VA Facilities Parallel Non-VA Sites in Care Access, Safety, and Quality

May 09, 2023 - For many years, the Veterans Affairs (VA) healthcare system has faced criticism for its shortcomings in patient care, including care access, safety, and quality.

However, recent studies have shown that when it comes to surgical care, VA health facilities deliver care that is as good as, if not better than, non-VA medical centers in terms of care access, quality, and safety.

Congress passed the Choice Act of 2014 and the MISSION Act of 2018, which addressed patient access to care, long wait times, and the quality of clinical care and patient safety by allowing patients to receive care outside VA sites.

To compare care quality provided by VA and non-VA sites, researchers conducted a systematic review of all relevant studies conducted between 2015 and 2021.

The review, published in the Journal of the American College of Surgeons (JACS), included 18 nationally representative studies that evaluated four key quality measures: quality of care, access to care, cost and efficiency, and patient satisfaction.

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“Surgery involves many steps of care,” lead study author Mariah B. Blegen, MD, a fellow in the surgery department at the David Geffen School of Medicine of UCLA, said in a press release. “This updated review is important because it tells us that the veterans at the VA are getting good care. Quality improvement, through the VA National Surgical Quality Improvement Program (VA NSQIP), has been the focus of the VA for several decades, and I think this effort is paying off.”

As reported, VA medical centers outperformed or at least matched civilian medical facilities. Out of the 13 studies analyzed, 11 showed that the quality and safety of surgical care at VA health centers was as good as or better than the care provided at non-VA health centers.

One of the studies, which looked at elective joint replacement, found that VA patients had fewer complications after surgery than veterans who received treatment at non-VA sites. Another study reported lower readmission rates among veterans undergoing joint replacement at VA hospitals than those getting the procedure at non-VA facilities.

Regarding lung surgery, veterans receiving treatment at VA healthcare settings had a significantly lower 30-day mortality rate compared to the general population in non-VA settings. However, there was no significant difference in mortality rates between VA sites and other medical centers for kidney transplants.

Moreover, another study on coronary artery bypass surgery found that veterans' mortality and readmission rates were comparable between VA hospitals and non-VA sites.

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“Among the studies included in the review that had the most robust comparison of veterans in the VA and non-VA sites, all of these outcomes were at least equal or showed better outcomes for veterans, apart from cost or length of stay,” Blegen said. “Overall, this is good news for how veterans are doing in terms of quality and safety.”

Out of six studies examining VA patient care access, four found no clear advantage to receiving care outside of the VA system.

The findings showed that VA appointment wait times were about six days shorter for orthopedic appointments in VA sites than in non-VA settings, while urology appointment wait times were two weeks shorter at VA sites.

However, it is important to note that outside of surgical care, other studies have reported long and inconsistent appointment wait times for veterans seeking VA medical care.

Moreover, VA facilities had some geographic care access barriers, as travel distance to a VA healthcare center was sometimes greater than to a non-VA facility.

In terms of cost and efficiency, one study found that the average price for total knee arthroplasty was nearly double for VA care than for non-VA care.

Similarly, cataract surgery and elective coronary artery bypass surgery cost significantly more at a VA medical center. Additionally, two studies showed that veterans at VA hospitals had longer hospital stays compared to the general population at non-VA hospitals.

As there was only one study included on patient experience, which showed no difference in overall hospital ratings, no conclusion can be drawn at this point, researchers pointed out.

“We need to provide better information to patients on the available quality of care, so that they can make informed decisions about where they can get the type of care that will work best for their unique needs,” Blegen said. “We hope this review will help policymakers make decisions in the future about the VA health care system.” 

These findings come after the VA has reported concerted efforts to improve clinical quality.

VA has been focusing on improving data collection in response to its previously notorious poor quality of care. The VA NSQIP was created in the 1990s to address a lack of national data and risk-adjusted models for surgical specialties within the VA. Since its inception, the VA NSQIP has been instrumental in tracking millions of surgical cases and improving outcomes, including lower postoperative mortality and morbidity rates.

“VA NSQIP was born out of the need to address critical gaps in surgical care. The database continues to drive statistically reliable research that can help VA hospitals better assess its surgical outcomes and develop quality improvement programs to continuously respond to patient needs,” said Clifford Y. Ko, MD, MS, MSHS, FACS, FASCRS, director, ACS Division of Research and Optimal Patient Care, said in the study’s press release.