The Veterans Affairs medical system is working as well or better than non-VA care, researchers with the RAND Corporation found in a study released on Thursday, with the caveat that there was "high variation" in quality across facilities.
The study, commissioned by the U.S. Department of Veterans Affairs and mandated by the 2014 law that established the VA Choice program, comes as Congress inches toward expanding the VA Choice program.
On average, VA hospitals performed the same or "significantly better" than non-VA hospitals on almost all patient, mortality and effectiveness measures, researchers found. But on average they had worse readmissions.
For outpatients, VA facilities performed better than commercial and Medicaid HMOs; and better or similarly to Medicare HMOs.
Researchers, who looked at fiscal years 2013 and 2014, did note that quality fluctuated significantly across various VA facilities, but they also pointed out that the variation was even greater in the subset of private sector hospitals analyzed for the study. For fiscal 2014, patient experience measures for inpatient VA facilities ranged from a 17 percentage-point difference for discharge information to a 42 percentage-point difference for quietness of hospital environment. The variance was higher for non-VA hospitals on the same measures, with a 39 percentage-point difference for communication with nurses to an 83 percentage point difference for quietness of hospital environment.
The study notes that researchers chose a subset of hospitals that shared similar characteristics to VA hospitals, so they could better draw apt comparisons between the two. The authors looked at teaching hospitals, urban hospitals and hospitals with equivalent numbers of beds.
The VA hospitals fared the worst, when compared to their non-VA counterparts, in the patient-centered quality measure for inpatients, as well as risk-adjusted readmission rates.
A VA spokesperson did not respond to a request for comment on the analysis.
This is the second recent RAND study delving into issues of the VA and prospects of expanding private care options for veterans as Congress works toward passing the promised VA Choice package.
Last month, researchers homed in on New York to ask whether private providers are ready to take on an influx of patients from the VA. The VA health system, which nationally cares for about 9 million veterans, is roughly the size of the Obamacare individual market.
In the New York study, authors found that private providers could assure prompt care but that when factoring in preparedness for conditions common among veterans and familiarity with the military culture "the number of prepared providers dropped precipitously."