Is VA a model for health care? Hard to know, says CBO

McClatchy NewspapersAugust 14, 2009 

WASHINGTON — The Department of Veterans Affairs has made significant improvements to its health system over the past two decades, but the fragmented way that most veterans receive medical care makes comparing the VA with other systems difficult, according to a new report.

The report, which the nonpartisan Congressional Budget Office released late Thursday, says that because VA patients also receive care from private health plans or Medicare, it's hard to measure the quality of the VA system against those other systems.

In recent years, the VA and its supporters have touted several studies that detail the VA's improving quality measures, sometimes saying that those studies show that the agency has the best health care system in the nation.

It's a big turnaround from two decades ago, when the VA was widely derided for the poor quality of its hospital system. Since then, the agency has transformed from a hospital-based system to an integrated network of hospitals and clinics that are commended for their emphasis on preventive care.

Comparing that system, however — and its implications for the debate over overhauling the nation's health care system — with other health plans is difficult, the CBO said.

For starters, the vast majority of veterans who receive some of their care from the VA also get care outside the system. In fiscal 2007, 79 percent of veterans in the VA system also had health coverage elsewhere, typically Medicare but also private health plans, the CBO said.

Veterans often pick and choose where and how to get their medical care, weighing the cost, the distance to the nearest VA facility, the availability of their favorite doctors and other factors. Because medical care received outside the VA system isn't automatically entered into the agency's computer system, the VA often has incomplete records on its patients, the CBO said.

While the VA can use its data to show its own improvement over the years, comparisons of the agency's performance with non-VA providers "are problematic" and "need to be interpreted with caution," the CBO said.

Generally, VA data show that its system performs well on what are known as "process" measures — whether a certain test was ordered, for example. The resulting impact on health outcomes — do patients in the VA system do better or live longer? — is far trickier to measure, however, in part because of the gaps in patients' health records.

"The link between process and outcomes is sometimes elusive," the CBO said.

VA supporters also have said in recent years that the cost of the agency's health care is growing far more slowly than Medicare's is, in part because of the elaborate electronic records system that the VA has built. The CBO, however, said that much of that cost difference is explained by the changing mix of patients as the VA opened its doors to younger and healthier patients. Once that's factored in, Medicare and VA health costs have grown at about the same rate over the past five years, the CBO said.

Last year, the VA treated 5.1 million veterans in its system of 150 hospitals and 900 outpatient clinics.

ON THE WEB

The Congressional Budget Office report

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McClatchy Newspapers 2009

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