Mark R. Howard
VA health care is a model that could benefit Medicare patients
Not too long ago I toured the Orlando Veterans Administration Medical Center in Lake Nona near Orlando. The center, which opened in 2015, is a beautiful facility that includes a 134-bed hospital, 120 beds in a community living center, a rehab facility and an array of inpatient and outpatient services. It’s expected to serve more than 110,000 veterans each year. The 1.2-million-sq.-ft. facility also serves as a center where the VA offers its physicians and other care providers simulation-based training in the latest medical technologies.
The hospital is the first VA facility built since 1995, and it didn’t arrive a moment too soon. Florida is home to some 1.8 million veterans, and central Florida, according to a Rand Corp. study, has a larger-than-average number of veterans — about 10% of the area’s population compared to the U.S. average of 6.8%.
The highlight of the Rand study, however, was a different statistic: Barring a major expansion of the military, the number of veterans nationwide will fall 19% between 2014 and 2024, from 21.6 million to 17.5 million. Most areas of Florida, in particular Jacksonville, will experience “negative net migration” of veterans in that period, the study predicts.
Over the next decade, that trend will put the Orlando medical center and the other VA facilities in Florida squarely in the middle as the national discussion about the VA’s future heats up.
It’s important that the discussion occurs in context. The hardest thing in thinking and writing about anything related to health care provided by the Veterans Administration is overcoming the persistent impression that it stinks. Our collective impression of the VA system is still dominated by headlines about decrepit facilities, wait times, construction cost overruns and allegedly shoddy care.
Among the few voices that have consistently and forcefully insisted on a more accurate picture of the VA is Phillip Longman, a senior editor at Washington Monthly and adjunct professor at Johns Hopkins University who, 25 years ago, was an accomplished writer and editor here at Florida Trend.
Longman, author of “Best Care Anywhere: Why VA Health Care Would Work Better for Everyone,” details how the VA, under the leadership of Ken Kizer, a Republican appointed by President Bill Clinton, instituted changes that took it from a disgrace to a model. By the early 2000s, studies consistently showed the VA outpacing the private-sector health care system in numerous indicators of quality, including patient satisfaction, patient safety, care coordination and use of evidence-based practices — avoiding overtreatment and expensive procedures in favor of cheaper, justas- effective alternatives.
The VA has been particularly effective, studies show, at using electronic medical records to coordinate care, at preventive care and control of chronic conditions like hypertension. In 2003, for example, the New England Journal of Medicine found care at the VA “significantly better” than private-sector care paid for by Medicare on 11 measures of quality. A 2015 Rand study found significant differences in quality across the VA system but noted that the system continues to compare favorably with private-sector care.
The VA has gotten those results while controlling costs much better than the private sector: By one estimate, the VA — while on average dealing with a patient population that’s older, sicker and poorer than the general population — held growth in spending to 1.7% between 1999 and 2005, while Medicare spending grew by more than 29%.
Is it tough to get your head around the idea that the VA is effective? Stop for a moment and consider: As some of the more recent controversies surrounding the VA have played out, have you ever seen a major veterans organization call for the VA to be privatized or dismantled? And despite the declining number of veterans and tightened eligibility rules, the number of veterans who use the VA system increased from 3.3 million in 2000 to 5.3 million in 2010. Veterans, as Longman points out, have voted with their feet in terms of where they’ve sought health care.
As for much-discussed “wait times” at VA facilities, “the latest available data shows that one in five VA patients is seen on the same day he or she makes an appointment,” Longman wrote in a recent report for the American Legion. Overall, the average wait time to see a VA primary care doctor is five days and nine days for appointments with VA specialists. Meanwhile, an independent assessment commissioned by Congress found that wait times at the VA for new patient primary and specialty care are shorter than wait times reported in studies of the private sector. “The familiar narrative about wait times at VA being worse than in the rest of the system is just demonstrably untrue,” Longman writes.
Longman says the relevant answer to many criticisms of the VA system is always, “Compared to what?” The VA has its problems but more than holds its own in a private sector dominated health care system that kills about 100,000 patients each year with mistakes and overtreatment.
In his book, Longman advocates expanding access to the VA system to all veterans — currently, only those who meet criteria relating to income and service-related disabilities are eligible. He also discusses the possibility of making the VA an option for Medicare recipients.
In light of the system’s performance and the shrinking population of veterans, those may be options worth considering. In any case, policy considerations involving the VA system in years to come need to be made soberly and without sensationalized, politicized claims about how the VA actually performs.
See other stories from Florida Trend's December issue.
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