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I get the regular emails from Colonel Dan.

This one is about how the VA lies to congress and the American people about our healthcare.

If this ain't criminal, what the hell is?


From: TESTVET@aol. com [mailto:TESTVET@aol. com]

Sent: Friday, May 11, 2007 4:06 AM

To: colonel-dan@ sbcglobal. net

Subject: nicholson

VA medical system isn't as big a success as officials have asserted

By Chris Adams, McClatchy Newspapers, May 10, 2007

http://www.realciti es.com/mld/ krwashington/ 17206765. htm

WASHINGTON - The Department of Veterans Affairs has habitually exaggerated

the record of its medical system, inflating its achievements in ways that

make it appear more successful than it is, a McClatchy Newspapers study


While the VA's health system has gotten very good marks for a transformation

it's undertaken over the past decade, the department also has a habit of

overselling its progress in ways that assure Congress and others that the

agency has enough resources to care for the nation's soldiers.

The assurances have come at a difficult time for the agency, as a surge in

mental health ailments among returning veterans over the last few years has

strained the system and a spate of high-profile problems with caring for

veterans in the VA and the Department of Defense's Walter Reed Army Medical

Center has provoked heightened public scrutiny.

A review by McClatchy of the quality measures the VA itself commonly cites

found that:

-The agency has touted how quickly veterans get in for appointments, but its

own inspector general found that scheduling records have been manipulated


-The VA boasted that its customer service ratings are 10 points higher than

those of private-sector hospitals, but the survey it cited shows a far

smaller gap.

-Top officials repeatedly have said that a pivotal health-quality study

ranked the agency's health care "higher than any other health-care system in

this country." However, the study they cited wasn't designed to do that.

In general, the VA has highlighted what it says are superior conditions in

its health system. Over the last 10 years, the agency has remade itself,

boosting outpatient and preventive care in a growing network of outpatient

clinics. It's received glowing news coverage for the transformation.

"Today we're positioned as an internationally respected force in health-care

delivery, leading private and government providers across every measure,"

Secretary James Nicholson said in a 2005 speech. "And we can prove it."

On key issues of access, satisfaction and quality of care, however, other

data contradict the agency's statements.

Consider how returning soldiers with post-traumatic stress disorder - a

major ailment to emerge from the war in Iraq - are cared for. The VA's top

health official, Dr. Michael Kussman, was asked in March about the agency's

resources for PTSD. He said the VA had boosted PTSD treatment teams in its


"There are over 200 of them," he told a congressional subcommittee. He

indicated that they were in all of the agency's roughly 155 hospitals.

When McClatchy asked for more detail, the VA said that about 40 hospitals

didn't have the specialized units known as "PTSD clinical teams." Committees

in the House of Representatives and the Senate and experts within the VA

have encouraged the agency to put those teams into every hospital.

Even considering that other PTSD programs are available, there are about 30

hospitals with neither PTSD teams nor any other kind of specialized PTSD

programs, although all hospitals have at least one person who specializes in

the ailment, VA records show.

The VA stood by Kussman's statement. He wasn't referring to a specific type

of team, officials at the agency said, but to the fact that a collection of

medical professionals will tend every veteran, whether or not his or her

hospital has a PTSD clinical team.

Experts inside and outside the VA point to studies showing the agency does a

good job, particularly with preventive care, and that it compares favorably

with the private sector. While that may be true, McClatchy also found top VA

officials buffing up those respectable results in ways that the evidence

doesn't support.


Secretary Nicholson told Congress in February about the VA's "exceptional

performance" in getting veterans in to see doctors. In 2006, the VA said 95

percent of its appointments "occurred within 30 days of the patient's

desired date." In previous years, Nicholson and other VA officials have

touted the department's record on this issue.

Evidence from the VA itself indicates the record might be inflated.

According to a 2005 report from the agency's inspector general, VA

schedulers routinely put the wrong requested appointment dates into the

system, often making waiting times appear to evaporate. In many cases, the

scheduler checked for the next available time slot and declared it the

patient's "desired date."

On Oct. 2, 2003, a veteran was referred to an ophthalmology clinic. On May

3, 2004, a scheduler created an appointment, saying the "desired date" was

June 21. The appointment was scheduled for June 23, the inspector general


Actual waiting time: 264 days. Reported waiting time: two days.

Some schedulers even kept "informal waiting lists" to consult when they were

ready to make formal appointments.

Investigators found that 41 percent of appointments contained errors in the

desired dates, and that only 65 percent of a key type of appointment they

analyzed were within 30 days of the desired dates.

After the report, the VA promised several fixes. But by December 2006, it

had yet to complete them, the inspector general reported. The inspector

general's office continues to find scheduling problems similar to those it

discovered in 2005, according to the VA's Odette Levesque, who's been

briefed on an ongoing follow-up study.

One of those promised fixes was a new training program. As of the end of

April, fewer than half the employees who need the training had completed it,

the VA said.

The agency has made several changes since 2005 and it told McClatchy it

"believes we have met the intent" of the inspector general's

recommendations; it also said that scheduling was "dependent on schedulers

who do make errors."


When he touted the VA's quality before a Senate committee in February,

Nicholson's first bit of evidence was a customer satisfaction survey.

VA satisfaction ratings, he testified, were "10 points higher than the

rating for inpatient care provided by the private-sector health-care

industry. VA's rating of 82 for outpatient care was 8 points better than the

private sector."

Kussman testified the same thing to a House committee.

But a review of data from the University of Michigan's American Customer

Satisfaction Index shows that Nicholson and Kussman compared the VA's

inpatient and outpatient scores to private hospitals' TOTAL score. The total

score combines three surveys: inpatient, outpatient and emergency room. The

VA doesn't do an emergency room survey, and that's what drags the

private-sector numbers down.

"The ER is a far less satisfying experience compared to inpatient and

outpatient services," said David VanAmburg, who directs the annual survey.

Comparing the VA with the private sector's overall score "is not necessarily

an apples-to-apples comparison," he said.

If the VA were to use the correct comparisons, it still would score higher,

although the gap would be half as much - 4 points, in the case of outpatient

care. If the survey were adjusted for age and gender differences between the

VA and private samples, the gap would tighten even more, although it still

would be about 3 points and therefore significant, VanAmburg said.

Asked about the survey, the VA at first said there were some ER patients in

its outpatient survey (although not the inpatient survey), which could make

the comparison with the overall hospital score valid. The VA said it didn't

know how many.

McClatchy then asked about a separate report indicating that about 1 percent

of outpatient visits are coded "emergency unit." The VA conceded that any ER

survey responses would be a "small fraction" of the overall sample.

It added: "To ensure we're providing the most accurate information possible"

about the ACSI survey "we will consider improving how we articulate its



To prove the quality of the VA's medical care, Nicholson and others - often

using identical words to Congress or the news media - repeatedly have cited

a study by the nonprofit RAND Corp.

In the last two years:

-Nicholson said RAND "ranked the overall quality of VA medical care as

significantly higher than any other health-care system in this country."

-Dr. Jonathan Perlin, then the top VA health official, said in a radio

interview that RAND "compared VA care to 12 other health-care organizations,

some of the best in the country," and found VA superior. Studies such as

RAND's showed the agency's care to be "the best that you can get in the

country," he said.

-Kussman wrote in a statement to McClatchy earlier this year that RAND

"recently" reported that veterans "receive better health care than any other

patients in America."

-The VA's public affairs department wrote in a magazine that the study "was

conducted by the RAND Corporation, an independent think tank," as well as

researchers from two universities.

As it turns out, the RAND study was neither fully independent nor all that

recent. A VA grant helped pay for it. Two of its main authors had received

VA career-development awards, and four of its nine listed authors were

affiliated with the agency, according to the study's documentation.

It was published in 2004 but used data from 1997 to 1999, when the system

treated far fewer patients than it does now.

The study does show that VA patients are more likely than non-VA patients to

receive a range of needed tests and procedures. In the eyes of health

experts, that's a real achievement; other studies have found similar


But Nicholson's claim that the agency performed better than "any other

health-care system in this country" and Perlin's assertion that RAND

compared the VA with 12 other health-care systems are wrong.

The study didn't compare the agency with other systems; it compared patients

in the VA with those who weren't.

The non-VA patients were drawn from 12 large metropolitan areas across the

country, while VA patients were drawn from two of its 21 regions. The two

groups were surveyed with very different methods, and the non-VA sample had

a far lower response rate than the VA sample.

Asked about the study, the VA said the agency had partially funded it but

that the preponderance of money came from other sources; RAND has a long

"reputation for independent evaluation," it said.

The VA did say that Perlin's quote was "partially inaccurate in describing

the study," which it chalked up to confusion. It stood by the other


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