Wednesday, December 11, 2013

Meet The Best Health Care, The VA

Published in Delaware Liberal by ProgressivePopulist on Dec. 11

Yes, the best health care in the USA is the VA.  Not private, for profit care but the system owned and run by the people of the United States, via the federal government.  Yes, government healthcare that is essentially socialized medicine.
How do I know?  I've been under their care for about 15 years and have some basis of comparison having had a career in health care marketing for an equal number of years, working on a strategic level with managements of some of the largest health systems across the USA.  Hands on and very much in touch with the measures by which this field judges its quality.
My own care was with the VA hospital and clinics in Houston and more recently right here in Wilmington, DE up off the Kirkwood Highway.  Issues?  Age (over 70), 35 years of blood pressure treatment, atrial fibrillation, runners knees, eye surgery to correct stigmatism and cataracts, diabetes and a one time cancer scare. Countless clinic visits and tons of meds to deal with the issues above.
A buddy gave me a heads up on the VA years ago  when I was lamenting the shitty care and systems I was receiving from a recently opened huge clinic my then wife's HMO health plan assigned us to.  A real architectural monument with all the external flourishes they taught at architecture school.  Only problem, they ran out of money after paying the architects and failed to bring their patient records and computer systems up to any kind of reasonable standard.  One department's IT system would not talk the the one next door down the hall.  So it was endless refilling out of forms by patients and staff, stop by stop down the hall.   I fired them and went to the VA down the street at the Texas Medical Center when approved.  It took them three months to transfer my medical records to the VA by courier after I hounded them repeatedly to do so.
Anyway, the first sight on my first visit to the VA waiting room filled will fellow geezers made me wonder if I'd made the biggest mistake of my life.  Turns out, they had a system of moving people through their appointments, blood work et al administered by the friendliest desk staffers I'd ever encountered as both a patient and consultant to hospitals and clinics.  Boom, they got it done with smiles, efficiency and compassion like I'd never experienced in the private sector.
Oh, and did I mention cost?  Co-pays for visits about $25 bucks and a list of meds that would choke a horse that cost a fraction, literally, compared to private sector meds pricing. A few hundred a year for about half a dozen meds taken daily.  My rates are based on my income; some pay less, some other low income vets pay nothing.
Systems?  While the rest of health care was debating whether to convert from paper to electronic medical records ad nauseum (they still are debating),  the VA created a system using open source that became the envy of the health care field.  The rest of the world is still catching up.  Records, physician notes, RX regimes, diagnostic results and the images from MRI, Xray, etc. all securely stored and pulled up with lightening speed by the providers.
The actual care delivery?  Primary care by salaried physicians, PA's and Nurse practitioners.  Turns out, the profession has discovered that routine primary care doesn't  need an MD, but these other folks with MD's on staff to consult with patient and them as needed.  Efficient as hell.  Cost efficient too.  So, into one room for labs/blood work, wham.  Out over to the clinic waiting room.  Wham again, visit complete with tons of info, smiles and good history/records update done by the clinician themselves.  Rx refills. Done online and either pick up down the hall in 20 minutes or mailed  to home more often than not. When specialists are needed, often this is provided by local medical school faculty and MD's in training on contract  who come to the VA to provide their expertise.  I've always sought out providers active with medical school faculties for their expertise on current research, not usually acquired on cruises by your friendly pharma or med-technology manufacturers.
And just in the past year, my records were flawlessly transferred electronically from Houston to Wilmington, where I met them with my new MD for intro and review with an appointment made before leaving Houston.  Now, on a smaller scale, the same friendly and efficient clinic visits, labs et al.
And, just introduced in the past year, a fantastic online resource called where I can reorder meds, schedule or change appointments, email questions to my nurse or MD and get same day answers or info.  I can review my meds list on it and can go in an read my medical records and recent visit Dr. or PA notes on my care, situation, etc.  Seamless and secure.
Yes, I am acutely aware of the terrible backlog the VA is fighting to process in new patients. No excuses are suitable for this travesty but sadly, the nation, congress, appropriations committees  et al either did not anticipate the Republican-driven consequences of two unfunded wars and the millions returning damaged forever by amputations, PTSD and other psychological damage wrought on young lives by these obscene misuses of our military. These young people have earned this care and deserve immediate attention, even if it has to be provided temporarily by the private health care sector under contract until the VA can be expanded to do their amazing work for this need breed of veteran.
Results of VA care ?  A 2010 study of available clinical literature on key quality measures concluded:
"Overall, the available literature suggests that the care provided in the VA compares favorably to non-VA care systems, albeit with some caveats. Studies that used accepted process of care measures and intermediate outcomes measures, such as control of blood pressure or hemoglobin A1c, for quality measurements almost always found VA performed better than non-VA comparison groups. Studies looking at risk-adjusted outcomes generally have found no differences between VA and non-VA care, with some reports of better outcomes in VA and a few reports of worse outcomes in VA, compared to non-VA care. The studies of processes of care are mostly those about medical conditions, while the studies of outcomes are mostly about surgical conditions and interventional procedures."
From another source, Phillip Longman of the New America Foundation : see "The Best Care Anywhere," Washington Monthly, January/February 2005), the VA also comes out on top of virtually every study ranking the quality, safety, efficiency, and cost-effectiveness of U.S. health care providers.
Mr. Longman updated his 2005 published work in 2010 with comparable claims.
Doug Waller of Time Magazine, in 2006 wrote this:
"For the sixth year in a row, VA hospitals last year scored higher than private facilities on the University of Michigan's American Customer Satisfaction Index... Males 65 years and older receiving VA care had about a 40% lower risk of death than those enrolled in Medicare Advantage, whose care is provided through private health plans or HMOs... Harvard University just gave the VA its Innovations in American Government Award for the agency's work in computerizing patient records."
Hospital inflation data suggests that during a recent 10 year period, VA costs remained static, with dramatically reduced staffing compared to private sector hospitals whose costs rose 40%.  I'll be writing more about these costs in future blogs.