I’ve worked at a few VA medical centers, including four years at the Phoenix VA. I’d like to report something missed in the media storm. Before spilling secrets, though, I’ll dispense with the non-secrets. Everyone who has entered a VA hospital knows:
Central Texas Veterans Health Care System Waco, Texas
- The system is overwhelmed. While we might have planned for the increasing needs of aging Vietnam-era vets, I doubt anyone predicted two long wars or the number of young vets who would suffer blast injuries and post-traumatic stress.
- Getting care at a VA can be unnecessarily frustrating. Starting with finding a parking space and ending with making sense of your printed discharge instructions.
- Working at a VA can be unnecessarily frustrating. Starting with parking and ending when your privileges are revoked because nobody in admin told you your ACLS card expired.
When the story broke at the Phoenix VAMC, I was embarrassed. If not criminal activity, the investigation would definitely reveal confusion, complacency, and probably deception – in more than one place. Our veterans deserve better.
Accordingly, I planned a bandwagon-jumping blog piece about the broken system and culture. Media and Inspectors General were maximizing national interest in veterans health care, and I’d been cataloging complaints in my head (and in unsent Outlook emails) for years. Finally a conversation was happening, and I could be a part of it. Conversation and an angry John McCain would catalyze a much-needed overhaul.
Then I looked into the actual performance of this broken system. I’d presumed my frustrations and those of my patients correlated with poor care delivery. But here are two secrets I learned which aren’t making headlines:
Veterans health care is good. Look it up. The data is thin but I can’t find anything suggesting outcomes or process measures are worse at the VA. Quoting from the 2004 RAND Corporation study (abstract here):
“…the VA patients received significantly better care for depression, diabetes, hyperlipidemia, and hypertension. The VA also performed consistently better across the spectrum of care, including screening, diagnosis, treatment, and follow-up. The only exception to the pattern of better care in VA facilities was care for acute conditions, for which the two samples were similar.”
Veterans care is also inexpensive. Check out the Congressional Budget Office’s 2007 report. It notes that comparisons were challenging, given a lack of industry-wide standard measures.
(More studies here and here. I’m sympathetic if recent events cast doubt on the data sets. In fact, the CBO reports that appointment wait times were reported inaccurately and shouldn’t be relied upon. I’d like to invite my favorite data analyst, Skeptical Scalpel, to weigh in. Also, I’m curious who has additional or contrasting data)
How can I confirm the inefficiencies and bad experiences and claim VA care is better and cheaper than the private sector? Because neither efficiency nor anecdote address cost-effectiveness. The VA is inefficient, yet cost effective. That is, the goals (blood pressure control, screening exams, etc.) are achieved at a lower cost in a system designed to monitor goals and reduce costs.
The private sector, by contrast, has no overall design and is neither efficient nor cost-effective. The private sector is definitely more efficient in certain areas, such as managing operating suites, but not in the totality of patient care. Integrated systems (like the VA, Kaiser, Mayo) hold substantial advantages for doc and patient over the loosely-connected, variably-accessible array of services most Americans must negotiate. It’s hard for me to follow my private sector doctor’s orders, for example, if I’m sent one place for blood draws, to another for an x-ray, to another for a specialist, and to another for prescriptions. The logistics are a huge deterrent – especially if I’m battling my insurance carrier over each item.
Consider too, that the private sector lab, x-ray center, pharmacy, etc. are all on different record systems – and my doctor has access to none of them. They will use 1970s technology (fax) to communicate my results. When I worked in a private clinic, we hired a person to spend the whole day chasing down faxes, x-rays, and such, because we had no integrated electronic record. The VA had the first electronic record and arguably still has the best. It’s a huge cost savings.
Cost effectiveness can’t easily be tracked or managed in the private sector – outcomes aren’t measured, data isn’t shared, and nobody (or everybody) is in charge of quality. Last decade, orthopedic surgeons across America implanted thousands of defective prosthetic hips then scratched their heads over their bad outcomes, unaware of the results of their colleagues. Meanwhile, Swedish surgeons in an integrated health system stopped implanting the defective hip after 30 cases – their national outcomes registry had revealed the implant problem.
The financial incentives of private health care can be wildly misaligned with cost-effective care. Check out this story about ophthalmologists boosting their incomes by using a $1,000 drug instead of an effective $50 alternative. Instead of better care, the whole fee-for-service model of private care incentivizes more care. More procedures, more lab studies, more revenue. Here’s an example of a trend in dermatology to perform more biopsies because the dermatologists earn income from the pathology service.
I’ve seen suggestions we simply turn over VA care to the private sector. But paying private sector docs to cover overloads is something the VA already does, routinely, at much greater cost over baseline – without evidence of better outcomes.
The VA needs work. It’s inefficient, there is a culture problem, and the recent revelations are shameful. We need to improve access and care to the huge numbers of new veterans joining the system. But, let’s not lose sight of the VA’s success in delivering measurable quality care at low cost. Nor should we presume the private sector is better, without evidence of such.
Chris Porter MD
(Since publication I found this excellent additional reading: Phillip Longman’s take on VA care in 2007.])
This article originates from Chris’ website OnSurg.
Chris Porter is a general surgeon and the founder of the surgeons’ web community at OnSurg. He currently practices at the Richmond VA Medical Center in Virginia.
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I have been going to the VA for over 15 years. All of my experiences have been favorable. I have been treated better than Royalty.
Love it, just goes to show we never get all the information on what is going on, the bad news gets the head lines while the good news slips away.
My VA care when I lived in Maryland (Washington Area) at the Washington VA was the best coordinated care I had received anywhere including several civilian doctors.
The care in Arizona since I moved to the Phoenix area is “lacking” . If my PCD is a doctor she must have left her knowledge in the trash can on the way out of school. The last order of pills took 3 months to arrive at my house. Referrals never happen. Don’t trust anything from down there.
This quote “I doubt anyone predicted two long wars or the number of young vets who would suffer blast injuries and post-traumatic stress.” sounds like an excuse.
When soldiers went to war, the VA should have had the foresight to start expanding services and health technicians. Lessons learned from Vietnam and Korean Wars.
This was a lack of leadership at the top of the VA and the management that was suppose to brief him/her.
I am 100% sc and have used the VA since ’74. I have been to numerous facilities all over the country, some better than others, but have always received excellent care for all my needs. Even women’s health when necessary. The VA in western MA is excellent in my opinion. Northampton and Springfield you might have to wait of course as there are alot of patients but when you get in to see the Dr your needs are met and they spend the time required with you. The dental clinic is outstanding. I only use the VA now as the private sector is in my opinion no different than the complaints I am reading about the VA and more expensive.
I have been going to the VA for 15 years. All of my experiences have been favorable. I have been treated better than Royalty.
I’m Service Connected for my feet when I got out VA diagnosed Me with Morton disease, since I was in the service My complain was pain in the bottom of my feet, over the years VA change Morton disease for plantar fisciitis, VA did a surgery to my foot now I’m the pain is worse than before. Another surgery maybe live in pain for the rest of My life!
I am a 40% service connected veteran
(Retired Army)
I have been an outpatient at the C.W. Bill Young VAMC (formerly BAY PINES VAMC) in Bay Pines, Florida since my retirement in ’86.
I have received nothing short of excellent care during the entire time.
I have never had an issue getting timely appointments or treatment.
I have received State-of-the-art hearing aids to compensate for my service connected profound hearing loss.
In April of ’09 I had a Bi-Articulate (full) hip replacement.
In August of 2013 I had a Crainiotomy to remove a tennis ball size tumor from my brain.
In June 2014 I had a (T1a Carcenoma) tumor removed from my right kidney.
On 7 July,2014 I will be treated for Melenoma (skin cancer) on my head and neck.
I have never incurred any cost whatsoever for any VA services.
I have been treated by top surgeons and respected VA medical staff (RNs).
I may be one of the lucky ones, but I thank God and the VA for saving my life on more than one occasion, and the level of care I have received
over the years
Charles L. Shafer
SSG U.S.Army (retired)
My basic gripe is that the V A hire third world doctors that have little or no basic medical training and place our welfare in their hands, EA: I had an Indian female doctor that would not put her hands on a patient to check his pulse. 2. I personally had a doctor supposedly trained in Bombay, further educated at Edinbourgh ,Sccotland, done residency at St Guys in London (where the royal family are treated) and somehow end up in the middle of the US practicing Orthopaedic surgery on Veterans . Can anyone see what is wrong with this picture? Also I had an Asian doctor tell me the reason I was passing blood from the rectum was because I was defecating too much, I ended having my descending colon removed for cancer (outside of the V A) Yes I am irritated at the V A and some of their practices.Also I have documented proof of some of these action.
Pretty clear your site does not like truthful comments concerning criminal activity by VA Managers. OIG is useless concerning the corruption at Phoenix. Tampa VA is excellent. Phoenix is probably the worst example of how to run a healthcare facility. Get rid of the bonus payments, they are nothing but an incentive to lie and cause harm to veterans.
I have been receiving care at the CW Young VA Hospital In Bay Pines FL since 2000. I had tried to stay out of the system but lost insurance and needed my medication. I have multiple health problems and require quite a few medications. I was having increase in shoulder and hip pain and my civilian Drs kept telling me it was just my fibromyalgia. Well, I started going to the VA and they sent me to Dr. S. Fink Rhuematologist, who agreed I had fibromyalgia but that I had something else going on. He order appropriate testing, and it turned out I had Polymyalgia Rheumatica and Giant Cell Arteritis. I could very well have lost my eye sight if it had not been for him. I now travel from the East Coast of Florida to Bay Pines FL a 3 hour drive one way for care. I have a clinic just 7 miles from the house, but they don’t have a women’s clinic there, plus the new VA hospital is now several years past the date of opening in Orlando which would be easier to get to for me than the current on in Orlando. I have excellent Drs at the VA. If I have a health complaint, they respond appropriately in ordering the testing or the referral for specialty care. I am usually seen with in a week or two of referral. I can not complain one bit about my care at the VA.
Bottom line, government cannot run anything better than free enterprise… government positions that cannot be terminated for poor performance just begets more and more inept people working in a system, while those who are more capable move on to other venues where they do not have to contend with the inept and corrupt.
Unfortunately as the federal government grows ever bigger, we will see such problems grow ever worse in our society. It is inevitable.
I too am a disabled vet. I was discharged in 1998 and went to the Phoenix VA within a month to start the process of being screened for eligibility. I am service connected and all I can say, execpt for a couple of occasions, that I have received excellent health care from them. My wife is a former RN and goes with me to all of my appointments, she wishes she could see my primary care physician herself. We also do not make a point of tell the doctors that my wife is a former RN, she tells me after the appointment if there was anything fishy.
Yes it’s slow, and appointments can be frustrating at times but on the whole I can honestly say that I have been well treated. I have had a mess of a time for an appointment that I have tomorrow because of all of the shake up but I still have my appointment at 1530.
Does the VA need to be fixed? YES!! Is there corruption and mismanagement? Sadly but yes. Is the entire system worthless? NO! Some parts of it need to be fixed and the entire system needs to be brought in to the 21 Century. Such as going to the Lab for a Chem 6. That went out of the civilian world 20 years ago.
Hey Donn, I lived in Minnesota and was treated at the Minneapolis VA as well they are SUPER!!I also used to work there. I now live in Arizona and have nothing but good things to say about the Prescott VA. My doctor there discovered I had prostate cancer and immediately got me in with the urology Dr downtown and within a month I would had surgery and have been cancer-free for 4 years! I personally am totally satisfied with my care at the VA. I agree also with everybody yelling about the bonuses they receive. The money is there our country is gracious enough to give us the money needed to take care of the higher management the administrators are greedy enough to keep that money for themselves.instead giving bonuses to the higher echelons they need to pay the front line workers better, to attract more qualified & dedicated workers.
In 1980 I started to file a disability claim through the VA and at that time all of my service records and in service medical records were available. But the VA Service Officer did everything he possibly could to dissuade me from filing that claim telling me that I didn’t have a chance of getting any help and I was wasting my time and other things. So eventually I dropped it. Many years later after my health had totally deteriorated and I had been disabled I filed a claim again but this time I discovered that all of my records had mysteriously vanished. All of my inservice medical records and even my service records had disappeared. All that remained was my 214 and one copy of an entrance physical and a few things that a National Guard unit that I had served with had somehow managed to hold on to. But all of my Active Army records had been destroyed somehow and never made it back to the archives. What would you like to bet that the VA had a hand in that? There was information in those files that would certainly have allowed me to claim a much higher percentage of disability than what I finally managed to get. But it somehow disappeared and with it my chances of getting any kind of help. That is the sort of thing that’s happened to many people I’ve talked to others who have had the same sort of problems too.
By the way the files were returned as soon as they were photocopied.
I know of the problems at the Phoenix VA firsthand, I had a ratings doctor try and force me to bend over further than possible due to spinal injury, my knees gave way and I hit the tile floor face first. My complaint about the incident was buried by the inept and corrupt former director John Fears. I filed a formal complaint with the FBI in Phoenix, they were complicit with the VA in burying the complaint. As I took this to Washington, I was told by an anonymous phone call to drop it or risk getting hurt a lot worse. I was prescribed a dose of prednisone, 85 mg a day, it was supposed to be short term, it turned into 14 months at 85 mg a day, when they realized it and saw the detrimental effects, instead of dealing with it, they shredded the records and all the pharmacy records, over 200 pages of my official file were shredded. I had the common sense to steal my file and take it to fed-ex and have it copied in full. Upon my return, I was escorted off the property by VA Police. I took my complaints to the AZ Board of Medical Examiners and they were outraged and stated that but sadly they had no jurisdiction on Federal Property. My saving grace was moving to Tampa where it is like night and day, Tampa is a top notch facility and they do a great job considering the number of Veterans they see there and the polytrauma center’s patient load. If I had reined at Phoenix, I would most likely died from malpractice issues. Tampa is an example of how things should work. People like former Director John Fears need to face the music for the games played all in the name of a bonus payment.
I, am a veteran, who, on many occasions, has had the need for VA services..the last requested service was for a general practicioner, after I was released from another VA Medical Facility on May 31 2012, i reported into the VA medical hospital about approximately 45 days later for medicine refills…etc..and also for.follow-up in another section of the VA facility…Today’s date is June 25 2014 and I still do not have a general practicioner assigned at that VA facility…I filled 2 or 3 complaints and when I have had to seek care , I have had to go to the emergency room atg VA to be seen…waste of triage time, not to mention waste of nujrses, doctors, resources in the ER room…when all I actually need was a general doctor to help me with physical issues…I am 100 % disabled, that is another story in itself…But now I no longer go see any doctors as I don’t have faith in the system again. I had tried to seek help in 1997, St Louis, VA…they pretty much blew me off saying that my condition was something else , not PTSD, I tried to get help in 1984/1985 in another part of the country, couldn’t even get an appointment to see anyone there… I have now after 6 months of not going to the VA in Arkansas, moved to Missouri and I have a general practioner appointment within 30 days….Mt Vernon…So now I get to go back thru all of the stuff I have went thru over the past 5 years with another set of doctors so I can getg back on the 11 or 12 m edications I am suppose to take on a daily basis. The VA is much too big of an organizaition to be held accountable….no one can…
The only issues I have with the VA are
1) Repeated, embarrassing “tests” and nothing ever gets done. I had to go all the way to Cleveland, spend the night, and received the same test all three times. Nothing more was ever done to help my incontinence which was chalked up to “overactive bladder.”
2) Their refusal to obtain maximum-absorbent incontinence supplies for me;
3) The fact that they _still_ don’t know how to deal with women veterans; and
4) Rude, uncaring clerks and bean-counters with their mouths permanently set at “NO.”
I was injured in a fall from a truck at Fort Ord in the line of duty. I had a severe concussion, separated shoulder, torn rotator cuff, several misaligned vertebrae, and associated nerve damage in my right arm and leg. It hasn’t been all that long ago that the VA _finally_ awarded a disability for “spinal disc condition,” for 80 percent compensation given that I have some heart and lung trouble and multiple chemical sensitivities as well. (And the last time I tried for “totally and permanently” I was all but told I had better not re-apply…
My husband is a disabled vet from Viet Nam and he has received nothing but expert and excellent care from both the VA system in Albany, NY and the VA system in Gainesville, FL. We live in The Villages, FL where there is an excellent clinic that services many of the non urgent needs of seniors located here, and that system is excellent as well. The biggest problem here in The Villages is that they are having trouble staffing all the services they would like to provide and have had to outsource some of them to private facilities. The services at the private facilities have been subpar compared to same services provided by the VA in Albany. So our take on it is that the VA provides an excellent for most of its vets and there may be pockets of problems in various locations such as AZ, but they are the not the norm. We are grateful for the fantastic health care workers of the VA system and for the unparalleled service we have been fortunate to be able to utilize. Privatization is definitely not the answer – providing the financial resources for the VA to do its mandated job is!
Personally, I have had wood and bad experiences with VA healthcare. Still, the VHA has won healthcare awards by outcompeting top private hospitals[1; quotes].
Sadly, the VA is significantly failing ill 1991 Gulf War veterans though[2; quote].
Quote: ” As recently as the 1980s, the VHA health system was a mess: the hospitals were deteriorating, morale was low, efficiency was down, quality was uneven.”[1; page 12]
Quote: “The National Committee for Quality Assurance (NCQA), an organization that provides information about health care quality for business, ranks health-care plans on 17 different performance measures. Philip Longman reporting on the NCQA evaluations writes “Winning NCQA’s seal of approval is the gold standard in the health-care industry. The winner in 2005 was not Johns Hopkins or the Mayo Clinic or Massachusetts General. In every single category, the VHA system outperforms the highest rated non-VHA hospitals.”8″[1; page 12]
Quote: “”As inexcusable as the revelations here have been, what VA has been doing to Gulf War veterans for twenty years is far worse,” he said. “Instead of middle managers lying to senior officials to get bonuses and cover up that veterans aren’t getting care, you have senior officials and middle managers lying to Congress, to veterans, and to the medical community, to purposely deny veterans access to care.”[James Binns, 2]
References:
[1] Wright, Erik Olin; Rogers, Joel. American Society: How It Really Works. Chapter 8: Health Care. ssc.wisc.edu[online]. 2014. Available from: http://www.ssc.wisc.edu/~wright/ContemporaryAmericanSociety/Chapter%208%20–%20health%20care-FINAL.pdf
[2] Reno, Jamie. EXCLUSIVE: White House Honoree Slams VA, Says Administration’s Investigation Barely Scratches the Surface, June 4, 2014. therenodispatch.blogspot.com[online]. 2014. Available from: http://therenodispatch.blogspot.com/2014/06/exclusive-white-house-honoree-slams-va_4.html
That is because nobody has checked the medical care among other things at the BOP (Bureau of Prisons). If they ever did that, there would be a REAL media storm…
Pensacola VA MEDICAL CENTER C&P DEPARTMENT, Has a Nurse Proctentioner doing all the exams, she is known for reducing veterans benefits amounts…. Complained about her several time, but know results.. Took the VA three months to reduce me by 10% and now tells me it takes up to five years for an NOD appeal. Doctor says I would nee a know replacement to solve my problem / Nurse reported that my knee has gotten better which is not the case.
OK, lets see…
The private sector does not have an integrated information system simply because they cannot agree with standards, even though those standards were set up in the mid 90’s. Integrated software was and is available. I know, I helped write some.
The VA’s IT system software has not been upgraded since I started as a patient in the early 90’s. The only thing that has been upgraded is the actual hardware, which is now woefully outdated. But, my local hospital still uses MUMPS, a system designed in the early 80’s. This is a nationwide issue, and yes, the VA at least is better off than the private sector.
As far as diagnostic equipment, it is far worse than the private sector. I recently had an MRI in the exact same machine I went through 14 years ago. New then, but outdated now.
The VA administrators did not or could not spend the money on good care, and the doctors were told to push pills over prevention, push pills over proper weight control, push pills over proper psychiatric care, push pills over …over…everything.
Then the VA is called on the carpet by Congress and now they are over reacting by swinging the prescription pendulum the other way, just to show that they can do SOMETHING.
Give the administrators the proper hire/fire process, even over themselves. Fire doctors, nurses, administrators if they cannot do the job. And quit thinking the VA is a geriatric ward! Speaking of wards, give the veterans proper facilities and up to date diagnostic equipment and an up to date formulary. The Government should quit spending the money on wars, creating the backlog they claim to be trying to fix.
I’ve been inpatient at teaching hospitals that have the look and feel of a five star hotel. Conversely, I’ve been inpatient at several VA hospitals and the care was horrible. Open wards, nurses that were playing ball in the corridors while patients were trying to sleep. student doctors that did not have proper guidance. Veterans don’t ask for everything to be high quality, they do ask to be treated at a facility that treats them as people, not numbers. Low cost care should not mean low quality care.
The entire nation should come to their senses, not in just VA Hospitals, but the overall.
Thank you for your article.
I have been using the VA since 2000. I can honestly say if it wasn’t for the VA I would be pushing up daisies. I’m a Vietnam Vet with Diabetes Type II, had five heart attacks and by-pass surgery and now have stage 4 Lymphoma. NEVER do I wait for an appointment with the exception of the dental clinic at times but for the most part they are on time. I have had doctors call me at home (how many times can people say that about their doctors in the private sector?) The Syracuse VA Medical Center is second to none. It’s spotless and the doctors, nurses and every employee that I’ve ever come in contact with is genuinely courteous and helpful. I’m sure with the influx of new veterans coming in from two different wars makes it a most complex situation and there are going to be problems in many areas but it doesn’t seem to be so in Syracuse. At least from my perspective.
I have been receiving care at the Minneapolis VAMC for 20 years as an outpatient and an inpatient. I can’t recall how long it took for my initial appointment but don’t think it was an unduly long time. Some of my ailments were discovered by routine blood analysis and/or xrays. When these were found I was notified timely and scheduled for follow up by the appropriate clinic/specialist. At some speciality clinics, e.g. vision and audiology it takes a long time to get an appointment. Overall, though, I am very satisfied with my treatment by the VAMC. Over these 20 years I have been treated with kindness and dignity by all employees there.
mister back I work at the v_a in minneapolis for a couple of years and I am happy to see what you have written.I worked in the radiology department we did CT scans mr. Eyes and x-rays. I must say in that department took great pride in serving our veterans we had many veterans working there and considered it like helping family. I feel that if a model VA exists Minneapolis would be it.
Thank you, doc, for your article. I retired from the VA as an RN. I feel so strongly that our patients get top notch care. The new primary care model has made such a huge difference in care at the CBOC I worked in. It provided us with the ability to know our patients well, and anticipate their needs. Our waiting time for new patients is 13 days. And, I find the biggest complainers are those with Duel Care. Many a time, the team has suggested that they choose one or the other to avoid mistakes that could be fatal. Then they say the VA is kicking them out. I am also a patient in the VA, and I receive all my care from there. True, I have insurance, and, for instance, I fell and broke my arm a month ago. I went to my primary care provider, who wrote a script for me to get an X ray locally, as I did not want to drive 1 hr. for the X ray. But, it was my choice. And, you are right about the fax. They had to fax the results to my PCP. I feel the good of the VA far exceeds the bad. People pick one little incident, and embellish on it, and then the whole system is bad! For free or low cost good care, grow up, and realize that you can not get that on the outside unless you have money!
I am so lucky to be associated as a patient with, in my opinion, the Premier VA hospital in the Nation. Fayetteville Arkansas. When one drives into any of the parking lots, they may see license plates from states in a 1,000 mile radius. This happens because they know they shall be cared for. In the last two years, millions have been invested into the infrastructure at this location. There may still be a wait for first time appointments. of that I do not know. I began in march of ’08 with no problem getting any appointments and by the end of the first month, I had already had many tests and exams. The staff is beyond reproach, the outpatients are mostly in good spirits, and most of the time you find popcorn, and coffee or tea served by one of the many volunteers who would rather be helping a vet than doing anything else. I salute each and everyone of them. Granted, I have been a patient and outpatient for 6+ years and am on a first name basis with most of the staff but overall, I would take The VA over any private organization. any day of the week.
Very true. While I am extremely satisfied with the care from the Tulsa clinic and Muskogee hospital. The fact remains those doing C&P evaluations at Muskogee are ignorant on VA policy of the presumptives for Gulf War Illness. They are denying claims of IBS, Fibro, CFS, etc even though these are publicly posted on the VA.gov website. I have requested a Congressional inquiry into the matter.
Thank you,
Glenn Stewart
US Army & NG retired
Gulf War Illness / aka CMI casualty & advocate
Why this doctor even writes such an article has me scratching my head.
The VAntage Point Blog is nothing more than propaganda served to veterans to disseminate the false narrative that everything is fine in the world of the VA. The only difference in the doctor’s piece, than most, is he acknowledges “the (current) media storm.” I will take that as the doctor’s euphemism for scandal. His total outrage at the practices at the Phoenix VA, while working there,are unsent, let me repeat that, unsent, emails.
He then goes on to tell how cost effective the care is. He also states that the private sector cannot track the cost of healthcare. That last statement is untrue. At a HVAC hearing, just the other night, Dr. Thomas Lynch, the Assistant Under Secretary for Health at the VA could not answer the question what was the RVU at VA hospitals. The reason is the VA doesn’t make that measurement. This is how you determine cost of treatment. It is the industry standard. To somehow prove his point, the doctor gives an extreme example of a singular case Unless the doctor has somehow been able to measure the RVU for the VA, his assertion is nothing more than speculation and an attempt to bolster and to perpetuate the bureaucracy.
I don’t know how long the doctor has been away from private practice. The private healthcare I use is interconnected by computer. I recently went to a private ER. I followed up with a vascular surgeon and an orthopedic specialist located in three different towns. All of them were on the same system, as well as the pharmacy I use.
However, recently I went to my local VA and asked for some records I needed from another VA. How was the request handled? My VA sent the other VA a FAX. It took 3 weeks for me to receive the information.
Sorry, Dr. Porter, your “facts” do not impress me, or as it appears by many of the comments, a considerable number of other veterans.
I totally agree. It is obvious that this doctor is simply trying to advance his career at the VA. Since we hold Doctors in high esteem – Shame on you!
Now lets get this fixed so we can all stand behind a working VA System. And yes, I’ll say it. For those of you who supported Obamacare, this should be a hint to the problems you will face:
* Hard to get care
* Long waits
* Inconsistent Service
* Pharmacy System that as mentioned above is “penny wise and pound foolish”.
Currently waiting 3 weeks for the Long Beach VA GI department to call me to setup an appointment. Having pain all along my right side and was CT’ed 4 weeks ago. Diag with gull stones. The pain isn’t to bad but I know for sure that whenever they setup an appointment it will be another 3 to 5 weeks out. Was much the same story for the CT. But I know exactly why that was. The Long Beach VA Health Care System only has ONE CT unit. WTF!!!!!!!!!!!!
I must add however once in, the care is excellent.
The general staff who make the appointments and do the grunt work do a lot of standing around talking and bickering. I would start firing them on the spot. That might/would motivate who ever is left to get there stuff together fast. If not there are a lot of people who would love to have a job.
It is true that the clerks waste a lot of time, and fight in front of Veterans. Why are they not fired?? Ask AFGE….the crooked union that represents all of them.
if you ask me to union is a big part of the problem!they have made it so hard for the execs to get terminated that it is next to impossible. They claim they will help the workers solve issues yet a friend of mine was told when she complained about one of her supervisors: well I will help you write your letter of resignation.the union is there to help the executives because they paid the most in union dues.once again it boils down to who is going to pay the most money. They’ve done away with the bonus system now let’s do away with the union.
Nashville tn va is great to say so little
the Nashville va hospital has saves my life two times. one was hearth surgery. the other was bladder cancer. they have helped me with a lot of other problems also. I give great thanks to them they are a wonderful people. and a wonderful hospital . my primary care doctor is also great!
I only have great things to say about my care at the Phoenix VA. Signing up was a snap with care from lots of good people. My evaluation went very easy, with getting my rating and pay within 3 months from the start. My doctors have been great. My primary doctor is 2nd to none. In fact if I don’t contact him, he has called me several times to make sure we are still working together. His staff and the office clinic is nothing but the best. I had both my eyes worked on and my vision is so good that for the first time since I was 5 years old, I don’t need glasses. For years I’d had trouble walking due to bad bones in my feet. They repaired the joints in both feet and now they feel great. I’ve had test that doctors in the private sector would never give me. I’ve used the emergency room at least 3 times in the last 10 years and at the most only had to wait one time more than 30 mins. and that was only about one hour. I’ve have to have MRI’s often to monitor my head and it’s always my primary doctor that takes care of it. I had trouble sleeping and breathing (stopped for mins. at a time) and they did a sleep study and now I have the equipment that allows me to sleep without choking. My PTSD is pretty well being controlled as well as can be expected. Heart, blood chem. and pressure are being controlled with the care I get. Not all of us are upset with the care we get. For the first time since Viet Nam I feel like someone is actually wanting to help and care for my needs. Thank you all at the Phoenix VA. I’m one happy ex-GI.
Thank you for your service, and your glowing testimony. Unfortunately, what we say, or this doctor says, will not convince those that already have their mind made up that the system is crap. Many of those who say those things have never even been in the service, or they tried to get on about 20 years ago, when the system was crap. I feel the system now is very good.
I do not know where you get your information from, or how you know that ” Many of those who say those things have never even been in the service”. I have been in the service (Vietnam – infantry) and am 100% disabled . I have used the private healthcare system ever since leaving the army, and the VA healthcare for only 5 years now. As I stated, I can attest to the fact that there is no comparison between the two; VA wait-list problems are only the tip of the ice-burg. The VA healthcare system suffers from a “culture” problem that is most likely systemic and leads to other problems such as; falsification of medical records, patient abuse, and medical malpractice. These problems that have been growing for years now. There is little to no oversight and a complete lack of transparency.
If you are going to make statements such as I have quoted you above, please provide the sources that you are quoting. Thank you for your service (I am assuming that you are a veteran).
Ms. Hurd, well there are many g oodVA facilities, the system is crap! When you have executives getting bonuses bigger than a lot of disabled veterans get paid in a year, that system is crap. When you have veterans living in cardboard boxes while VA executives make over $170,000.00 a year before bonuses , that system is crap! let’s not forget though god bless our veterans god bless our troops and god bless america!
I have been very satisfied with the care provided by the doctors (especially, Dr. Scott Cassidy and Dr. Carey McKain) and other professionals at the Charles George VAMC in Asheville, North Carolina,
Thank God for VA Hospitals I know we live in a broken world and broken system we are not in heaven yet but I been going to the VA Hospital for many years I have nothing to complain about . thanks VA Thank you Lord and thanks America
You initial comments that characterize the issues at the VA as, “confusion, complacency, and probably deception,” are a dead giveaway that what was to follow was either in part or totally initiated by, researched by, and sponsored by whatever public relations organization is attempting to heal the VA’s wounded image, an attempt that frankly offends me. I have personally done a fair amount of research (at Harvard) and know how difficult it can be to either validate or disprove an article such as yours and will thus state up front that I have made no attempt to check your sources, although I will say that from the onset your article seems to break all the rules of “unbiased research.” I find it shameful that at a time like this, and in an organization that readily admits it is overwhelmed, the Veterans Administration would spend any amount of resource to defend itself. You mention “culture” issues as though it was just an ancillary issue; it is in fact more likely than not the biggest issue the VA faces. A culture that allows employees to lie, cheat, steal, etc. is a monument this problem that pales all others in its shadow. Yes, there are doubtless many dedicated and honest VA employees who sincerely wish to serve veterans, but there is also very little doubt that there are many others who view veterans simply as the necessary evil of a very large self-centered and culturally flawed organization.
I have personally seen and in many cases been the recipient of patient abuse, falsification of medical records, and what I will referred to as attitudinal medical care, i.e. So while you may suffer from many of the penalties of working for a large bureaucracy, I’d like to remind you that unlike many chronically ill veterans who have no other choice, you go to the VA each morning because you do have a choice (not to mention a paycheck and a fat retirement plan).
Your article seems to be an attempt to soften the abhorrent scandal that the VA has brought down on their own heads, and one for which they should be held solely accountable; not something this culture is used to.
In summary Sir I say shame on you for being a mouthpiece of an organization that deserves every criticism being levied at it, perhaps your time might be better spent serving veterans and supporting the massive changes required to bring this bloated bureaucracy back into equilibrium with its own mission statement. Physician, heal thyself!
You are an idiot. Do some research on the private sector and how great they are and then comment. They can’t even figure out how to implement the ACA, which by the way is government run care. The private sector must switch from pay for quantity to pay for quality. Figure that out moron.
I couldn’t agree more with the author. Being a former VAMC employee and a veteran patient. I have experienced the best care of my life here in Minneapolis. I have been sent to the private sector for my annual eye exam because of the backup @ the VA. Additionally, I am a type 1 diabetic on an insulin pump and the care I get from my NP Laurie Kubes is phenomenal.
I am also a grad student at a local university where I have researched the electronic record keeping at the VA the and it is light years ahead of the private sector. Obviously there are things that need to be fixed, and as the author states, I can testify that there definitely is a culture problem, Hopefully new leadership can stem that tide and get things pointed in the right direction. @ the end of the day, it is all about our fellow Vets.
if you told me i could go to a ragular hospital from now on and the va will pay. i would say no.thank you. and keep going to sav georgia va clinic and charleston sc va hospital. its some bad people that live on greed that killed our brothers.. and there gone. thank god. let em fix it. and dont listin to fox news! when i tell you they care more about making our government look bad than realy helping vets im telling the truth in my opinion.im sure some tv stations are all about us with no politics involved. but to me. i just dont feel fox news is one of them..hannity just dosnt stop attacking the va and the president. like mr obama or not. he is trying to fix this. hey hannity! why dont you talk about what the va is doing to address the problem??? of course not. thats not on your agenda……
Dr. Porter’s opening comments are, as far as I know, common knowledge. I disagree with him about private care in general however. Not all private care is a hodgepodge like he describes, although he allows for integrated systems. In my area that would be Sanford Medical, which is modeled on some that he mentions, i.e., Kaiser. I am covered by both VA and private (Sanford), so I am in a position to compare them personally.
I have had both good and bad care and treatment from VA. For example, my triple bypass was performed at the Minneapolis VA. I cannot confer enough accolades to the cardiology department in Minneapolis. However, the cardiologist in Fargo was a box of rocks who almost cost me my life!
One major complaint that I have with the VA is the pharmacy departments throughout the system. Nowhere that I have read about recently brings up pharmacy, but this department seems to have no sense whatsoever. They are constantly doing irrational things and imposing difficulties on patients for reasons that seem to me to be nothing but systemic bean-counter nonsense, and yet they remain untouchable and unanswerable for their behaviors and policies. Little oversight seems to apply.
I have seen the pharmacy do things that at first looks like cost effectiveness, but seen in a brighter light seem only mean spirited and wasteful in the end. This is what we call mindless bureaucracy for the sake of mindless bureaucracy.
I hope the pharmacy gets some of the scrutiny that is going on right now. Maybe some heads should roll in that department as well.
David
How you can try to put a pretty face on Veterans care at the VA I’ll never know… The VA administration has been slapping each other on the back for years, even as we Speek! Eye wash and hear say! If you were getting big bonuses, you would do what ever it takes to get an even bigger bonuses. They are even covering up in the mist of a present investigation. GET REAL? REALLY? They clame they don’t have enough money for doctors and care of veterans. But they don’t have any problems getting money for bounces. Again…. Bounes are the problem!
WOW…GOOD THING NO ONE SUBMITS FRAUDULENT CLAIMS AND DEMAND SERVICES FOR NON SERVICE RELATED ISSUES THAT CLOG UP THE SYSTEM
As a veteran and currently serving veteran who is employed at the Va bonuses are not the problem with everyone. Some people work to enhance their bank accounts tons of vets myself included work their to help my brothers and sisters and I send my bonus to varies non profit veterans organizations. I go to work everyday knowing I can make a difference for veterans by dedicating the hours I get paid for and giving my full effort. When my day ends I leave work and help veterans navigate the va system on my time at my expense.
I joined the VA system in 2000, after several years of spousal insistence. From the first day I have received nothing but the best care. At times frustrating, and sometimes not very timely, I have become a staunch supporter of the VA care here in the Northwest. The devotion and care the Doctors and nurses provide is very good, Specialty clinicians are also very good but very overworked and over-scheduled. These Doctors and staff do a very good job.
George,
My story is exactly the same as yours. I also joined the system about 2000, and I have consistently been surprised, and gratified by the level and quality of care I have received from the VA, no matter which facility I have gone to. I truly am grateful for the VA and the professional staff and quality care that they provide.
I also have been in the system since 2000 and have had nothing but excellent care and experiences.
Same for me except treatment in 5 different cities. Superior treatment. The only problem was me. I arrived 5 mins. late for my eye appointment and had to reschedule. Good for them. There are signs all over this building saying that if you haven’t been seen in 15 minutes–go to the desk. The signs were there before I joined the system. Love the VA!
The VA system is overwhelmed because to many Medicare eligible persons are using it. Buying supplemental coverage for these vets, trying to save a few bucks, would save time and expense.
I am 100% service connected, but since I have Medicare and supplemental insurance, I should not use the VA. That is very disturbing.
It is not just the VA. ALL government departments have these problems; they just haven’t been put into the spotlight. If you were to look you would find the same culture that the VA has. In fact it is not just government, it is everywhere. Lying, cheating, stealing – we learned how to do it from the cradle on up. Isn’t that right Bill Clinton? O.J.? Catholic priests with little boys? On and on.
So you are saying it OK?
While the problem is just now surfacing, it has been going on for a long time. I used to go to the Gainesville FL VA and quit going because of very poor service. I drove 90 miles past the Gainesville VA to the VA in Lake City FL. Everything was good until the Gainesville and Lake City merged and the service went down hill fast. The VA in Florida knew my PSA was high when I retired and said nothing and did nothing. It wasn’t until I moved to AL and the Birmingham VA told me my PSA was high and did a biopsy. To late, they had to do surgery and radiation and now I’m less than half a man. The problem will not be fixed until ALL service members’ standby together and demand the service we deserve. Look at congress, they fixed themselves up with health care for life and it is 100s time better than what we get. How many of them has had to work 24/7 for months/years, pulled away from family for years, no luxuries at all, freeze, sweat, have bullets flying over head, well you get the picture.
DIDNT KNOW FREE HEALTH CARE WAS A PROMISE TO ALL VETERANS…
well, all the OIG is to do is to pay attention to all who had file a form to their office and take all of them serious cause now the cat is out of the Bag. Come talk to us veterans not the employee cause they are afraid to speak out. My Harlingen Texas VA refuse to refill my service connected Meds back in 2010. I follow all procedures to fill a Torn Claim and it got deny all the way to Washington DC so what does this tell me, our government is behind all this VA issue themselves. They don’t want to help their veterans who served….Retired SFC Victor M. Zavala, 3940.Disable Korea Vet, 70% VA Rating.
I understand your a dedicated employee, you have to realize when you have a rampant system overrun with corrupt officials that try to run an organization with deception then you have workers just looking to enhance there overall welfare and those of family and friends. I know this first hand from officials that work at the va in northport Long Island and it had been stated that the work force is made up of family member after family member which many have never served in the military and they only want to increase salary and receive higher bonus money . corrupt workers never provide quality care to any one . I don’t beleive your statements ,I beleive you were put up to write this !
U want to see a family of VA employess? Go to the West Palm Va
I agree, the West Palm Beach VA gave me great service and quickly. I lived in Okeechobee and made the 65 mile drive and was back home a little over 3 hours after I had left home! Also the South GA/N.Florida VA in Gainesville is great. I now live in Tucson and the VA should give the Southern AZ VA Hospital an award as the best in the nation. I’ve never had a problem with them. They always call me and follow up. Recently when I was sick, I called them at 9am and was seeing a Doctor by 10:30 am. There ARE more VA Hospitals that are outstanding, so sad the few bad ones dominate the news and make the “great” VA hospitals look so bad.
I am a veteran, and I am an employee with the V.A. Hospital and I can reasure you the service they give to Veterans is bad for both.
If one is not able to provide a broader point. Reasons for your remarks. Having worked for the VA for nine years and a Vietnam vet, I have witnessed a few bad apples amongst the employees, but most are dedicated to their work and would disagree with your comments. After several incidents with a stomach problem and seeing several civilian Dr’s in which after being led to a room, vitals taken and than sitting waiting for the Dr. I became very turned off. I went to the VA and have found their medical services to be very competent. They always follow up, are not in a rush for the next dollar to examine, and most important remember ME.
Considering all of the false data that the VA has published, I would not believe that they are providing top care. Additionally, I looked at Phillip Longman’s book and bio. He promotes VistA which he happens to be a board member of. Therefore, his testimony is highly questionable.
The new Acting Secreatary of the VA is in a honeymoon phase in which we all are giving him the benefit of the doubt. However, actions speak louder then words, so we are looking forward to the actions that change the systematic problems with the VA.
As recently as last week the VA denied my ER visit to a local hospital. Stating I should have traveled the 100 miles to the local VA Facility. I was having extreme chest pain, and checked in at the local ER with my blood pressure reading 200/100. So far I have been denied the names of the personnel making this decision.
Same here, I had BP of 205/105, called my Va clinic and was told to come to the clinic, I went directly there and sat for 2 hours and when I asked as to why I had to sat that long the doctor told me she had no time for me and for me to make an appointment! I drove 100 miles home to my local non VA doctor and he gave me meds to control my BP! Again I called my VA clinic fo an appointment for some problems that needed to be seen about and they told me it would be 12 to 18 months B4 I could see a doctor! I am a Vietnam Veteran with several medical problems and I get treated this way!
Go to the VA web page to Health Benefits; Non VA Care; For Veterans and print this out and ask them what part of this do you not understand. This is what you should be looking at: If you’re eligible for health care through the Department of Veterans Affairs, our goal is to provide you with the care you need in a VA facility. However, sometimes that isn’t possible…because you live too far from a VA facility, the specialist you need is not available at your VA, or it will take too long for you to be seen at a VA facility. In those cases, you may be referred to a community provider through the Non-VA Care program.
In most cases, having VA pay for care in the community requires pre-authorization. And, any care needed or recommended beyond the scope of that authorization must be approved by the VA facility that authorized the care.
In the event of an emergency when a VA facility is not the nearest medical facility, do not delay treatment by attempting to request VA payment authorization first. Simply proceed to the nearest emergency room to get the care you need. A medical emergency is generally defined as a condition of such a nature that a prudent layperson would reasonably expect a delay in seeking immediate medical attention to be hazardous to life or health. Eligibility for VA payment of emergency care as well as deadlines for filing claims depend upon whether or not you have a service-connected condition and your specific eligibility for non-VA care. It is important to inform the non-VA medical facility treating you that you are a Veteran. If inpatient care is required and you desire VA care and payment consideration, always inform the non-VA medical facility staff that you want to transfer to a VA facility when your medical condition stabilizes. It’s important to contact the closest VA facility as soon as possible to find out more about VA payment of your emergency care.
KC VA was trying to deny my husband’s ambulance cost from a non-VA facility to a KC VA. Found the information in this web page that they would pay for the transfer even if an ambulance was necessary to the non-VA facility. Once you quote from their manual, they pretty much have to pay. Read and use this manual. This is for your benefits. Hope this helps.
If you are admitted to a non-VA facility, you must notify the VA within 72 hours.
The VA in Atlanta saved my life. No where to go, no job, no health insurance and no money. I have cross some of the best Doctor’s and nurse’s who helped me. I was not as greatful to them as they was to me but they show me how. I know things happen sometime but 99.9 % of the time they the people at the VA do care and know their jobs. Thank god for the VA and all the people in this huge family god bless you and thank you for having my 6s. Mr. Clayton.
My problem with the Phoenix VA is the Eye and Low Vision Clinics, the cardiologist, and the Head & Neck clinic. The Podiatry Clinic seems to be catching up, possibly due to the findings of the IG. My primary care can spend only 30 minutes with me and says that the bulk of problems a 79 year-old has, should be addressed at my annual physical – however I don’t remember ever getting a notice that I am due for an annual physical.
C’mon, feller ! YOU can remember to arrange your physical for on or about your birthday, then just reschedule after the physical for the next year! That’s worked for me s…you’ve been told, just DO IT!
That’s worked for me since 1986, thru Long Beach, Seattle/Lakewood, san Bernardino and Los Angeles/Santa Maria CBOC. Fine medical care, records USUALLY current, few if any problems gettinto ‘specialty’ clinics or outside referrals more recently…
Capiche??
Marty that might work for u in Long Beach but here in Missouri we are not allow to schedule any appointments if they are 3 months out or longer. So I am unable to schedule my appointments when I leave the doctors office. I have tried on several occasions to schedule my next visit and they will Not let me. There response is you will receive something in the mail stating your next appt. the problem is I fall through the cracks and never receive the letter in the mail. Then when I do realize I never receive the letter I call the office and I end up having to wait 2 or 3 months from the time I call. By then it will have been 5 or 6 months out when the doctor said to come back in 3 months. I wonder why some Va doctors will allow you to make the appt right then and there ? Once again different policies for different doctors. I have over 10 different doctors/specialist I see on a regular basis and it would be much easier to schedule all my appts when I leave my doctors office. Then I would not fall through the cracks. Also they show I have cancelled appts when in fact I have never cancelled the appt. so before you judge what someone should do you might want to make sure the rules and policies are the same
I have appts scheduled for six months out. Not sure why those in MO. can’t schedule on 3 months out. I’d ask the VAMC patient advocate or administrator. Hopefully, this crap hitting the media will bring change; however, as long as the same people are responsible for implementing change….nothing changes.
You can us the MyHealthVet website and the Secure messaging feature to request appointments with your doctors. I use it all the time. I also use it to have my doctor renew my prescriptions when the last refill has been used.
Va system schedules 1 day minus a years. Worked in Va Clinics and hospital doing scheduling and getting first appointment. even opened several CBOC’s!
My husband needed to make an appointment so he called our local VA in Dayton, OH. The person who answered told him he had to make appointments in person. So, he went there to make an appointment and was told he had to call. This went on for awhile. He discovered he could make an appointment at a different VA hospital in Middletown and was successful. However, for a future appt. he had to go to Dayton. Middletown set up the appt. with Dayton for him. When he got there he signed in and waited for 2 hours; he did check with the receptionist a couple times about the wait time she wouldn’t look at him only told him to keep waiting. After the 2 hours he asked again the receptionist snapped at him that his appt had been canceled someone had called him! No one had called and we assume the receptionist thought he would just go away if she just kept telling him to wait. He was also informed he would get a letter saying when the appt was rescheduled for. It never came. They only way to be seen is if you show up for emergency needs. We try to keep other health care insurance on him but we can’t always afford it.
I don’t get notice of an annual physical at my private doctor either. I keep a calendar with my medical dates and keep track of what I have to do. We should learn to take responsibility for ourselves too.
I’m not talking about annual appts. Example: one of my specialist doctor wants to see me every three months but they Will Not allow me to make my own appt when I leave because its 3months out so how exactly do you think I’m suppose to make my own appt when there policy is they will send a letter in the mail and I never receive this letter. I do write on the calendar my appts but I have to receive the paper first. As I stated before we cannot schedule our own appts unlike you. We should be able to schedule out appts when we leave our appt. you can’t call to make them ahead of time or they will say the same thing ” you will get your appt in the mail”. Hope I cleared my concern up. I am not allowed to make my own 3 month follow up until I don’t receive the letter in 3 months then I can call and get it scheduled but then it’s another 2 or 3 months before I can get in. So now I’m at 6 months when the doctor Clearly wanted to see me in 3months so this has nothing to do with me keeping tracked of anything. I’m vary capable of scheduling my appts if they would let me.
Scheduling an annual physical is all good and well, however, I am the caregiver for my husband, who is100% service connected disabled since 1988. I have a chart that shows his blood results from 1992 to 2002. Never missed a single physical! What it shows is no one ever reviewed his lab results, however they were recorded on his chart. Had someone looked at the results he would not have gotten sicker and sicker over the course of those 10 years, they would have seen his enzyme levels exceeded acceptable range for ALL 10 years, Normal range is 0-65. At one point his levels were at 294! The result was he had to do 48 weeks of chemo with a program with only a 44% success rate.I might add, chemo that the wait time for was several months and you were placed on a WORLD WIDE wait list because demand exceeds supply by huge measures. Our VA?? Phoenix, Arizona. When he first became ill he explained to his Dr. what was happening….his Dr. patted him on the shoulder and told him “as we get older things start to slow down, we are not able to do all we once could do”! Are you kidding me….the symptoms were there, right down to the loss of a single front tooth, a trip to the VA Dental clinic and the very next day every single tooth in his head was extracted!! Did anyone tell us why everything was going South?? Nope :( It has been a solo performance for me as his caregiver….when you call the VA you are told..” You can tell us anything you want but we will not be discussing this patient with you” I have devised my own programs to care for this Mental Health Patient.
While at my ratings review the doctor asked questions about my previous x-rays which are easily accessible in the data bank but did not even refer to the previous x-rays to determine if my degenerative disc disease had worsened which she noted that the degenerative disc disease had gotten better.( Explain that one). The same week I ended up in the ER and they took x-rays and noted that the plate that was put in my neck was loose and the screw the Dr. put in had impinged further on a nerve and my degenerative disc disease had gotten worse from the previous x-rays. Frustrating to say the least.