Report lauds VA's focus on quality care, health IT

The Veterans Affairs Department has improved its quality of health care through management initiatives and use of health information technology, the Congressional Budget Office said in an interim report. VA's accomplishments come during a period of increased demand for its services from soldiers returning from Afghanistan and Iraq. VA has restructured efforts to permit more shared decision-making among its central office, regional managers and facility directors; measure performance, process and outcomes; and use health IT systemwide. The department's integrated structure and appropriated funding may have helped it focus on providing the best quality care for a given amount of money compared with fee-for-service incentives toward billable services and procedures, CBO said in the Jan. 9 report. The improvement in VA's health care quality has been documented in a number of independent studies, including by the Institute of Medicine. VA will provide care to more than 5.8 million veterans this year in its 153 hospitals and nearly 900 clinics. VA tracks the quality of its care using indicators such as adherence to clinical guidelines and standards that have been shown to improve outcomes, waiting times for access to services and customer satisfaction. This year, VA plans to adopt more industrywide quality measures, such as those in the Healthcare Effectiveness Data and Information Set, to boost comparability with other providers, CBO said. VA's structure as an integrated health care system makes it easier for the department to use two effective tools: incentives for managers and providers to meet quality of care and practice guideline targets, and health IT systems that provide reminders about tests and treatments recommended by the practice guidelines, CBO said. It also found that the low cost of care for veterans was an incentive for seeking care. Most payment systems for health care do not align incentives well with quality. Health insurance plans often pay providers based on the number of services performed instead of the quality of the care delivered. “In most cases, providers are not directly reimbursed for investments in quality,” said Allison Percy of CBO’s National Security Division, who wrote the paper. These investments include purchases of health IT to track adherence to clinical guidelines or spending on education and training to improve compliance with safety protocols. “VA has implemented a system for assessing the performance of its personnel at all levels that focuses on indicators of quality of care, access and patients’ satisfaction, and related areas,” Percy said. The managers of each of VA’s regional hospital networks are accountable for the performance of facilities in their region in providing preventive care and managing chronic conditions. VA physicians can receive bonuses linked to improved performance. VA has an electronic health record for every patient, which provides up-to-date information about a patient at the point of care, including medical history, allergies and medications. It also contains relevant diagnoses and laboratory tests, which lets providers avoid duplicate tests and adverse drug interactions. Research indicates that computer reminders and prompts can significantly improve adherence to clinical guidelines, particularly for preventive care. VA could serve as a model for improving other health care systems through sustained efforts to monitor indicators of quality, access and satisfaction. CBO’s final report, expected early this year, will consider how other health care systems can apply similar approaches and lessons from using health IT. CBO conducted this review at the request of the chairmen of the House Veterans' Affairs Committee and the House Appropriations Committee’s Military Construction, Veterans Affairs and Related Agencies Subcommittee.