Veterans should not have to endure low-quality health care. One of the key improvements made by the VA MISSION Act of 2018 was to ensure the Department of Veterans Affairs (VA) always provides high-quality care at its facilities. The Act gives veterans the choice to utilize community care if a VA medical center doesn't meet quality standards, and the VA is supposed to identify the low-quality medical service lines and fix them.
Unfortunately, this commonsense approach to improving the quality of VA care has never been fully implemented. During a global pandemic, many veterans are still waiting for the quality eligibility criteria for community care to be activated.
And, as the 2014 Phoenix VA wait list scandal revealed, poor quality and delayed care kills veterans.
Congress has made clear in the law that timely care, effective care, safety, and efficiency are the minimum elements in determining the standards for quality of VA care. Yet, for some reason, the VA has not included mandated efficiency in its federal regulation or timely care and efficiency into its quality standards.
To date, not one VA medical center or medical service line has been identified as providing sub quality care. This seems unlikely. When the Centers for Medicare and Medicaid Services (CMS) compares the VA to local community care hospitals on its Hospital Compare website, many times the VA ranks near the very bottom in overall hospital quality. The fact that no under performing VA facilities have been officially found means veterans are being denied the chance to choose community care.
The VA has some medical centers whose overall quality ratings are high compared to the local community hospital. The Asheville, N.C., medical center ranks 1st out of 13 facilities in the area, and the Columbia, Mo., center ranks 2nd out of 15.
But these are exceptions to the rule. The Memphis, Tenn., medical center ranks at the bottom of 23 area facilities. In St. Louis, the VA ranks next to last among the 55 options in that region. It seems obvious that VA medical centers with poor overall quality ratings would trigger the quality community care eligibility criteria, standards for quality, and activate the VA's remediation process. But that isn't happening. Until it does, veterans will remain trapped in low-performing VA facilities.
As we look at the high profile and scandal prone VA Medical Centers in Phoenix, and Washington, D.C., we see that both are in the bottom 25 percent for their overall quality rating, Phoenix Arizona Medical Center ranked 30 out of 40 and Washington D.C. Medical Center ranked 17 out of 20. The VA states in its standards of quality that both medical centers are worse than the community hospitals for overall rating of hospital quality.
Why can't veterans be offered choices among the top-rated hospitals in their communities? Instead of being stuck at the VA medical centers in Phoenix or Washington, D.C.,
why can't they choose between the top-ranked Mayo Clinic in Phoenix, or Sibley Memorial in D.C.?
It is time for the VA to properly implement the MISSION Act standards of quality by adding timely care, efficiency, activating the quality community care eligibility criteria and developing proper remediation plans.
Only then will veterans have full choice to access the high quality community care they earned.
Veterans need Secretary Denis McDonough to be their champion and have the Veterans Health Administration fix its low quality medical centers and provide the timely access to quality health care they deserve. Congress also needs to champion veterans by providing oversight and asking the VA hard questions about the quality of care it provides.
As President Theodore Roosevelt said, “A man who is good enough to shed his blood for his country is good enough to be given a square deal afterwards.” Part of that square deal is not having to be trapped in low quality VA medical centers. Veterans deserve no less than the choice of the highest quality care in their community.
Darin Selnick is a senior adviser for Concerned Veterans for America and an Air Force veteran. He served as veterans' affairs adviser on President Donald Trump's Domestic Policy Council and as a senior adviser to the VA secretary.