A 9 minute read
stethoscope with united states military jacket
April 24, 2017

*Updated in March 2020

Veterans’ benefit and assistance agencies have a long history in the United States, with roots tracing all the way back to 1636 and the pilgrims at Plymouth Colony. However, the Veterans Administration (VA)—or the U.S. Department of Veterans Affairs, as we now know it—was not formally established by former President Herbert Hoover until July 1930.

The long-standing goal of these agencies has always been to provide crucial medical care, dental care, rehabilitation, disability compensation, and employment benefits to those who have risked their lives in defense of the country. Within the past 40 years or so, though, the VA healthcare system has weathered criticism for its treatment of veteran patients.

A 2014 scandal, for instance, indicated that VA hospitals may have falsified records to cover up long patient wait times. Evidence of a “secret wait list” revealed that at least 1,700 veterans waited an average of 115 days, or about four months, to see their primary care provider. At one Phoenix, Arizona VA hospital, investigation confirmed that as many as 40 veterans died while on the wait list.  

Despite this, performance scores reveal that VA hospitals actually exceed non-VA facilities in several key areas of both clinical and quality care.

In 2010, the VA healthcare system began collaborating with the Centers for Medicare and Medicaid Services (CMS) to regularly publish their clinical and quality scores on the CMS Hospital Compare website—allowing consumers to readily access this information. Before this time, VA hospital ratings had been kept private. This is reportedly due to fear that bad scores might unfairly tarnish individual hospitals.

In this blog, we’ve highlighted several key areas in which VA hospitals closely compete with non-VA facilities or, in some cases, outperform them.

Lower inpatient mortality rates at VA hospitals

The VA healthcare system provides care to more than 9 million enrollees at over 1,200 different healthcare facilities—including 170 VA hospitals and just over 1,000 VA-associated outpatient clinics.

According to Definitive Healthcare data, these 170 VA hospitals consistently outperform non-VA hospitals in average mortality rate for heart attack, heart failure, and pneumonia.

30-day readmission and mortality rates at VA hospitals vs. non-VA hospitals

 

Measure

 

Readmission Rate (%)

VA Hospitals

 

Readmission Rate (%)

Non-VA Hospitals

 

Mortality Rate (%)

VA Hospitals

 

Mortality Rate (%)

Non-VA Hospitals

Heart Attack

17.24

15.7

12.09

12.84

Heart Failure

22.94

21.64

9.62

11.63

Pneumonia

17.47

16.63

13.02

15.78

COPD

15

19.5

N/A

8.54

Fig 1 Data table compares average 30-day readmission and mortality rates at 168 VA hospitals and 7,044 non-VA hospitals. Data is sourced from the CMS Quality Metrics Update January 2020, and accessed on the Definitive Healthcare Hospitals & IDNs database. Accessed March 2020.

The above data table indicates that VA hospitals report anywhere from 0.75 to 2.76 percent lower mortality rates across all three major condition measures tracked by CMS. Though the mortality rate is markedly lower among veterans’ hospitals, these facilities have recently reported higher 30-day readmission rates than non-VA facilities in all reporting areas except for one: chronic obstructive pulmonary disease (COPD).

While average readmission rates at VA hospitals may be consistently higher than those at non-VA hospitals, it’s worth noting that these rates are, on average, only about 1.5 percent greater than other facilities.

Improved patient safety indicators at VA hospitals

The Agency for Healthcare Research and Quality (AHRQ) is a U.S. Department of Health and Human Services agency dedicated to providing evidence that will make the U.S. healthcare system safer, more affordable, and of a higher quality. One of the many ways in which the AHRQ achieves this goal is by tracking patient safety indicators related to certain surgical or other procedural complications.

There are 26 different patient safety indicators, and all hospitals are awarded a score for each of these complications based on how often adult patients were treated for these serious, potentially preventable problems. The resulting score is a composite complication rate per every 1,000 patients.

Definitive Healthcare data reveals that VA hospitals perform better than non-VA hospitals across four of the most frequently reported surgical complications.

Serious complication rate at VA hospitals vs. non-VA hospitals

Serious Complication Measure

VA Hospitals

(rate per 1000 discharges)

Non-VA Hospitals

(rate per 1000 discharges)

Collapsed lung due to medical treatment

0.038

0.27

A wound that splits open after surgery on the abdomen

0.90

0.95

Accidental puncture or laceration from medical treatment

0.82

1.29

Fig 2 Data table compares average serious complication rates at 168 VA hospitals and 7,044 non-VA hospitals. Patient safety indicator data sourced from the AHRQ as of January 2020, and accessed on the Definitive Healthcare Hospitals and IDNs database. Accessed March 2020.

Low mortality rates and few post-surgical complications are two evidence-based claims that support quality of care at VA hospitals. Several other factors may also play a role in impacting this quality difference.

In 2015, for instance, the Veterans Administration launched a Diffusion of Excellence program designed to “identify, test, and diffuse” improved quality measures and clinical best practices across the VA healthcare system. Later, in 2017, the administration announced plans to introduce a high-tech healthcare improvement center aimed at specifically addressing facilities with lower performance.

In addition, the VA’s status as a federal administration means that it is subjected to more oversight and scrutiny than other privately-owned healthcare systems might be. With its performance data now readily accessible to researchers and consumers alike, public pressure has increasingly become a significant motivator in these quality improvement initiatives.

Competitive patient satisfaction scores at VA hospitals

Despite their relatively high clinical performance, VA hospitals report mixed scores in patient satisfaction surveys.

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a publicly reported, qualitative evaluation of hospital performance randomly administered to patients within six weeks of hospital discharge. The assessment measures a total of 27 different aspects of hospital care, conduct, and quality in areas related to the patient experience.

According to Definitive Healthcare data, VA hospitals tend to report lower HCAHPS scores than non-VA hospitals across both individual quality measures and overall hospital performance.

HCAHPS patient satisfaction scores at VA hospitals vs. non-VA hospitals

HCAHPS Measure

VA Hospitals

Non-VA Hospitals

Strongly agree that doctors always communicated well

80

81.32

Strongly agree that nurses always communicated well

79

80.60

Strongly agree that staff always explained medicines

67

65.69

Strongly agree that they received help as soon as they wanted

68

69.65

Strongly agree that the room was always quiet at night

59

61.50

Strongly agree that the room and bathroom were always clean

72

75.28

Strongly agree that they were given information about what to do during at-home recovery

86

87.08

Strongly agree that they understood discharge instructions

57

53.08

Rated the hospital a 9 or 10 on a 0 to 10 scale

72

72.72

Would definitely recommend the hospital

71

71.90

Fig 3 Data table compares average response rates on the HCAHPS Patient Satisfaction Survey across 168 VA hospitals and 7,044 non-VA hospitals. HCAHPS data is sourced from the CMS Quality Metrics Update January 2020, and accessed on the Definitive Healthcare Hospitals & IDNs database. Accessed March 2020.

Based on the above table, VA hospitals report the greatest negative difference in quality performance within the following two areas:

    • Patients strongly agree that the room and bathroom were always clean, and
    • Patients strongly agree that the area around the room was always quiet at night

It is worth pointing out, however, that neither of these two performance areas are directly related to clinical quality at VA hospitals. In fact, VA hospitals compete closely with non-VA facilities in most other HCAHPS performance measures listed above.

In two cases, VA hospitals actually perform better than non-VA hospitals in terms of clearly communicating medications and helping patients to understand their post-discharge instructions.  

Given the subjectivity of the HCAHPS patient satisfaction survey, there are a multitude of other factors impacting hospital scores that might be outside of their control. Noise complaints and cleanliness, for instance, could have more to do with where the hospital is located—as in, a densely-populated urban area—or how old a facility might be. Due to funding restrictions, many VA hospitals have seen little or no facility improvements since they were first constructed.

These things, combined with an always-present staffing shortage at both VA and non-VA hospitals, add nuance to problems that patient insights might otherwise highlight.

Learn more

For more information about veterans’ facilities across the country, read our blog about the 50 largest VA hospitals.

To access more data about changing quality performance at VA hospitals and how expanded healthcare options for veterans might impact the private sector, visit the Definitive Healthcare Hospitals & IDNs database.


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