehabilitation for the American Legion. "But
they could be, and they need to be well prepared."
So far, 205,000 of the 631,000 Iraq and Afghanistan war vets have come
to VA facilities for treatment. Michael Kussman, M.D., the VA's acting
undersecretary for health care, insists they "don't overwhelm our
system," which expects to care for 5.5 million veterans this year.
Kent Gilmore, a 56-year-old former Army medic, says VA surgeons saved
his life last June when he was stricken with a perforated colon and
inflammation of the abdominal cavity. While the surge of returning vets
hasn't affected his treatment and recovery, he thinks that if the VA
doesn't get more funding, "there may be cuts in everyone's care in the
future."
Congress is expected to approve an extra $1 billion or more for the VA's
$32 billion health care budget this fiscal year to accommodate new vets,
and the Bush administration has asked for $34 billion for the next
fiscal year.
For now, the VA is scrambling to distance its operation from the scandal
at Walter Reed and to preserve the reputation for five-star medical care
it built in the 1990s. Before then, the agency, which treats mostly vets
with service-related disabilities, was considered the black hole of
American medicine, with more than 1 million vets warehoused in decrepit
conditions.
Starting in 1994, Kenneth W. Kizer, M.D., VA health undersecretary,
shook up the agency's cumbersome bureaucracy, closed underused hospitals
and plowed the money saved into opening 300 more clinics around the
country. He also hired former astronaut James Bagian, M.D., who revamped
the patient safety program and encouraged medical personnel to report
procedures that could harm patients, without fear of reprisal.
Kizer set up cost-saving incentives and performance standards for
doctors to keep patients healthy and out of the hospital. Neal Evans,
34, a physician at the VA hospital in Washington, gets an end-of-year
bonus not for the business he brings in but for, say, how many of his
patients have lowered their blood pressure. He writes them regularly, to
remind them of their last cholesterol or blood sugar level. "If it's
still high," he says, "I ask them to schedule an appointment."
As word of the VA's improved medical care spread, hundreds of thousands
of vets ditched their private plans to join the VA program. Richard
Niedermair, 74, a Navy machinist mate from 1951 to 1955, switched five
years ago and saw his monthly drug bill drop from $400 to $65. When he
visits the VA's Greenbelt, Md., clinic, he says, "I barely get my coat
off, and they call me into the doctor's office."
But the VA didn't have the funding to handle the flood of new enrollees.
By 2003 the list of vets waiting six months or more for their first
appointment had grown to 310,000. The VA finally had to restrict access
only to vets with service-related injuries or with low incomes—a move
that still rankles veterans groups, which complain the VA shut the door
to half a million lower-priority vets who wanted to enroll.
As of mid-March, the list of those waiting 30 days or more for their
first appointment was down to 1,707.
Despite improvements in the VA system, there's still room for more. Many
facilities, for example, are showing their age (the average is 58 years
old). Officials say 90 percent of the maintenance problems found in the
March review were for routine wear and tear.
And sometimes medical mistakes occur. Last year a surgical team at the
VA's Tampa, Fla., hospital placed an unsterile cranial plate in the head
of a wounded vet and was saved from repeating the error on another
patient when the implant didn't fit. A nurse discovered the plates
hadn't been shipped presterilized, and e-mail alerts were sent to other
VA medical facilities.
But even the VA's mistakes may prove instructive. Many private hospitals
don't report close calls or investigate them, says patient safety expert
Bagian. "In most places nobody would ever tell anybody," he says. "The
VA didn't try to cover it up." And the patients didn't get infections.
Douglas Waller is a former senior correspondent at
Time magazine.
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Who’s Eligible?
Only about 5.5 million of almost 24 million American vets are receiving
VA medical care.
* All who served on active duty in the Army, Navy, Marines or Coast
Guard (and Merchant Marines in World War II) and who were not
dishonorably discharged are eligible.
* But because of budget limitations, the VA can't enroll all vets and
has set up a priority system. The highest priority: vets who incurred
injury or illness as a result of military service or who have low
incomes. Since 2003, the VA has suspended enrollment of veterans in
Priority Group 8— higher-income vets with no service-related
disabilities.
* Active-duty, Reserve and National Guard members who served in Iraq and
Afghanistan are eligible for free VA medical care for two years after
their discharge.
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Larry Scott --
