WHITE RIVER JUNCTION, VT—Veterans are being given more options for obtaining care outside of the VA healthcare system. The question raised in new research is whether doing so improves care.

A research letter published in Annals of Internal Medicine pointed out that many of the nine million veterans enrolled in the VA healthcare program will, at some point, have to decide whether to seek care at a VAMC or an outside facility.1

The authors from the White River Junction VAMC and the Dartmouth Institute for Health Policy and Clinical Practice, both in Vermont, noted that the VHA is the largest integrated healthcare system in the United States, providing care at 1,243 healthcare facilities, including 172 VAMCs and 1,062 outpatient sites. The study team used the most current publicly available data to compare health outcomes within 121 local healthcare markets that included both a VAMC and a non-VA hospital.

“We wanted to take a closer look at local healthcare markets and specific health conditions because, if you’re a veteran deciding where to seek treatment what you’re really concerned with are the outcomes at your local VA,” explained co-author William Weeks, MD, PhD, MBA, of the Dartmouth Institute.

Earlier this year, President Donald Trump signed into law the VA MISSION Act, which streamlines the VA’s community care programs to remove bureaucratic obstacles to care in the private medical community. It sought to improve the possibility that veterans receive efficient, timely and quality care, according to sponsors.

The law has been criticized by some groups, including veteran service organizations, for moving closer to privatization of VA healthcare. This study calls into question whether outside care really is better for veterans.

Weeks and co-author Alan N. West, PhD, of the White River Junction VAMC pointed to several recent studies that used broad representative samples of VHA patients and compared them with outside representative samples to determine that VHA outcomes are at least as good as those in the private sector.

At Least as Good

Week and West suggested several explanations:

  • The VHA mighty provide better care than the private sector in every local area.
  • Non-VHA care may be better than VHA care in more local areas but by a small amount, or
  • VHA care might be better than non-VHA care in fewer local areas but by a large amount in each area.

Researchers set out to determine what was reality. To do that, they identified 15 outcome measures that were reported by VHA and non-VHA hospitals, using data from Hospital Compare, a Centers for Medicaid & Medicare Studies website, which provides information on how well hospitals provide recommended care to their patients.

Measures included 30-day risk-adjusted mortality rates for four common diseases:

  • acute myocardial infarction,
  • chronic obstructive pulmonary disease,
  • heart failure, and
  • pneumonia.

The study team also looked at 11 additional patient safety indicators.

By using each hospital’s ZIP code to assign the hospital to one of 306 hospital referral regions, the research was limited to the 121 regions in which at least one VHA and one non-VHA hospital reported at least one of the measures.

Within those regions, defined by the Dartmouth Atlas of Health Care as distinct health care markets, VA hospitals were likely to provide the best care in a local healthcare market and rarely provided the worst, the researchers reported.

“Our findings suggest that, despite some recent negative reports, the VA generally provides truly excellent care,” Weeks said. “If that is the case, outsourcing VA care to non-VA settings solely for patient convenience should be reconsidered.”

Weeks and West also raised the possibility, however, that VA and non-VA hospitals might report data differently to Hospital Compare. If so, the authors recommended the VA and CMS adapt reporting methods to ensure fair comparisons by end users who are trying to make healthcare decisions.

The authors added that, for veterans, “comparisons that provide a national average may be less useful than a local comparison. For example, individual veterans probably don’t care whether VHA or non-VHA hospitals provide better care on average but whether the nearest VHA hospital or the local non-VHA hospital is better for them.”

1. Weeks WB, West AN. Veterans Health Administration Hospitals Outperform Non–Veterans Health Administration Hospitals in Most Health Care Markets. Ann Intern Med. [Epub ahead of print ] doi: 10.7326/M18-1540