A USA TODAY analysis of Veterans Affairs data provides the broadest picture to date of how each of 146 VA medical centers compares to non-VA care.
When 66-year-old Navy veteran Phyllis Seleska arrived at the emergency room at the Department of Veterans Affairs hospital in Loma Linda, California, in August 2017, the waiting room was crowded with dozens of veterans, some in wheelchairs lined up to the entrance.
Seleska was suffering throbbing pain after shattering her wrist but received no medication and had to wait more than seven hours to see a doctor, records show. By then, the orthopedics staff had gone home. So a nurse strapped a Velcro splint on her wrist and told her to come back in the morning.
“I don’t know why it took so long to get back there to be told we can’t do anything to help you,” said Seleska, who worked on the flight deck of aircraft carriers in both Gulf Wars.
Her experience wasn’t unusual. At roughly 70 percent of VA hospitals, the median time between arrival in the emergency room and admission was longer than at other hospitals, in some cases by hours, according to a USA TODAY analysis of the department’s data. That included Loma Linda, where the median wait is more than 7 ½ hours.
The USA TODAY analysis provides the most comprehensive picture to date of how 146 VA medical centers compare to other health care facilities on an array of factors. The analysis is based on scores of spreadsheets the VA has posted online in recent years containing comparisons of its medical centers to non-VA averages on everything from the ER wait times to infection rates and patient-survey results.
The analysis produced some positive findings for the VA. As of June 30, a majority of VA hospitals reported lower death rates than other facilities. Many VA medical centers also stacked up better on prevention of post-surgical complications such as blood clots.
At the same time, dozens had higher rates of preventable infections and severe bed sores – a sign of potential neglect. And nearly every VA performed worse than other medical providers on industry-standard patient satisfaction surveys.
VA spokesman Curt Cashour said certain veterans may have conditions that make them more susceptible to complications, and “caution should be exercised” when drawing conclusions from the comparisons.
He said the VA “does recognize the need to improve the speed by which it can admit veterans to the inpatient unit,” but he said non-VA hospitals also struggle with long waits.
“VA provides some of the highest quality health care available today,” Cashour said.
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The Department of Veterans Affairs has been buffeted by crises since 2014 when news reports revealed that patients died awaiting appointments at the Phoenix VA hospital. There were lethal lapses in Oklahoma City, patient safety failures in Memphis, Tennessee, and equipment and sterilization problems in Washington D.C.
The USA TODAY analysis adds to evidence of uneven quality within the VA system, with some hospitals such those in Asheville, North Carolina, and Sioux Falls, South Dakota, excelling on a wide range of measures while others, such as Memphis, lagged.
The analysis comes as the Trump administration is considering sweeping new rules to widen veterans’ access to outside health care paid for by the VA. It would deliver on a campaign promise made by President Donald Trump to expand health care choices for veterans.
Critics have warned that increasing VA-funded private health care would drain money from the department and lead to its privatization.
As the administration weighs the standards under which expanded non-VA options would be allowed, it is considering variables such as wait times, distance, and – for the first time – quality.
Quality VA care? Where do you live?
The VA began publishing online an array of spreadsheets it dubbed “scorecards” in the months after Trump took office. The quarterly assessments include comparisons on 65 measures.
USA TODAY compiled and analyzed the scorecards from June 30, the most recent available, and found that death rates after heart attack, heart failure and pneumonia were the same or lower than non-VA averages at two thirds of VA medical centers.
Most VA hospitals also had lower rates than other facilities for a majority of post-surgical complications such as hemorrhages, clots and death.
But nearly 50 VA hospitals had higher rates on at least three of four avoidable infections, such as potentially life-threatening intestinal bacteria and bloodstream infections. More than half had higher rates of severe bedsores.
At some facilities, problems happened far more frequently than at other hospitals – VA or non-VA.
Cashour, the VA spokesman, said some key quality measures are not risk-adjusted, and so could appear inflated. He said certain veterans, such as those with spinal cord injuries, are at “much higher risk” of developing bedsores.
While some hospital-quality specialists said adjusting rates for risk factors is typical in the industry, others say such steps are unnecessary for preventable infections and post-surgical complications.
Bill Finck, former chairman at The Leapfrog Group, a non-profit hospital rating organization, said there should be zero – much like an airline aims to have zero crashes.
“You either give a person an …infection or you don’t, whether or not they’re severely compromised or they’re in there for sniffles and colds,” said Finck, a longtime health care industry executive and Vietnam veteran who gets care at the Philadelphia VA. “Safety is safety.”
The VA hospital in Asheville was among the better performers on that front. The hospital had the same or lower rates on a majority of complications and infections than non-VA facilities.
“I can’t say enough about how good it is,” said David Hall, a 65-year-old Vietnam veteran who has received care at the Asheville facility for years.
“I wish the other VA hospitals could use their (example) and the other successful hospitals as a guideline and try to be more like them. I want all veterans to have the same experience I have.”
The VA has tried for years to spread best practices from higher-performing hospitals to more troubled ones. In 2015, the agency launched a “diffusion of excellence” program to replicate successful programs across the country, including direct scheduling of eye and ear appointments and text messaging of appointment reminders.
In 2017, the VA set up a tracking system at headquarters to identify problem facilities and dispatched teams to help them improve.
Yet as of October, five VA hospitals ranked the lowest one star out of five for the third straight year in agency ratings, including in Loma Linda and Phoenix, the site of the 2014 wait-time scandal. The others were Memphis and the VA hospitals in Big Spring and El Paso, Texas.
VA spokesman Cashour said those hospitals have undergone “intensive improvement initiatives over the past year” and each has “achieved significant gains in multiple areas.”
Veteran (dis)satisfaction revealed
On patient satisfaction surveys, veterans overall were less likely than non-VA patients to feel medical workers treated them with respect or listened to and respected what they had to say, the USA TODAY analysis found.
They were also less likely to recommend VA hospitals to others and rated their medical care providers lower.
The VA scorecards analyzed by USA TODAY feature questions for inpatients and outpatients about their healthcare experiences. Nearly every VA facility – 141 out of 146 – scored below other facilities on a majority of questions surveyed.
The Memphis VA hospital received lower ratings from patients than the median of non-VA providers on 27 of 30 questions – the worst of any VA facility.
Mary Alimenti, whose husband receives care at the Memphis VA – roughly 100 miles from their home in Huron, Tennessee – said hospital staff have been “really mean” when she accompanied him to appointments and “don’t listen.”
“They don’t take the time that they need to with the vets” she told USA TODAY. “It’s like, you know, you’ve got a line of cows, and they’re coming in and going right back out again.”
Cashour, the VA spokesman, said the outpatient survey results are not adjusted for factors like age that could influence the outcomes. He said older patients on average give higher ratings than younger patients for the same care, and sicker patients give lower ratings than healthy ones.
Cashour said the VA does take age and health into account when calculating the results for inpatient surveys. And he said results about whether veterans would recommend VA hospitals are unreliable.
“Veterans often will respond to the survey by telling us they rated the hospital highly but answered this question ‘no’ because their friends and family are not eligible for VA care,” he said.
Seleska, the veteran who waited more than seven hours in the Loma Linda VA emergency room, said she had no such confusion and wouldn’t recommend the hospital to anyone.
She isn’t looking to switch to non-VA care, even if the VA pays for it. She just wants the VA fixed.
“All we’re asking is do your job,” Seleska said. “Do what you’re supposed to be doing – your job is to take care of us.”
She has reached out to patient advocates and administrators in Loma Linda, the VA inspector general’s office and even Trump’s new White House hotline for veterans over a litany of problems she has had with VA care beyond the emergency room – to no avail. Seleska said she also went to her member of Congress and veterans’ organizations.
“This is what motivated me to … keep accelerating until I got somebody’s attention, anybody’s attention — because it’s not just me,” she said. “It’s my brothers and sisters over here. I mean, people are in pain.”
How does your VA hospital stack up?