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GAO: VA Quality Measures on Hospital Compare, Agency Websites Not Accurate, Complete Enough

by Sandra Basu

December 15, 2017

By Sandra Basu

WASHINGTON—VA does not have “reasonable assurance” that the healthcare quality measures it reports on Hospital Compare and its own website accurately assess how VAMCs are performing, a new study suggests.

“This is because the quality measures are calculated using clinical information recorded in patient medical records, but VA Central Office does not know to what extent this information has been accurately and completely recorded across VAMCs,” a recent Government Accountability Office (GAO) report stated.

As a result, the GAO recommended that VA conduct an assessment of the “completeness and accuracy of patient clinical information across VAMCs that is used to calculate the healthcare quality measures VA reports and address any deficiencies that affect the accuracy of these measures.”

“Studies and other evidence we reviewed indicate potential problems with the completeness and accuracy of the clinical information recorded in patient medical records at some VAMCs (e.g., diagnoses given and treatments received),” the GAO authors explained. “This is significant because the accuracy of VAMCs’ performance on quality measures that are calculated and reported by VA on Hospital Compare and its own website depends on the completeness and accuracy of this clinical information.”

That was one of the conclusions in the GAO report titled “VA should improve the information it publicly reports on the quality of care at its medical facilities.” The report also recommended that VA take additional steps to ensure its website reports healthcare quality measures “that cover a broad range of healthcare services, highlights key differences in the clinical quality of care, and presents this information in an easily accessible and understandable way.”

“Until VA can provide information on a broader range of health care measures and services, highlight key differences in the quality of clinical care at VAMCs, and present this information in a way that is easily accessible and understandable, VA cannot ensure that its website is functioning as intended in helping veterans make informed choices about their care,” the report stated.

VA reports healthcare quality measures on its website as well on the HHS Hospital Compare website.

“Hospital Compare publicly posts health care quality measures for over 4,000 non-VA hospitals that participate in Medicare, which enables veterans and others the opportunity to compare the performance of non-VA hospitals and VAMCs on a common set of quality measures. VA also separately reports on its own website information on the performance of VAMCs on a range of health care quality measures,” according to the report.

VA’s website consists of two separate webpages with information—the “Access and Quality” webpage, launched in April 2017, and the “Quality of Care” webpage, which VA has used since 2008, according to the GAO.

The Access and Quality webpage is intended to be the primary source of information on quality of care at VA for veterans, according to VA officials,” the report stated.

GAO found in its audit that VA’s primary Access and Quality webpage generally reported healthcare quality of care information in ways that are more accessible and understandable than VA’s older Quality of Care webpage. VA’s primary Access and Quality webpage did “especially well” at presenting information on quality of care on two subpages that focus on access to care, the reviewers found.

Those pages provided information written in plain language with accompanying graphics and allow users to rank order VAMC’s by level of performance on a given quality measure, among other things.

Too Few Outcomes

On the downside, VA’s primary webpage “does not provide information on a broad range of health care services, nor does it highlight key differences in clinical quality of care,” report authors noted. “For example, the primary webpage reports only on the incidence of two types of HAIs and not on any other types of outcomes, such as readmissions and mortality rates associated with different medical conditions.”

Additionally, VA’s primary webpage “only provides limited information about key differences in patient experiences and the key strengths and limitations of the data reported,” the document pointed out.

In contrast, GAO found that VA’s older Quality of Care webpage displays quality measures in ways that “generally do not meet any of the presentation criteria,” adding that the older webpage still provided veterans with more relevant information than the VA’s primary webpage.

“VA’s Quality of Care webpage performs better on the relevance criteria primarily because its four subpages together provide information on 100 different measures spread across a broader range of measure categories,” the GAO suggested.

The report said that VA concurred with its recommendations.

When it comes to its website, “VA provided additional information about its plans to expand the quality measures reported on its Access and Quality webpage, including information on which additional measures it was planning to add to the webpage and the steps it planned to take to continue to enhance the presentation of this information for veterans. VA indicated that its target completion date for these activities was December 2017,” the GAO stated.

VA “concurred in principle with our second recommendation for VA Central Office to conduct a systematic assessment of the completeness and accuracy of patient clinical information across VAMCs that is used to calculate the health care quality measures VA reports and address any deficiencies that affect the accuracy of these measures,” according to the report.


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