Data Spur Changes In Va Care

[allan]

Subject: Data Spur Changes In VA Care

Wall Street Journal

March 29, 2011

Pg. D4

Data Spur Changes In VA Care

By Thomas M. Burton

Hospitals serving U.S. military veterans are moving fast to improve care after the government opened a trove of performance data -- including surgical death rates -- to the public.

The U.S. Department of Veterans Affairs in November started posting online comparisons of the nation's 152 VA hospitals based on patient outcomes: essentially, how likely patients are to survive a visit without complications at one hospital compared with the rest.

This unusually comprehensive sort of consumer information on medical outcomes remains largely hidden from the tens of millions of Americans outside the VA system, including many of those in the federal Medicare system.

While many of the nation's nearly 23 million veterans have yet to catch on to the program, the quick response by some poor-performing VA hospitals underscores the potential impact of releasing such data.

The information was released at the urging of VA Secretary Eric K. Shinseki. Among other things, it presents hospitals' rates of infection from the use of ventilators and intravenous lines, and of readmissions due to medical complications. The details have been adjusted to account for patients' ages and relative frailty.

Hospitals that fall into the bottom 10% of national results can expect the VA to intervene with actions ranging from urging medical improvements to dismissing doctors."The VA secretary pays attention to this," says William E. Duncan, the agency's associate deputy undersecretary for health quality and safety. "Unless people in the VA system have an organizational death wish, they will pay attention to this, too."

When VA hospitals in Virginia and Oklahoma learned an abnormally high number of their patients contracted pneumonia while on ventilators, they took steps to cut the rates. And a hospital in Kansas City, Mo., that recently ranked relatively poorly on surgical-death rates says it has improved by making staffing and other changes in radiology, cardiology and emergency medicine, including better avoiding hospital-borne infections.

Still, after seeing that the Kansas City VA Medical Center's posted surgical-death rate was about 79% higher than expected for the severity of its patients' illnesses, a veteran might opt for the VA hospitals in St. Louis; Columbia, Mo.; or Wichita, Kan.; which posted relatively lower surgical-fatality rates. Former soldiers, sailors, airmen and women and Marines are free to choose among VA facilities.

"Why would we not want our performance to be public? It's good for VA's leaders and managers, good for our work force, and most importantly, it is good for the veterans we serve," Mr. Shinseki said in an emailed statement.

The same sort of information is nearly impossible for most Americans outside of the VA system to get.

Medicare, the nation's largest medical-insurance program, publishes risk-adjusted death rates only on patients suffering from congestive heart failure, heart attacks and pneumonia. Medicare directly serves nearly 50 million patients, and most other Americans get essentially the same care and information about their hospitals as do Medicare recipients.

A November 2010 report from the Health and Human Services inspector general concluded that one in seven Medicare patients is harmed by medical care, nearly half of those avoidably.

Medicare spends billions of dollars every year for care of patients who have been rehospitalized or endure lengthy hospital stays after bleeding, infections and other post-surgery complications. Rehospitalization alone costs upwards of $15 billion a year, according to estimates by Medicare and others.

Medicare does publish extensive data about medical processes, such as whether a heart-attack victim was given an aspirin or a beta-blocker.

"More is planned in the way of outcomes measures," said Michael T. Rapp, Medicare's director of quality measurement. He says the agency later this year will publish details such as post-surgery respiratory failures, accidental punctures and surgery deaths from certain complications.

One reason the VA can offer such detailed data is that it operates a closed, centrally managed system, whereas Medicare and the broader health-care system encompass a wide array of hospitals with disparate management and computer systems.

The VA's November data release was the first version and will be made more user-friendly, Dr. Duncan says.

The system's results aren't broken down by specific type of operation-say, how a patient might fare in liver or prostate surgery-but the VA's Dr. Duncan says that is being considered. Nor has the VA embraced another step advocated by some medical-quality

experts: Checking to see, for instance, whether a patient is cancer-free a year after surgery, or whether a patient's reconstructed knee works right.

At VA hospitals in Oklahoma City and Salem, Va., the rate of pneumonia acquired by patients on ventilators was shown last fall to be significantly higher than the national VA average. The Salem hospital says a relatively low number of patients on ventilators skewed its infection rate higher, but staff members at both facilities say the numbers prompted action.

Seeing the data helped, says the Salem hospital's chief of surgery, Gary Collin, because "you can become kind of complacent."

VA officials say the data push hospitals to constantly improve. "There's always a bottom 10%," says VA Deputy Undersecretary William C. Schoenhard. "When one hospital improves, somebody else goes in the barrel."

Full Disclosure

Some information the VA publishes, by hospital:

*Surgical death rate, over the past 12 months

*Acute-care death rate

*Intensive-care unit death rate

*Ventilator-acquired pneumonia rate

*Rate of intravenous-line infections

*Hospital readmission rate

"Keep on, Keepin' on"

Dan Cedusky, Champaign IL "Colonel Dan"

See my web site at:

http://www.angelfire.com/il2/VeteranIssues/

http://www.facebook.com/dan.cedusky

[john999]

VA hospitals should be the light on the hill for all other medical in our country. The VA should set the standard instead of cutting corners and trying to get by the cheap way.

[Vync]

Here's the link to the compare site:

http://www.hospitalcompare.va.gov/index.asp