[Congressional Record Volume 147, Number 99 (Tuesday, July 17, 2001)]
[Senate]
[Pages S7801-S7802]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                 VA LEADS THE NATION IN QUALITY OF CARE

  Mr. ROCKEFELLER. Mr. President, the Department of Veterans Affairs 
has made great strides in becoming a leader within the health care 
profession. Too often, we dwell only on what is going wrong or what 
else can be done. However, as Chairman of the Committee on Veterans' 
Affairs, I would like to instead draw attention to what VA has done to 
bring a high quality of care to our nation's veterans. While there is 
no doubt that VA go even further in this area, we know that they have 
made great strides in delivering the standard of care veterans deserve.
  A few years ago, the Democratic staff of the Committee on Veterans' 
Affairs issued a report examining the standards of quality within the 
VA Health Care system. VA spends considerable effort and resources 
aimed at providing veterans with the highest quality health care in its 
hospitals and clinics. Over the years, VA has developed dozens of 
programs devoted exclusively to quality of care issues, yet public 
attention continues to be focused on examples of poor care within the 
health care system.
  With nearly 950 sites and growing, VA operates the largest health 
care system in the United States. Veterans should know that the care at 
one VA hospital or clinic is at the same high quality level as the care 
at another VA health care facility. The study concluded that this can 
only be possible if the VA has a national system of quality which has 
built-in safeguards sufficient to overcome the inevitable fact that 
human error will always occur.
  The committee is currently working on a follow-up to the original 
study. As more technological solutions to the problem of quality 
standardization are implemented, they will need to be examined. Quality 
of care is a vital issue to which I am very committed, and will 
continue to monitor closely as the VA health care system reconfigures 
itself to accommodate the changing demographics of the population it 
serves.
  Coronary disease care is one area in particular that VA has excelled 
in with regard to quality of care. With coronary atherosclerosis being 
the second-most frequent diagnosis among veterans enrolled in VA health 
care, it is imperative that VA is able to treat this condition with the 
best care possible. They have met that challenge, with VA medical 
facilities now providing the same level of care as non-VA hospitals. 
The New England Journal of Medicine recently published a report that 
made this conclusion, based on a study of heart attack patient care 
within VA. The report also applauded VA's efforts to improve their 
overall quality of care.
  I ask unanimous consent that an article from The Topeka Capital-
Journal, highlighting the report from The New England Journal of 
Medicine on the study of VA's quality of care, be printed in the 
Record.
  There being no objection, the article was ordered to be printed in 
the Record, as follows:

            VA System Quietly Becoming Model for Health Care

                          (By Mathew J. Kelly)

       It has long been one of American medicine's most precious 
     assets and, until recent years, its best-kept secret.
       On Dec. 27, the New England Journal of Medicine (NEJM) 
     published a report on a study that found the quality of care 
     for heart attack patients is as high in Department of 
     Veterans Affairs medical facilities as in non-VA hospitals.
       At first review, that might seem like faint praise--but not 
     for a health care system often singled out to prove its value 
     and justify its existence. And it continues to do so. The 
     accompanying NEJM commentary of a VA doctor nailed it: 
     ``Overall, the [VA health care system's] quest to improve 
     quality must be regarded as a laudable success and itself 
     deserves study for lessons that may have general value.''
       The study and associated observations corroborate what we 
     in VA have long been aware of--the exceptional quality of 
     care we provide, and the fact that VA is a model for the 
     health care industry, often outperforming the private sector. 
     VA is delivering cutting-edge health care, and its patients 
     and the medical world are noticing and applauding.
       For too long VA has methodically and quietly improved the 
     way it delivers health care to a special population, while 
     allowing the public to believe that our hospitals are like 
     those shown in movies such as 'Born on the Fourth of July'' 
     and ``Article 99.'' At the time these motion pictures were 
     released, the portrayal was inaccurate, and today, they and 
     the images they conjure are even more distorted.
       The Department of Veterans Affairs health care delivery 
     system, once maligned, has overcome the stereotypes, is 
     quieting its critics, and has established itself as a force 
     in health care delivery, research, and medical education, and 
     in such special services as blind rehabilitation, severe 
     psychological conditions, prosthetics and spinal cord injury. 
     Of the latter, actor Christopher Reeve, now quadriplegic, 
     said, ``The whole VA system today is a model for what 
     research can and must be. And when I look down the list of 
     accomplishments of various centers and how proactive it is, I 
     just rejoice.''
       The patient population VA cares for is, on average, 
     significantly older and poorer than the non-veteran 
     population, more likely to have mental illness or substance 
     abuse problems, more likely to have hepatitis C, more likely 
     to have multiple diseases, and less likely to be married and 
     have a social support structure. Despite these challenges, VA 
     health care has transformed itself into what Dr. Donald 
     Berwick, President and CEO of the Institute for Healthcare 
     Improvement, calls ``the most impressive work in the country 
     so far on patient safety'' and ``the benchmark in many 
     areas.''
       Even though the veteran population is declining, veterans' 
     health problems are increasing as they age. More veterans 
     than ever are enrolling for VA health care. In the last five 
     years, VA, which operates the nation's largest integrated 
     health care organization, has shifted from an inpatient-
     focused system--we have closed more than half of our acute 
     care beds--to one that is outpatient-based.
       To apply for health care, veterans can now fill out and 
     submit an easy-to-follow Internet-based application form, 
     which is automatically electronically mailed to the VA health 
     care facility selected by the veteran. VA employees register 
     the data, print the form and mail it back to the veteran for 
     signature. Veterans can also print out the completed form and 
     mail it to a VA health care facility themselves.
       Since 1996, when all honorably discharged veterans became 
     eligible to enroll for VA health care, more than a half-
     million additional veterans have done so. Why? Every VA 
     patient now has a primary care provider and team. VA has 
     computerized mail-out pharmacy services that ensure the 
     timely delivery of drugs to patients. VA has instituted

[[Page S7802]]

     aggressive performance measures that have led to 
     implementation of the best practices of government and 
     private sector health care. On average, VA medical facilities 
     now receive higher accreditation scores than do private 
     sector facilities.
       While this transformation was taking place, VA became an 
     industry leader in such areas as patient safety, surgical 
     quality assessment, the computerization of medical records, 
     telehealth, preventive screenings and immunizations.
       There have been no big wars lately, no long lines of troops 
     coming home, no welcoming parades necessary. And as these 
     events and the years between fade, so too do memories. It 
     might be only human to become complacent about those who not 
     so long ago left their families, their schools, their jobs, 
     and the security of their lives because their country asked. 
     They now need our help, as will future generations of 
     servicemen and women, but platitudes on Veterans Day and 
     Memorial Day are woefully inadequate. Words alone will not 
     mend broken spirits and cannot heal broken bodies. The best 
     possible care--the type VA provides as part of a 
     comprehensive system of benefits--is the most appropriate 
     honor we can bestow on veterans.

                          ____________________