Printer Friendly Page
PRIVATIZING THE VA IS BEING DONE FOR POLITICAL
PURPOSES
AND A FAST BUCK -- Veterans' Advocate Jim
Strickland
adds his thoughts to this hot topic.
The "lighter side" of Jim.....
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...
---------------
Larry Scott’s recent article addressing the
privatization of VA healthcare started me thinking. (Article here...
http://www.vawatchdog.org/old%
20newsflashes%20OCT%2006/newsflash10-11-2006-7.htm) His
article was focused on the recent announcement that VA has awarded a 21
million dollar contract to OhioHealth in Columbus, Ohio for inpatient
and some specialty outpatient care.
My career since 1970 has been in the private healthcare sector, the last
years of my career were at the leadership and consulting level so I have
a sort of insiders perspective on what this will mean for the Veteran. I
believe I’m qualified to make comment.
Privatization of Veteran’s healthcare isn’t a pretty picture no matter
how a politician spins it.
Civilian healthcare in America switched tracks over 20 years ago. As a
young man I knew that our hospital’s best doctor was the one who
admitted the most patients and kept them the longest. When a bill was
submitted to “The Blues”; Blue Cross and Blue Shield, they just paid it,
no questions asked. Employers paid most of their employee’s health
insurance and everyone was happy.
We attracted patients by hiring interior designers to decorate rooms
more comfortably, renowned chefs were hired away from their exclusive
kitchens to come to hospitals and cook up some duck L’orange and decant
a spicy Alsace Gewürztraminer to accompany the bird. If we needed more
beds, we raised some money with our powerful social network, named the
new wing after our best doctor and packed in the patients.
Then the California Blues started whining that they weren’t making
enough money and informed hospitals they had to cut some expenses by
ensuring that patients treatments cost less. Rather than being admitted
2 days before your operation you were suddenly required to arrive at the
hospital at 5:30 the morning of surgery and you were given a cheap prep
razor to shave your own incision site before you arrived. Pre-operative
testing was being done on an outpatient basis. Medicare had started this
extremely unpopular foolishness of Diagnosis Related Group (DRG)
payments and hospitals were all getting the same small check for an open
heart operation no matter how long you stayed in the hospital or how
much they charged. Charges suddenly meant nothing. One payment for all,
that was it.
Blue Cross-Blue Shield jumped on the bandwagon and then from our
trendsetting California cousins we heard the dreaded, “Managed Care”
mantra. Much like the DRG of Medicare, managed care set a single price
for a given service. If you got an open heart bypass with 3 vein grafts,
the hospital and doctor got paid (x) dollars and that was it. If you
stayed a month, (x) dollars…stay 2 days, the same (x) dollars. The
players soon discovered the magic to making a profit from all this was
to reduce length of stay (LOS) and the average length of stay (ALOS) for
all comers. No more duck on that menu, how about some lukewarm soup
instead sir? Truth be known, don’t worry about it sport, you won’t be in
here long and you aren’t going to have much time to eat anyhow.
The only way to make money in a hospital today is to become more
efficient, faster, cheaper and all hospitals must make a profit to
survive. If you don’t believe that, talk to your relatives and friends
in cities where hospitals have closed by the hundreds in the last 20
years.
While all this was going on somebody noticed that cutting corners for
profit might not be such a great idea if it weren’t carefully monitored.
If you haven’t fully recovered from that heart operation and go home
quickly to die a day or two later, well…the pesky public relations
people said that may not be great publicity so something had to be done.
The buzz-phrase “Quality Outcomes Management” came into play and is
still a powerful force in effect today. QOM is a way to assign a score
to how well your hospital and doctors did while treating your illness
and to seek ways to improve that score. Studies were done to show that a
certain percentage of people can be expected to live through their heart
surgery and suffer no complications. If your hospital had a score that
didn’t at least match the standard or better it, you might want to shop
around a bit before going there. Certain levels of hospital acquired
infections can be anticipated to happen and if your hospital has less,
great. If more, not so great. You get the idea, it’s not rocket science
in theory although the management of quality outcomes is a tough science
to master. There’s a lot of very difficult math involved to provide a
level playing field and still some scholarly debate rages on but today
we think we understand how to compare health care institutions in
understandable and fair terms.
This QOM concept was being battled in civilian hospitals (particularly
those who didn’t score very well) and nobody was paying much attention
to VA except the Veterans trying to avoid VA hospitals. Many of us
recall that two decades ago a VA hospital was the last place you wanted
to send a sick Veteran…the reputations of VA medical centers were as low
as they could go then. But then somewhere along the way, VA had hired
some serious leadership and they got the message to produce the highest
quality outcomes possible and still manage the costs.
And they did. Today you can’t pick up a paper without an article on how
well VA compares to other “civilian” systems. VA doctors are as good as
it gets, specialty boarded and certified and many are National Guard or
Reserve or Vets themselves so they know their patient’s problems. Nurses
and technicians wait for months or years to get a VA job. Once they have
it, you find them there 30 years down the road, still giving excellent
care to Veterans. VA has set the standard in America and maybe the world
with the electronic medical record they call VISTA. All your health
records, x-rays, lab reports, everything on every VA health center
computer for all doctors to pull up to treat you right. The VA focus on
preventive care is legendary. There is no other health care system on
the planet that gives away health screenings, glucometers, flu shots,
eye exams and assistive devices like VA does to keep you well.
Many scholarly articles are written why VA was able to do this and why
civilian systems are lagging. One theory that made a lot of sense to me
was that VA doctors don’t get to choose what they do. They all treat you
within a given protocol or treatment plan that’s known to be safe,
effective and will likely work for you. VA doctors have bosses just like
the rest of us and they must perform to a certain standard or it’s buh-bye
good VA job and hello to the world of high malpractice insurance and 18
hour days. If they want to keep their prestige jobs, they have to do
their best to make you well because someone is always looking over their
shoulder.
In a 2004 study published in The Annals of Internal Medicine (21
December 2004, Volume 141, Issue 12, Pgs 1-42) researchers say, “Since
the early 1990s, the VHA has worked to improve the quality of the health
care it delivers. An important part of that effort has been a program
that measures health care quality and holds administrators of VHA
medical centers responsible for maintaining high-quality care at their
institutions. Recent studies suggest that, in the areas where the VHA
measures quality, care in the VHA system is better than it is in other
health systems.”
One significant difference between a VA hospital and a civilian hospital
is that a VA hospital doesn’t make a profit. There is no profit motive
but there is a mandate to meet a very tight budget each year while
providing measurably high quality care for Veterans.
I know there are a few who aren’t happy with the results of their VA
care. Even so, I can promise you that on a per capita basis, there are
many more civilians unhappy with their care than are Veterans with the
VA health care.
We also know that the recent Medicare prescription drug debacle is
failing largely due to the way that the players aren’t allowed to
negotiate drug prices like VA does. Vendors quake in their boots at VA
pricing of everything from aspirin to MRI machines. Throughout my career
vendor’s sales representatives winked at me and told me they were going
to give me “VA pricing” on my capital equipment purchase. They weren’t
of course, they would have gone bankrupt in no time. This is one reason
that VA hospitals often seem to have the newest of everything in their
x-ray departments, operating rooms and clinics…they can afford it at
those prices.
Fast forward to today and politicians are trying to privatize the VA on
the theory that somehow that will save big bucks. We’re at war in a
foreign land again and our military forces are fighting for all we hold
sacred and your elected representatives want to play games with injured
Veterans lives.
They propose to hand over the keys to a system that has proven itself to
be the best of the best and then ask OhioHealth to take over the care of
our Veterans for a pre arranged set fee. We already know that VA
negotiates the lowest cost for everything so each Veteran patient in the
OhioHealth facility will be branded as the lowest payer there. The
Veteran’s armband, hospital gown, chart, dietary and pharmacy record may
be stamped with a large red “VA” so that everyone knows he’s a no-pay
patient.
Don’t kid yourself into thinking this doesn’t make a difference to those
dedicated civilian doctors and nurses. It does.
VA patients will rank lower in the hospital’s caste system than the dead
broke and homeless Medicaid patients. VA will pay OhioHealth less for a
Vet’s care than they get for either Medicare or Medicaid patients.
VA is known as a very slow payer. In the last 5 years I’ve switched
eyeglass vendors 3 times because contracted opticians couldn’t get VA to
pay them. They couldn’t survive as a business dealing with VA and
stopped accepting VA patients as they cancelled their contracts, leaving
me in limbo. Eyeglasses are one thing but when the contract runs out
while you’re in the OhioHealth Intensive Care Unit, it becomes a
different ballgame.
Let’s forget quality for a minute and think of some of the other things
we’ll lack. Will there be a canteen or just a snack bar? Where are the
VA Volunteers that are everywhere in a VA hospital today? Are there
Veterans Day memorials in the chapel where grown men can cry openly at
this civilian hospital? Will we see the inspirational and historic
photographs and paintings we see in our VAMC today? Are they taking away
our chaplains, most of who are former military guys? Is there a gift
shop where an old Gunny can get a 4th Marine Division cap to wear during
his radiation treatments? Will DAV be providing van service to and from
the hospital? Do the Veterans Service Organizations have an office where
they’re accessible to the Veteran? Are there Veterans advocates
available?
Privatization of any VA health care does not bode well for the Veteran
or the future of our fighting forces. It’s proposed that we give away
the only function of the federal government that’s scoring an A plus and
relinquish control to a civilian business group who score an average B
at best. This is being done for political purposes in the name of a fast
buck or two. I can’t recommend to a young person today that they should
risk military service. It won’t be worth it if the severe hardships of
military service leave you physically and mentally damaged as happens to
so many. VA won’t be there to care for you, you’ll be just another poor
person lined up in an overcrowded, drab hospital waiting room…always at
the far end of that line.
---------------
Larry Scott
