Given the heat the Veterans Administration faced after its hospital in Phoenix, Ariz., was caught cooking the books to make patient wait-times disappear, this promise might seem dead on arrival. But the picture is more mixed than that.
The goal of making the VA a leader of health care reform is expansive and vague, making it too difficult to measure on its own.
In context, however, this promise is based on specific measures candidate Barack Obama said he wanted to take. Obama included it in a lengthy white paper on veterans policy in 2007. He's fallen short on some promises in that document, such as the one to reduce the claims backlog. We rated that Promise Broken.
This promise targeted the quality and practices surrounding veterans care.
So let's go through each part.
Electronic medical records
Sharing patient records quickly and digitally no matter who patients see or where they go for care is the holy grail of reform across the health care landscape. It's proven tougher than you might expect and, according to the Government Accountability Office, Congress's program auditing arm, the VA has tried but come up short.
For Congress, a major goal for the VA was for it to work hand in hand with the Defense Department.
In a recent report, the GAO said that efforts to build a joint patient records system with the Defense Department were "unsuccessful," so the VA shifted to going solo. While the "VA has developed a number of plans to support its development of its electronic health record system," the GAO auditors expressed doubt that the work would be done in 2018 as VA officials predicted.
On the other hand, Paul Shekelle, who is both a staff physician for the VA in Los Angeles and a researcher with RAND, a prominent policy analysis group, told us medical records are easily transferrable within the VA.
"There is no question this is better now than eight years ago, and way, way better than any other health system I know of," Shekelle said. "Routinely in clinic, I have patients show up in Same Day Care saying things like 'I need my medication refilled,' or whatever, and they just are in from Florida or Minnesota or wherever and don't know the names of their medications, and I am able to look up right then and there everything that was done for that veteran in Florida or Minnesota — medications, doctor's notes, lab test results, everything."
Effectiveness research/Accountability for performance and quality
We look at these elements together because knowing what works best doesn't mean very much if staff don't put those steps into practice.
The VA's Center for Healthcare Organization & Implementation Research has the job of doing the research and bringing caregivers along. The center lists many projects, from preventing infections during surgery to using blood thinners to avoid strokes. So, for starters, the research is underway. Some projects, like the one on blood thinners, are done. That one reported that all the clinics had either done what the research recommended or were hiring people to do so.
The VA came up with software to show practitioners how well they were doing, and the report said it "has been fully operational since May 2013, and is facilitating performance measurement."
This process never ends. Technologies and drugs change, and practices have to keep up. So the bottom line for now is that the VA is doing the research and measuring performance.
Shekelle said sometimes this went too far.
"The VA's measurement and performance management has grown faster than the science can support, so that now we are being measured on and having benchmarks set for things where this is no science base for how to improve it," Shekelle said.
The VA has wellness programs for veterans. Depending on what the veteran wants, the Office of Patient Centered Care and Cultural Transformation folds education, diet, exercise, counseling, yoga and meditation into the overall care regimen. The approach is most intensive for veterans with Post-Traumatic Stress Disorder. A review of studies by VA researchers found between one-fourth and one-half of veterans were using some form of these methods. Nearly 90 percent of VA facilities offer complimentary and alternative medicine services.
Follow-up from wait-time scandal
The disclosure of efforts inside some VA centers to hide the actual wait-times for care led to the Veterans Choice Act of 2014. That law funded audits to track whether the reforms actually helped veterans. The RAND corporation assembled the work of many separate research groups into a final report. Its findings showed progress, with more work yet to be done.
Specific to this promise on health care, analysts concluded that the "quality of care delivered by VA is generally equal to or better than care delivered in the private sector."
On the matter of veterans' ability to get the care they need, the report said some veterans continue to face delays "especially in a number of key specialities," and that the VA "has stepped up the purchase of care from the private sector," although little was known about the timeliness or quality of that care.
The scandal itself continues to rankle. Sen. John McCain, R-Ariz., said the agency has failed to truly hold managers accountable.
"Under needlessly generous civil service rules, many VA employees who were originally fired for wrongdoing have since been reinstated at the VA," McCain wrote for the Fox News website on May 27, 2016. "In some cases, corrupt executives were even promoted."
In sum, the Veterans Administration has taken many of the core steps that are part of health care reform. Its strongest performance is in the area of checking what sort of care works and using that to shape what providers do. Regarding wellness programs, the VA has them. For electronic health records, the picture is more mixed. While the VA's system seems to help its own providers, it has yet to deliver better coordination with providers outside the VA. Independent assessments both praise and criticize the VA, which suggests that its role in health care reform is more complicated than a simple yes or no answer. We rate this as a Compromise.