DonovanSlack ,USA TODAY 3:05p.m.ESTDecember7,2016
WASHINGTON —The Department of VeteransAffairshasfor yearsassigned star ratingsfor each of its medical centersbased on the qualityof care and service theyprovide, but the agencyhasrepeatedly refused to make them public, saying theyare meant for internal use only.
USA TODAY hasobtained internal documentsdetailing the ratings, and theyshow the lowestperforming medical centersare clustered in Texasand Tennessee. VA hospitalsin Dallas, El Paso, Nashville, Memphisand Murfreesboro all received one star out of five for performance asof June 30, the most recent ratingsperiod available.
Manyof highestrated facilitiesare in the Northeast —in Massachusettsand New York—and the upper Midwest, including in South Dakota and
Minnesota. Those medical centersscored five out of five stars.
The VA determinesthe ratingsfor 146 of itsmedical centerseach quarter and basesthem on dozensof factors, including death and infection rates,
instancesof avoidable complicationsand wait times.
USA TODAY Networkispublishing the ratingsin full for the first time so that membersof the public—including patientsand their families—can see
how their local VA medical centersstackup against othersacrossthe country.
Some lowerranking medical centershave remained poor performersdespite highprofile crisesand yearsof attention and resourcesfrom
For instance, the PhoenixVA wasa onestar medical center in 2014 when newsbroke that veteranshad died awaiting care there while schedulers
kept secret wait listsmasking how long veteranswere waiting for appointments. The revelationstriggered a national scandal, hearingson Capitol Hill and the replacement of the VA secretary.
Phoenixremained a onestar facilityin the most recent ratings.
VA Undersecretaryfor Health David Shulkin cautioned against using the star ratingsasa “ranking tool” and said theyare considered an “internal
“It isessentiallya system within VA to see who’simproving, who’sgetting worse, so we can identifyboth,” Shulkin said.
The documentsobtained byUSA TODAY list star ratingsfor everyfacilityfor the fourth quarter of 2015. The VA subsequentlyagreed to provide a list
of one and fivestar facilitiesfor the quarter that ended June 30, the most recent ratingsavailable, but declined to identifythose with two to four stars.
Shulkin said he wasapprehensive about anyratingsbecoming public. Myconcern isthat veteransare going to see that their hospital isa 'one' in our star system, assume that’sbad qualityand veteransthat need care are not going to get care,” he said. “And they’re going to stayawayfrom hospitals
and that’sgoing to hurt people.”
But without the star ratings, membersof the public—including patients, membersof Congressand others outside the agencywho could hold it accountable —have no wayof knowing whether VA medical centersare
improving or declining, except to plow through a dizzying arrayof hundredsof spreadsheetson the agency’s website.
“The data’sthere, but you’d have to be an expert to get through it,” Shulkin conceded.
He said 120 of the 146 medical centersthat the VA rateson the star scale have shown improvement since he began overseeing the VeteransHealth Administration in July2015. He said all of the onestar facilitieshave shown improvement except for the VA medical center in Detroit, which
Pamela Reeves, director of the Dingell VA Center in Detroit, said that officialsthere are "working closelywith our performance improvement teamsin the development and oversight of action plansto addressthe
opportunitiesidentified bythe …data.” In Phoenix, VA officialsappointed a new director in October and are pumping millionsinto the effort to improve the medical center.
Shulkin said that nationwide, medical centerswhere performance hasdeclined are getting extra scrutinyand help from national VA officials. If theystill
don’t show sufficient progress, hospital management could be replaced.
That’swhat happened in Wilmington, Del., where the VA ousted the medical center’sdirector in October after monthsof deteriorating quality. Wilmington wasamong several hospitalsplaced on a “highrisk” watch list earlier thisyear because of declining performance, according to the internal VA documents.
Also on the list were hospitalsin Tomah, Wis., and Oklahoma City, Okla.
The Tomah VA Medical Center made national headlinesnearlytwo yearsago after a veteran died there when he wasprescribed a fatal cocktail of
narcotics. A USA TODAY investigation published last December revealed gaping lapsesin care (/story/news/politics/2015/12/22/veteranssufferingpoorvacaredespitewashingtonfixes/77556860/) at the Oklahoma CityVA.
Rep. Jeff Miller, RFla., chairman of the House Veteran'sAffairsCommittee, said the VA should immediatelyrelease all the ratingsand qualitydata and do so on a continuing basis. He argued that the statusquo —“in which VA officialsoften attempt to downplayand sometimesmislead the publicabout
seriousproblemsuntil it'stoo late” – isunacceptable.
"The secrecywith which VA treatsthese qualityratingsisalarming,” Miller told USA TODAY. “Veteransseeking care at VA hospitalsdeserve to know exactlywhat theyare walking into. Additionally, Congress, taxpayersand
other stakeholdersneed to have a quickand efficient meansof comparing the performance of variousVA medical centersin order to identifyfacilitiesin need of improvement.”
AlexHoward, senior analyst at the Sunlight Foundation, a nonpartisan transparencyadvocate in Washington, said there’s“no rationale that I see for withholding that from veterans, much lessthe general public.” “I would thinkthe onlyentitythat wouldn’t want that data publicwould be the facilitiesthemselves, which isnot sufficient cause,” he said.
The VA also rarelyreleasesnationwide averagesshowing overall improvementsor declinesin agency performance measures, so it can be hard to determine exactlywhat’schanged since the scandal in 2014, when President Obama tapped Bob McDonald, a former Procter & Gamble CEO, to take over assecretaryand overhaul the agency.
The documentsobtained byUSA TODAY detail those averages, and when asked about them, VA officialsagreed to provide updated statistics. Overall,
the data show something of a mixed bag, with improvementsin some areasand declinesin others.
On average, veteransare dying at lower ratesand contracting fewer staph and urinarytract infectionsfrom cathetersin VA medical centerssince
2014. Veteransare not staying aslong in VA hospitalsand theyare being readmitted within 30 daysat lower rates.
At the same time, veteransare experiencing higher ratesof preventable complicationsduring hospital stays, on average, than theydid in 2014. Those
on ventilatorssuffered more problems, such ascatching pneumonia, and the rate of turnover for nurseshasincreased.
The VA hasalso seen increasesin the percentage of veteranswho have to wait longer than 30 daysfor appointmentswhen theyare new patients. Overall, more than 500,000 veteranswere still waiting longer than 30 daysto be seen asof Nov. 15. More than 125,000 of them were waiting
longer than two months, and 46,000 were waiting more than sixmonths.
Shulkin said half of the 500,000 appointmentsare for more minor needssuch asdental, hearing, vision and diet consultations. “I can sleep at night,”
he said. “The onesI worryabout are the oneswho can’t wait or shouldn’t be waiting, so that’swhere our entire focusof our system isright now. I don’t
care about you waiting for eyeglasses, I mean that’spoor customer service, I understand, but I do care if you have a lung nodule. I mean, that
Shulkin said the number of veteranswaiting longer than a month for urgent care hasdecreased from 57,000 to 600 since he tookover last year.
And he sayshe isworking to ensure that veteransget samedaycare —if theyhave urgent needs—at VA medical facilitiesacrossthe countrybythe
end of the year.
“If you have an urgent care problem, your wait should be zero,” he said.
The Department of Veterans Affairs has for years secretly rated its medical
centers on a scale of one to five stars, with one star being the worst and five
being the best. USA TODAY obtained internal documents listing the ratings and is publishing them here for the first time. Search for a state, town, hospital name or star rating below.
SOURCE: VA internal documents obtained by USA TODAY; Current VA data.
The VA agreed to provide USA TODAY updated ratings for one- and five-star
medical centers, but declined to provide updated ratings for the rest. These are marked with * above.
HOW DOES YOUR VA STACK UP? Guys, go to the article link and scroll to the bottom. There you'll see the star rating for your VA facility. HH: http://www.usatoday.com/story/news/p...rans/94811922/