Meet The Best Health Care, The VA

Filed in National by on December 11, 2013

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 MyHealthVet.com 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.

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  1. Norinda says:

    The VA pioneered Electronic Health Medical Records over 10 years ago. Anywhere in the country a Veteran goes for VA care, the VA can pull up a patients’ medical records. May I also say, the VA treats Vets cost-effectively with complex medical conditions, mental health disorders (PTSD ect.) and homeless Vets. They even have a Forensic Units for Vets with Psych Issues & Criminal backgrounds. Yes, a friend was taken care of on the Lock Down Forensic Unit w/ Respect, Dignity & Compassion. Medications are much more affordable because the Federal Government can buy in such high quantity (volume) and negotiate prices cheaper than in the private sector/market. Bonus, only 1 of few places left in the US where Employees can still earn a Pension.

  2. Truth Teller says:

    As VET with a service connected disability I can vouch for the excellent treatment I have received from both the Veterans hospital in Wilmington and the out patient service here in Georgetown both are outstanding.

  3. Joanne Christian says:

    Having been around a few health systems myself, I will say the VA system has DRAMATICALLY improved in the last 15 years. If you are able to access, by all means do so–prior to the 80s, they were often pitiful, desperate , almost warehoused sources of care–and lacked expertise, technology and competent care. Unfortunately, war and tumult put the spotlight on these facilities circa Desert Storm, and fortunately our government responded to the appreciable diference you see now. Wasn’t quite so for the Viet Nam vet—and oh what a difference.

  4. Tom McKenney says:

    The VA computerized health records system is amazing. Everything is at the providers fingertips no searching through paper records….they can compare all meds from all doctors with a few keystrokes….especially helpful when dealing with patients with multiple problems
    I also have a service related disabilities and I’m impressed with the standard of care. The VA provides a great case for socialized medicine.

  5. radef16 says:

    There is no question that the VA system works well. However, it is not extendable to the general public. Consider the following:
    The doctors who work at the VA choose to do so. Most physicians are also entrepreneurs. They invest in building clinics and buying big ticket items like MRI machines. They also employ 10′s of thousands in very good paying jobs. Without this level of opportunity many will not choose medicine as a career. Most physicians do not see themselves as salaried employees.
    The VA controls what procedures are done, what drugs are prescribed as well as just about everything else. This approach is cost effective but may or may not work for an individual patient. Independent physicians do not work under these restrictions. Hopefully, they never will.
    VA patients don’t get to choose their doctors. If someone in your family needs major surgery will you be content with luck of the draw? Personally, I’m going to find the best and even travel to see her. (Beau Biden & his recent trip to Texas comes to mind).

  6. LeBay says:

    the VA system has DRAMATICALLY improved in the last 15 years.

    My mother’s 2nd husband was a Coast Guard vet. He received excellent care from the VA & got amazing discounts on expensive drugs (coumadin was one, and this was 10 yrs. ago) after he suffered his 2nd heart attack, quickly followed by a stroke. VA paid for inpatient rehab and in-home care after everyone involved realized he was never going to get out of that wheelchair.

    Our shitheel congressmen and senators have been bought & paid for. Federal law prevents medicare from negotiating drug prices like the VA does.

  7. stan merriman says:

    Radef16, the facts simply do not bear out your claims. By 2008, the Medical Group Management Association said that over 50% of medical practices were owned by Hospitals and growing exponentially. Why such a group, by the way ? Because by reputation, physicians, you claim to be entrepreneurs, are such lousy business managers, facing bankruptcy and the like for their ineptitude in running their practices and managing money.
    Let me also point out that MD Anderson in Houston’s medical staff are salaried and are tied to the UT Medical School. I was cared for by them at the VA in Houston with whom they contract Oncology services.
    You mention clinics. The big ones, such as the Cleveland Clinic, Mayo Clinic, Kaiser Clinics, Scott and White Clinics…..the list goes on across the country, with high quality reputations and outcomes data salary their physicians.
    Buy big ticket items like MRI’s? Such random, helter skelter purchases of technology since medical deregulation in the 80′s is precisely the reason, according to health care economists, why health care is the most inflationary part of our economy, historically. Simply put, there is too much of this high priced technology stuff around in places where the demand data says it isn’t needed. And when physicians invest is such things, including pharmacies (when law allows them to have this conflict of interest), they overuse it to help recover their investment. Again, inflation.
    My VA doctors and primary care providers consult with others on their staff, sometimes at my request for a second pair of eyeballs. Few independent physicians (what few are left, a dying breed) do so and when they do, it is a second charge for me. Finally, few mainstream patients have a clue about their surgeon’s track record, mortality rate, infection rate, etc. They fly blind because the medical profession has suppressed disclosure to protect the earning power of their physicians/surgeons. Reputations of “name brand” surgeons are built by medical p.r. companies, not hard earned, transparently disclosed results data.

  8. cassandra_m says:

    I got lost at this bit of stupidity:

    The doctors who work at the VA choose to do so.

    The doctors who work at the private practice you go to, or the hospital your kid is in or even for Médecins Sans Frontières work at these places because they *choose* to. Sheesh.

  9. cassandra_m says:

    NPR has been running a special report all week about the veterans who come out of the service with “bad paper”, less than honorable discharges. In the main they are focused on those who got their discharges due to PTSD issues, and can’t get much help from the places who have PTSD expertise (the VA and affiliates). It is a tough problem. But they talked to someone who discussed some of the non-profits that have sprung up to try to address the PTSD issue outside of the VA and he noted the normally the first people to show up for help in these places are Vietnam vets — who have been living with PTSD and its effects for decades and just recently can put a name to it.

  10. Tom McKenney says:

    The war in Iraq brought out a lot of issues Viet Nam vets thought they had hidden away.

  11. LeBay says:

    cassandra_m-

    I’m a hardass and, and some people might call me a raging asshole. Steve Newton and Dennis P. Williams can confirm. I own a mirror and know how to use it, so I’m fine w/ that.

    I nearly cried when I heard the story of the Marine Corps vet who was dishonorably discharged, became a crack/meth/whatever-he-could-get-his-hands-on-head/drunk.

    I would encourage anyone who cares to go to NPR.org & look up the story. It will break your heart at first & then it will restore your faith in our government. Seriously…it made me want to cry .

    I’ve cried exactly 1 time since 1991.

  12. radef16 says:

    cassandra_m :

    I’ll rephrase myself. The doctors who work at the VA choose to practice as salaried employees. Out of all of the physicians that I know, only 2 work for a salary. The others all run their own practice. They went to medical school with that intent in mind & probably would have chosen another profession if they could not do so. If all physicians were required to work for a salary, I am convinced that the best & brightest would be doing something else- it is simply a part of their personality.

    stan merriman :

    The purchase of expensive medical technology often does not make business sense.
    The orthopedist who chooses to have a $50K x-ray machine in his office & uses it only a few times per week will probably never break even. However, his patients will have the benefit of better & faster care. A group of small town doctors who fork out $1M plus for an MRI machine will save their patients a long drive to the next closest machine but probably never make a profit from it.

    If medical technology is purchased only when it makes business sense, only when justified by sufficient demand, most of this country will find itself without the option of state of the art care. I’m glad my doctor got a good tax deduction for buying all of that expensive stuff in his office & I am certain that, should I need it, it will be available close to home & without a long wait.

  13. cassandra_m says:

    These are the NPR reports about veterans with PTSD issues who were discharged other than honorably. The report that LeBay referenced is the 4th one, I think. I thought that the young man’s story in the first part of this series was pretty heartbreaking too.

    Help Is Hard To Get For Veterans After A Bad Discharge

    Other-Than-Honorable Discharge Burdens Like A Scarlet Letter

    For Veterans, ‘Bad Paper’ Is A Catch-22 For Treatment

    Path To Reclaiming Identity Steep For Vets With ‘Bad Paper’

    Filling The Gaps For Veterans With Bad Discharges

  14. cassandra_m says:

    If all physicians were required to work for a salary, I am convinced that the best & brightest would be doing something else- it is simply a part of their personality.

    In other words, greed is a part of the process AND part of why our medical bills are so inflated.

    In much of the rest of the world, doctors work for a salary. And here, Stan already mentioned a list of some of the most prestigious medical clinics and hospitals in the country whose doctors are working for a salary. Some of the best places for doctors to be ask their doctors to work for salary in order to eliminate the conflicts of interest that are inherent the fee for service model. Salaries are paid whether you do more for patients or less. Fee for service means you don’t get paid unless you rack up lots of procedures. Paying doctors as though they were doing piecework just means that you get subject to plenty of stuff you don’t need. Which is a key problem in the system. And why doctors taking Medicare scream about what they get paid. Reducing the fees paid for service narrows the opportunities for being able to make more money on increased services.

  15. stan merriman says:

    Radef16, it would be good if you did at least a minimal amount of homework on your assertions. You can by an Xray machine for $,3-5 K., affordable for practically any practice. Though there are certain gaps in care in rural America, the AFA is designed to close those gaps long term.
    Currently though, most rural areas are serviced by outpatient clinics with at least basic diagnostic tech financed by hospital systems based in more urban/suburban areas for rural physicians, few as there are, to refer patients; they use them as marketing feeders to their hospitals. These systems have the cash and borrowing power to equip with expensive tech (which Xray is not !).
    The demand data to justify (or not) medical technology/facilities was typically produced for healthcare organizations in making application to state healthcare regulatory agencies to control costs; this disappeared across the country under Reagan’s deregulation under the theory that competition in healthcare would drive down costs; good luck with that ! This data was not a “business” decision, it was a communty need/good decision by government, now all but gone.

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