Agencies   /   Department of Veterans Affairs (VA)

Despite Criticism, VA Healthcare as Good or Better Than Other Systems

by Brenda Mooney

June 10, 2018
Earlier this year, Seth Holst, MD, an ophthalmologist conducts an eye exam at the VA Pittsburgh Healthcare System. Regular eye examinations for diabetic patients is one of the areas in which the healthcare system excels, according to a recent consultant study.
VA photo.

WASHINGTON — The good news from a recent consultant study is that, overall, the VA healthcare system is generally equal or better than others when inpatient and outpatient quality is measured.

The bad news in the RAND Corp. study is the high variation in quality among individual VA facilities.

The study published online by the Journal of General Internal Medicine explained that the VA’s healthcare system was compared to non-VA hospitals for the inpatient comparisons and to commercial HMOs, Medicaid HMOs and Medicare HMOs for the outpatient comparisons.1

“The variation among VA health facilities shows that veterans in some areas are not receiving the same high-quality care that other VA facilities are able to provide,” said co-author Carrie Farmer, a senior policy researcher at RAND.

On the other hand, the variation in the quality of care provided across the VA—which operates the nation’s largest integrated health system—was smaller than what researchers observed among non-VA health providers.

As a whole, the study — which was mandated in the law creating the Choice act, which allows veterans to seek outside care under certain circumstances — found that the VA performed very well. “Consistent with previous studies, our analysis found that the VA healthcare system generally provides care that is higher in quality than what is offered elsewhere in communities across the nation,” emphasized lead study author Rebecca Anhang Price, PhD, a senior policy researcher at RAND, a nonprofit research organization.

Performance Measures

VA’s quality of care in outpatient and inpatient settings was assessed using widely recognized performance measures reported across several national surveys during 2013 and 2014. Among the information analyzed were the Healthcare Effectiveness Data and Information Set and the Survey of Healthcare Experiences of Veterans.

RAND researchers actually compared each of the VA’s 135 facilities to three similar non-VA hospitals based on geographic location and whether the setting was rural or urban. In addition, the healthcare system was measured against other overall care networks.

The VA hospitals performed the same or significantly better than non-VA hospitals on:

  • all six measures of inpatient safety,
  • all three measures of inpatient mortality, and
  • 12 measures of the effectiveness of inpatient care.

The only areas in which VA hospitals performed significantly worse were three readmission measures and two effectiveness measures. Patients’ experience on pain management was an area where VAMCs scored low, while patient experiences for management of care transitions scored high.

As for the outpatient measures, VA facilities outperformed both commercial HMOs and Medicaid HMOs for all 16 measures of the effectiveness of outpatient care, while doing better than Medicare HMOs on 14 out of 16 measures of effectiveness.

VA care was closest to commercial HMOs in the rate of antidepressant medication management during the acute phase and closest to Medicaid HMOs in the rate of ongoing beta-blocker treatment after an acute heart attack. It far outstripped both of those networks, however, with a high rate of eye examinations for patients with diabetes.

While offering some explanations for the stark differences in care among VAMCs, such as older and sicker patients in some locations, the RAND researchers urged more quality improvement efforts to assure across-the-board excellence in care for veterans.

The VA-funded study pointed out how variable quality ratings were among different facilities in the healthcare system. For example, on the rate of beta blocker treatment for at least six months after discharge for an acute heart attack in 2014, the gap between lowest and highest rated facility was 50 percentage points.

While the study might answer some of the concerns raised by Congress and veterans’ service organizations about quality of care in the VA system, the RAND report did not address access to care or whether it was delivered in a timely manner.


1Anhang Price R, Sloss EM, Cefalu M, Farmer CM, Hussey PS. Comparing Quality of Care in Veterans Affairs and Non-Veterans Affairs Settings. J Gen Intern Med. 2018 Apr 25. doi: 10.1007/s11606-018-4433-7. [Epub ahead of print] PubMed PMID: 29696561.

Related Articles

New Agents Extend Options for Increased Survival in Metastatic Prostate Cancer

Accounting for nearly a third of all cancer diagnoses, prostate cancer is the most frequently diagnosed cancer in the VHA, where past research has suggested that the malignancy is caught earlier than in other healthcare systems.

Personalized Medicine Brightens Outlook for Most Common Kidney Cancer

In the past five years, 10 new system therapies have been approved for renal cell carcinoma (RCC), the most common type of kidney cancer.


U.S. Medicine Recommends


More From department of veterans affairs

Department of Veterans Affairs (VA)

Bill to Streamline, Expand VA’s Choice Program Signed Into Law

Legislation that would streamline VA’s community care programs into one program and expand VA’s caregiver program to veterans of all eras was signed into law earlier this month..

Department of Veterans Affairs (VA)

VA Inks Contract for Massive New Health Record System

Calling it one of the largest IT contracts in the federal government, with a ceiling of $10 billion over a decade, then-VA Acting Secretary Robert Wilkie announced that the agency signed a contract with Cerner for its new electronic health record (EHR).

Department of Veterans Affairs (VA)

Surprise! President Nominates Wilkie for Permanent VA Secretary

President Donald Trump said last month that acting VA Secretary Robert Wilkie “has done an incredible job” and, in a surprise move, nominated him for the permanent Cabinet position.

Department of Veterans Affairs (VA)

Fibromyalgia Presents Differently in Male, Female Veterans

Research on fibromyalgia, a poorly understood, chronically disabling pain syndrome, generally has focused on its clinical presentation and treatment.

Department of Veterans Affairs (VA)

How Veterans Feel About Remote Management of Their Care

The VA is expanding remote management of patients to improve disease prevention and care.

Facebook Comment

Subscribe to U.S. Medicine Print Magazine

U.S. Medicine is mailed free each month to physicians, pharmacists, nurse practitioners, physician assistants and administrators working for Veterans Affairs, Department of Defense and U.S. Public Health Service.

Subscribe Now

Receive Our Email Newsletter

Stay informed about federal medical news, clinical updates and reports on government topics for the federal healthcare professional.

Sign Up