Many observers have wondered about the glaring disconnect between the strong reputation the Department of Veterans Affairs healthcare system has enjoyed for quality of care, and the ongoing revelations about long waiting times, off-the-books waiting lists, and in some cases, serious quality and safety problems at VA facilities around the country. Indeed, Modern Healthcare reporters recently called Kizer and Jha, two leading experts on the VA system, to ask for their assessment. But they obviously were already busy working on their own article diagnosing the problem.
Their evaluation goes beyond solutions offered by the divergent ideological camps—either pouring more money into the VA system, or shifting more veterans’ care from the government-run system to supposedly superior private healthcare facilities. Kizer and Jha explicitly rejected that dichotomy, saying “neither narrative adequately captures the challenges.” Kizer has particular credibility because, as the VA’s Under Secretary for Health from 1994 to 1999, he is widely credited with helping turn around the troubled system and building its reputation for coordinated, high-quality care.
In their article, Kizer and Jha acknowledged that inadequate numbers of primary-care providers, outdated facilities and dysfunctional scheduling systems are part of the problem. But they primarily blame poor VA leadership, unrealistic performance standards, increasingly unworkable quality measurement tools, extreme bureaucratic centralization, and growing isolation from the private healthcare sector.
Their prescriptions are promising, but a little less clear than their diagnosis. They urge the VA to pare back its quality measurement system to far fewer measures, particularly access to care, mortality rates, infection rates, and patient satisfaction. To improve access, they want the VA to deploy state-of-the-art information technology to better connect patients and providers and address individual patients’ needs. Additionally, they recommend that the VA participate fully in public performance-reporting programs with outside entities, such as the CMS’ Hospital Compare and the Leapfrog Group’s patient-safety assessments.
Acting Secretary of Veterans Affairs Sloan Gibson appears to agree with their view that previous VA leaders created a “toxic milieu” by imposing an unrealistic and flawed waiting time-monitoring system upon which employee performance was measured. On Thursday, Gibson announced the agency will remove the 14-day scheduling goal from employee performance contracts “to eliminate any incentives to engage in inappropriate behavior.”
Now we’ll see what he or whoever takes over as VA Secretary will put in place to ensure that veterans get timely access to quality care. VA leaders should start by studying Kizer’s and Jha’s diagnosis and prescriptions.
Follow Harris Meyer on Twitter: @MHHmeyer