Veterans' Advocate Jim Strickland looks at study by Dr. William Weeks of the Dartmouth Institute for Health Policy and Clinical Practice.

-------------------------

Veterans' Advocate Jim Strickland provides regular columns for VA Watchdog dot Org.  If you would like to contact Jim about his columns, you can email him here...  The archive of Jim's articles is here...  To find an answer to a specific VA benefits question, use the VA Watchdog search engine... click here...  And, be sure to use Jim's:  A Military Veterans Guide To Disability Compensation and Pension Benefits -- A Compendium of Resources and Knowledge For The Disabled Veteran -- click here...   JIm's series for new vets, "Welcome Home," is also featured on Military.com. And, you can follow Jim on TWITTER here ...

-------------------------

-------------------------

by Jim Strickland

I recently received this email:

Dear Jim,

My colleagues and I have published an article I believe you and your readers will find interesting. In summary, the study we conducted shows that there is plenty of room for improvement in VA care, particularly as far as containing costs goes.

Our research showed that, overall, VA care costs 33% more than if it were purchased in the private sector; inpatient care provided at the VA costs 56% more than comparable private sector care.

While we believe that veterans continue to receive high quality preventive health care, it is apparent that VA could do better by outsourcing inpatient services (particularly surgical care) to high performance private sector hospitals for three reasons:

1. costs of care would decline

2. risk-adjusted mortality rates for a number of surgical procedures are higher within the VA than in the private sector and

3. despite recent passage of the Health Care Personnel Enhancement Act, the VA does not offer proceduralists comparable salaries, and is unlikely to in the future.

William B Weeks, MD, MBA
Office of Professional Education and Outreach
The Dartmouth Institute for Health Policy and Clinical Practice
35 Centerra Parkway, Room 209
Lebanon, NH 03766

My thanks to Dr. Weeks and his colleagues for delivering this important data (recently published in the Journal of Health Care Finance) directly to the readers of VA Watchdog dot Org.

I was somewhat surprised to see the conclusions you draw. I'm one who has always considered older studies that show VA far and away as being a leader of extremely cost effective care as well as having superior outcomes in most studied disciplines.

It's apparent that all that isn't quite true in today's world. Your points are well taken. When I stand back and consider, for example, the cumbersome and top heavy administrative burden at a VA medical center, it rivals anything in the civilian sector. We're all quick with criticism when discussing the insurance companies and how many finance staff a civilian hospital must employ but we often forget how loaded down with clerical and administrative types our VA facilities are.

I know that many physicians, nurses and other health care providers who work for VA don't practice much bedside medicine. The majority of their time is spent in administrative duties sorting through massive and often incomprehensible regulations. All that adds to the high costs of running that business. To pay a physician to do administrative work simply doesn't add up.

Beyond that, there are often significant scheduling issues when it comes to major procedures with cancellations and rescheduling being the norm at some centers.

It makes sense that costs could be dramatically lower and veterans would be better served were many of the major procedures fee based out into the veteran's own community when possible. It makes little sense that the veteran may have to travel hundreds of miles to a VA facility for heart surgery if a local civilian center that has excellent outcomes could provide the service. If the local center does more of those surgeries than the VA center, it's more likely than not that total costs would be lower and outcomes will also be better.

Many years ago I was a staunch supporter of continuing the model of the VA Medical Center as the best way to go for veterans. Today, I'm not so sure. One thought that helped me begin to consider other options was how we address veterans educational opportunities as compared to health care services.

After WWII had ended and Congress was making significant decisions about increasing benefits to veterans, there were 3 major items address. There were housing, education and health care.

Housing was to remain largely in the civilian sector with veterans able to use a government backed loan certificate that made getting a loan easier for the returning GI.

Veterans could advance their education at any accredited college or university or trade school they chose. The veteran was given money under the GI Bill and then he or she paid the school directly.

Only health care was segmented off to provide a veteran-specific solution. The Congress didn't build many wide tracts of veteran only homes nor did they establish a system of veteran only colleges across the country.

The popular thought seemed to be that veterans health needs were different from the rest of our populace and that the VHA would be best to manage that need. The massive system of VA health acre facilities came to be and promptly failed. Most researchers as well as most veterans would agree that during the 1960's through the period to about the late 1980's, VA health care had a deserved reputation as one of the worst systems imaginable.

Most of us did all we could to avoid VA care at any cost.

Throughout the 1990's to today the VHA system has made great strides in performance improvement, customer service and the tracking of high quality outcomes. In spite of some shortcomings, most of us who use the VA system give it very high marks.

However, Dr. Weeks' research indicates that all isn't as it would seem at first glance.

Now that this data is available, Congress and the VHA should begin to consider alternatives based on this most current research.

I suggest that a good place to start would be to remove administrative burdens from health care providers and put them back on the front lines to do what they were trained to do...take care of patients.

From there, the possibilities are limitless. An overall reduction in the huge number of administrative and clerical staff would seem a logical next step. It's no secret that the VHA is locked in a stranglehold by unionized workers who add very little to productivity and a great deal to the overall costs.

As our country weighs decisions about providing changes in health care for all its citizens, the time has come to assess just what we want our future VHA to look like.

You may read Dr. Weeks' article here ... (Click for viewing or download.  Note:  There is a second study in this document which I will be addressing in a future article.)

-------------------------

TOPICS: veterans, veterans' benefits, VA, Department of Veterans' Affairs, Jim Strickland, Veterans' Advocate, Dr. William Weeks