In 2006, Business Week did a detailed story on medical care provided by the Veterans Administration.
http://www.businessweek.com/...
this chart from the article provides the damning numbers.
- VA was able to hold cost growth per patient to ZERO!!!!!
- VA was able to be the best provider of service in 16 of 19 areas, better then private hospitals,
better then academic hospitals, better then public hospitals.
More after the JUMP
(Yes I blogged this yesterday, but it's important to hammer the message to educate people.)
To much of the public, though, the VA's image is hobbled by its inglorious past. For decades the VA was the health-care system of last resort. The movies Coming Home (1978), Born on the Fourth of July (1989), and Article 99 (1992) immortalized VA hospitals as festering sinkholes of substandard care. The filmmakers didn't exaggerate. In an infamous incident in 1992, the bodies of two patients were found on the grounds of a VA hospital in Virginia months after they had gone missing. The huge system had deteriorated so badly by the early '90s that Congress considered disbanding it.
I worked at the Loyola Hospital complex in Maywood, we shared quarters with VA Hines/Maywood Illinois.
Nice doctors there, but, the facilities seemed aging, and the care was marginal. I remember the system in the 1970's which was just plain bad. The patients at Lakeside would drift around Chicago, and they always had a ghastly look to them. It was just plain victorian, as if the men had escaped from Bedlam.
Instead, the VA was reinvented in every way possible. In the mid-1990s, Dr. Kenneth W. Kizer, then the VA's Health Under Secretary, installed the most extensive electronic medical-records system in the U.S. Kizer also decentralized decision-making, closed underused hospitals, reallocated resources, and most critically, instituted a culture of accountability and quality measurements. "Our whole motivation was to make the system work for the patient," says Kizer, now director of the National Quality Forum, a nonprofit dedicated to improving health care. "We did a top-to-bottom makeover with that goal always in mind."
No, kidding, they really did a complete makeover. A buddy of mine needed brain surgery, got it done at VA, because he was a Korean War vet. They did a fantastic job on him.
Just fantastic.
How Fantastic is VA?
-- if you want to be sure of top-notch care, join the military. The 154 hospitals and 875 clinics run by the Veterans Affairs Dept. have been ranked best-in-class by a number of independent groups on a broad range of measures, from chronic care to heart disease treatment to percentage of members who receive flu shots. It offers all the same services, and sometimes more, than private sector providers.
According to a Rand Corp. study, the VA system provides two-thirds of the care recommended by such standards bodies as the Agency for Healthcare Research & Quality. Far from perfect, granted -- but the nation's private-sector hospitals provide only 50%. And while studies show that 3% to 8% of the nation's prescriptions are filled erroneously, the VA's prescription accuracy rate is greater than 99.997%, a level most hospitals only dream about.
Let's Repeat that.
VA is higher then anyone else in Standard of Care.
VA maintains a prescription error rate 5 orders of magnitude better then private pharmacies.
and Most Importantly?
This keeps happening despite the fact that the VA spends an average of $5,000 per patient, vs. the national average of $6,300.
VA spends 20% less per patient then Americans do.
The US currently spends $3 trillion on health care. If we put the VA in charge of everything, it would
only cost $1.5 Trillion for every american.
NYCCEVE, Where are you?
Now how did this happen
the VA was reinvented in every way possible. In the mid-1990s, Dr. Kenneth W. Kizer, then the VA's Health Under Secretary, installed the most extensive electronic medical-records system in the U.S. Kizer also decentralized decision-making, closed underused hospitals, reallocated resources, and most critically, instituted a culture of accountability and quality measurements. "Our whole motivation was to make the system work for the patient," says Kizer, now director of the National Quality Forum, a nonprofit dedicated to improving health care. "We did a top-to-bottom makeover with that goal always in mind."
much of the bureaucracy that once hobbled the organization has been streamlined. Kizer ended Washington's centralized decision-making and set up a military-like organization of 22 regional divisions. And doctors don't have to worry as much about malpractice lawsuits, since government agencies are somewhat protected. That made it easier for the VA to go out on a limb in 2005 and institute a systemwide policy of apologizing to patients for medical errors -- an act of contrition rarely done in the private sector. "Most families just want to hear an apology when a mistake is made," says Dr. Jonathan B. Perlin, Kizer's successor as Under Secretary for Health.
The "Sorry Now" program, as it's called, is an extension of Kizer's plan to transform the VA from an unaccountable bureaucracy into a transparent system that constantly seeks to improve care. "They've adopted a culture of patient safety and quality that is pervasive," says Karen Davis, president of Commonwealth Fund, which studies health-care issues.
and what is their key tool for this?
he centerpiece of that culture is VistA, the VA's much praised electronic medical-records system. Every office visit, prescription, and medical procedure is recorded in its database, allowing doctors and nurses to update themselves on a patient's status with just a few keystrokes. In 1995, patient records at VA hospitals were available at the time of a clinical encounter only 60% of the time. Today they are 100% available. Some 96% of all prescriptions and medical orders, such as lab tests, are now entered electronically. The national comparison is more like 8%. "One out of five tests in a civilian hospital have to be repeated because the paper results are lost," says Veterans Affairs Secretary R. James Nicholson. "That's not happening in our hospitals." VistA is a big reason why the VA has held its costs per patient steady over the past 10 years despite double-digit inflation in health-care prices.
VistA has also turned out be a powerful force for quality control. The VA uses the data gathered in its computers to pinpoint problem areas, such as medication errors. The network also allows it to track how closely the medical staff is following evidence-based treatment and monitor deficiencies. Such tracking pays off. When Rand did an extensive study comparing quality of care at the VA with private-sector hospitals, it found that performance measurement played an important role in helping the VA score higher in every category except acute care, where it came in about even
20% of all tests are lost? Think of that, 20% of all lab fees are just because they can't keep track of the paperwork.
Evidence based medical care? Think of that, they have all the data on 12 million patients available for analysis.
At the hospital pharmacy, prescriptions are doled out by robotic devices -- one reason the organization is able to hold co-pays at $8. Each bottle of medicine carries a bar code that is scanned by the computer. If a patient is allergic or takes a conflicting drug, the system will sound an alarm. Similar bar codes are affixed to patient ID bracelets to protect against the wrong patient getting a procedure, a common mixup in hospitals. The bar code idea was thought up by a VA nurse in Topeka, Kan., who noticed that rental cars were checked in with portable bar code scanners and figured the same technology could be used in hospitals.
Any dosing errors are caught by VISTA, any dispensing errors are caught by the robots.
VA because of this has errors reduced to 1:100,000. That's getting close to lightning strikes.
and what does this mean for the Doctors?
Dr. John Sanderson, the Buffalo VA's director of medicine, clicks on to VistA as soon as he enters the clinic each morning to check the progress of his patients. Sanderson is a primary care doctor, so he plays point man in the team of specialists assigned to each vet according to the patient's needs. He meets with an elderly man with severe asthma, takes a quick look at his electronic records, and learns that the patient has not yet had a pneumonia shot. That's a big issue at the VA. The organization has cut hospitalizations by 4,000 patients a year since its pneumonia vaccination rate went from 29% in 1995 to 94% last year.
Sanderson also decides the patient needs to see a pulmonary specialist and arranges an appointment with one on the spot so the vet doesn't have to make a second trip. Such consideration for the patient is evident throughout the hospital. In every department of the giant building hangs a poster with the name, photo, and phone number of the supervisor, inviting patients to call with questions or complaints. The hospital is determined that no patient remain in the waiting room more than 15 minutes. Sanderson would like to get that down to five. After every outpatient visit and inpatient release, a staffer follows up with a call a few days later for feedback on the vet's experience and to make sure there are no problems.
Sanderson is able to spend more time with his patients because he spends less time record-keeping than his counterparts in private practice. That lets him focus on preventive care, and particularly diabetes prevention
So the Doctors are being doctors not clerks, and the patients are healthier, because the computer keeps pinging on what they need.
he VA scored very high in the Rand study on diabetes care -- 70 out of 100, vs. 57 for the private sector. But to keep patients from developing diabetes in the first place, the VA offers overweight patients the opportunity to join a weight-management program that pairs them with a nutritionist. Few insurers will pay for such prevention in a civilian setting. To Sanderson, preventive care is just one reason he is sure the changes at the VA "have saved thousands of lives over the years."
The VA invests in preventative care, which has helped cut their costs.
The VA's mission brings with it some special burdens, however. Its patients are generally older, poorer, and sicker than those in civilian hospitals; there is also a higher prevalence of mental illness and addiction. And it has large numbers of patients with a malady that is much less common in civilian hospitals: post-traumatic stress disorder (PTSD).
And this isn't a cherry picked population of young healthy people.
This is 10 million WW2 geriatric patients, this is 2 Million Korea vets. This is a milllion Vietnam vets.
This is the Old, the sick, the downtrodden. And VA spends $5K/patient/year.
he biggest lesson? A nationwide health-care network that gets its funding from a single payer can institute mighty changes. Proponents of national health-care reform extrapolate even further. "The VA proves that you can get better results with an integrated, organized, national health-care system," says Dr. Lucian Leape, a professor at the Harvard School of Public Health and a leading expert on hospital safety. "We will not achieve even close to the level of quality and safety we need [in the U.S.] as long as we have individual practitioners and hospitals doing individual things."
The VA is, in many ways, the exact opposite of America's fragmented private-sector system, where doctors work for hospitals as independent contractors, and third-party insurers pay the bills as they see fit. By far the largest health-care network in the U.S., the VA serves 5.4 million patients -- double the number it treated 10 years ago. Most veterans are eligible for free or low-cost care, paid for out of the federal budget. The 2006 allocation comes to $35 billion.
The Biggest Lesson?
SINGLE PAYER SAVES MONEY, SINGLE PAYER SAVES LIVES
BTW: I mentioned this on a wingnut website, and the response was
"VA, after Walter Reed, you must be kidding"
Tools. That's the problem with the Wingnuts. For Bonus points,
please put in the comment what the problem is with their reply.
Postscript: VA Does seek 3rd party reimbursement from Medicare and Medicaid, and that has been
running about 5% of their budget. Nice but not critical. The big one is how VA has held the line
on costs growth, despit ehaving an aging sick population.