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VA Must Vet Resources Aiding Patient Treatment Decisions

The VA has great care quality transparency to assist patient treatment decisions. However, that data needs vetting and must be more complete.

va patient treatment decisions

Source: Thinkstock

By Sara Heath

- The VA’s care quality transparency on Hospital Compare and its own website help inform patient treatment decisions, found a recent report from the Government Accountability Office (GAO). However, the agency must do more to ensure the accuracy and accessibility of this information.

Patient-facing resources, such as Hospital Compare, help patients make informed decisions about where they should access healthcare, GAO said. These websites display care quality and patient safety information, as well as information about the patient experience and patient satisfaction.

As a part of the stipulations of the Veterans Choice Program – which allows veterans facing extraordinary access barriers to receive care in civilian facilities – the VA submits quality and patient experience data to the CMS Hospital Compare website.

Most hospitals submit 79 healthcare quality measures to the Hospital Compare website, but the VA only submits 35 quality measures, GAO found. VA submits all of the patient experience measures, most of the process measures, and some of the outcomes measures.

VA stated that it plans on reporting 12 more of the 79 quality measures “in future years.” Eleven of those measures will pertain to outcomes. The VA has no plans of reporting 32 others of the quality measures.

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“VA officials determined that these measures are not relevant for VA’s health care system, given its distinctive funding sources, patient population, and health care delivery structure,” GAO reported.

The VA also operates its own patient-facing resources. In 2008, the agency launched the Quality of Care webpage. In 2017 the agency created the Access and Quality webpage, which the VA intended to be the primary source of patients seeking experience information.

GAO commended VA for hosting such resources and stated that the Access and Quality page is navigable and easy to understand, proving an effective tool for patients. However, the agency still faces some barriers to facilitating patient treatment decisions.

First, the primary Access and Quality page lacks all the quality data the VA currently possesses. The more modern webpage only displays 15 quality measures, compared to 110 displayed on the 2008 Quality of Care page.

“We found that VA’s primary Access and Quality webpage does not provide veterans as much relevant information as VA’s older Quality of Care webpage,” GAO reported. “Our analysis shows that VA’s primary webpage meets only two of the seven relevance criteria. In contrast, we found that VA’s older webpage performs relatively well on the relevance criteria—meeting six of the seven criteria.”

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The 2008 page is difficult to find and not easy for patients to understand, according to GAO.

“Until VA can provide information on a broader range of health care measures and services and present this information in a way that is easily accessible and understandable, VA cannot ensure that its website is functioning as intended in helping veterans make informed choices about their care,” GAO explained.

GAO also found that the data quality may be lacking. The VA Central Office is in charge of collecting quality and experience data from all VA medical centers (VAMCs), but currently does not have an adequate system for vetting that data.

“VA Central Office officials told GAO that they have not systematically assessed the completeness and accuracy of the clinical information across VAMCs and the extent to which this affects the accuracy of its quality measures because they have focused on other priorities,” GAO said. “However, the lack of such an assessment is inconsistent with federal standards for internal controls related to information and monitoring.”

Thus, the VA has no guarantee that the quality measures reported to both Hospital Compare and VA’s own websites correctly demonstrates the quality of VAMCs. The VA has not assured that veterans have all of the accurate information necessary to make decisions about their treatment, GAO asserted.

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GAO offered two recommendations to VA. First, VA should report more of its quality and patient experience measures in an accessible manner on the Access and Quality website. Second, VA should conduct an assessment on the patient-facing quality information for all VAMCs.

The VA has been under both the government’s and the public’s microscope for some time. Since a 2014 scandal during which VA employees falsified patient wait times, the agency has been working to regain its credibility.

In recent months, the agency has advocated for its Veteran’s Choice Program, helping veterans receive access to third-party care when necessary. In 2016, the agency began a widespread culture change of putting the patient first, working to facilitate better appointment access, and creating an overall positive patient experience.

In this most recent report, GAO appears to acknowledge the steps that VA has taken to improve healthcare for the nation’s veterans.

“VA uses Hospital Compare and its website to provide veterans with information on how VAMCs perform on a range of health care quality measures,” GAO wrote. “By providing information on the quality of care at VA facilities, the quality measures are intended to help veterans make informed decisions about their care.”

Going forward, VA must streamline care quality transparency protocol, thus equipping patients with ample information to make informed treatment decisions.

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