[Congressional Record Volume 151, Number 18 (Thursday, February 17, 2005)]
[Senate]
[Pages S1588-S1589]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                             VA HEALTH CARE

  Mr. AKAKA. Mr. President, over the past 10 years, VA has made 
tremendous strides in its delivery of health care. In fact, VA's 
quality of care currently surpasses that of the private sector, 
according to several notable studies.
  Though VA has been able to provide high-quality care despite less 
than generous budgets, we cannot count on that holding true. Indeed, if 
the administration's proposed cuts for VA care come to fruition, VA 
will no doubt begin to lose its footing. The President's budget offers 
a very modest increase for VA care--one that does not even cover 
medical inflation.
  Veterans groups are united in saying that the proposed budget is not 
sufficient. The Disabled American Veterans has called the 
Administration's budget, ``one of the most tight-fisted, miserly 
budgets in recent memory.'' The Paralyzed Veterans of America says that 
this budget shortchanges America's ``sick and disabled veterans.''
  The President's budget calls on VA to save some $600 million by 
squeezing efficiencies out of the system. I have been to VA hospitals 
and clinics, and I can tell my colleagues that $600 million worth of 
efficiencies are not possible without cutting staff and services, the 
very services that have made VA care excellent.
  As many of my colleagues know, VA already obtains some of the best 
prices on pharmaceuticals. VA's costs are far below retail prices--in 
some cases 55 percent of average prices. It is unfortunate that the 
administration does not believe that Medicare's costs would be lowered 
if the Government could negotiate with drugmakers. VA has proven that 
it works. My point is that there really are not any more efficiencies 
to be gleaned from VA drug purchasing.
  I will be working to increase the VA health care budget--to move from 
the realm of miserly to what is truly needed to care for all veterans. 
In the meantime, we should focus now on the tremendous advances VA has 
made and do our best to maintain VA care at the highest levels.
  One of these studies, done by RAND Corporation, found that VA 
outpaces private health care systems in delivering care to patients. 
Among its findings, RAND found that VA patients were more likely to 
receive recommended health services than those in a national sample of 
patients using a private provider. It also concluded that VA patients 
received consistently better care across the board, including 
screening, diagnosis, treatment, and follow-up.
  Additionally, an article---which I highly command to my colleagues--
in Washington Monthly titled ``The Best Care Anywhere'' explained at 
length how, in just 10 years, VA hospitals went from less than 
excellent care to the pinnacle of quality health care. Fostering the 
change is the focus on new technology to reduce medical errors. Such 
computer systems allow clinicians to electronically pull up all medical 
records for any patient. Doctors are able to enter their orders into a 
computer system that immediately checks that order against the 
patient's records. If the software then detects a dangerous combination 
of medicines or a patient's allergy to the newly prescribed drug, a red 
flag goes up on screen. The technology also reminds doctors to 
prescribe appropriate care for veterans after they have been discharged 
from the hospital, and it keeps track of which patients are due for 
follow-up services.
  VA has made several other important strides in recent years, steps 
that have been crucial to VA's assent to the top of the medical care 
field. Until the mid-1990s, VA was considered by most to be in crisis. 
Starting in 1996, however, Congress forced VA to focus on primary care 
and outpatient services. This change, known as eligibility reform, led 
to improvement in care at VA. I am proud that we made those changes. 
Veterans are coming to VA like never before. Rather than closing the 
doors--as the President is proposing--let us welcome all veterans into 
the system.
  As ranking member of the Committee on Veterans' Affairs, I will work 
to ensure that VA continues to be a leader in health care by fighting 
for additional funding. We must all work to guarantee that all of our 
Nation's veterans get the care they so greatly deserve.
  I ask unanimous consent that the RAND study be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

    Improving Quality of Care--How the VA Outpaces Other Systems in 
                        Delivering Patient Care

       In its 2001 report Crossing the Quality Chasm, the 
     Institute of Medicine called for systematic reform to address 
     shortfalls in U.S. health care quality. Recommended reforms 
     included developing medical informatics infrastructure, a 
     performance tracking system, and methods to ensure provider 
     and manager accountability. The Department of Veterans 
     Affairs (VA), the country's largest health care provider, has 
     been recognized as a leader in improving the quality of 
     health care. Beginning in the early 1990s, the VA established 
     system-wide quality improvement initiatives, many of which 
     model the changes the Institute of Medicine would later 
     recommend.
       How does the VA measure up against other U.S. health care 
     providers? To address this question, RAND researchers 
     compared the medical records of VA patients with a national 
     sample and evaluated how effectively health care is delivered 
     to each group. Their findings:
       VA patients received about two-thirds of the care 
     recommended by national standards, compared with about half 
     in the national sample.
       Among chronic care patients, VA patients received about 70 
     percent of recommended care, compared with about 60 percent 
     in the national sample.
       For preventive care, the difference was greater: VA 
     patients received about 65 percent of recommended care, while 
     patients in the national sample received 20 percent less.
       VA patients received consistently better care across the 
     board, including screening, diagnosis, treatment, and follow-
     up.
       Quality of care for acute conditions--a performance area 
     the VA did not measure--was similar for the two populations.
       The greatest differences between the VA and the national 
     sample were for indicators where the VA was actively 
     measuring performance and for indicators related to those on 
     which performance was measured.


                   va delivers higher quality of care

       Using indicators from RAND's Quality Assessment Tools 
     system, RAND researchers analyzed the medical records of 596 
     VA patients and 992 non-VA patients from across the country. 
     The patients were randomly selected males aged 35 and older. 
     Based on 294 health indicators in 15 categories of care, they 
     found that overall. VA patients were more likely than 
     patients in the national sample to receive recommended care. 
     In particular, the VA patients received significantly better 
     care for depression, diabetes, hyperlipidemia, and 
     hypertension. The VA also performed consistently better 
     across the spectrum of care, including screening, diagnosis, 
     treatment, and follow-up. The only exception to the pattern 
     of better care in VA facilities was care for acute 
     conditions, for which the two samples were similar.


                 va changes helped improve performance

       The VA has been making significant strides in implementing 
     technologies and systems to improve care. Its sophisticated 
     electronic medical record system allows instant communication 
     among providers across the country and reminds providers of 
     patients' clinical needs. VA leadership has also established 
     a quality measurement program that holds regional managers 
     accountable for essential processes in preventive

[[Page S1589]]

     care and in the management of common chronic conditions.


            performance measurement plays an important role

       How does performance measurement affect actual performance 
     in health care delivery? To answer this question, the 
     researchers conducted another analysis focused solely on the 
     health indicators that matched the performance measures used 
     by the VA. They found that VA patients had a substantially 
     greater chance of receiving the indicated care for these 
     health conditions than did patients in the national sample. 
     They also observed that performance measurement has a 
     ``spillover effect'' that influences care: VA patients were 
     more likely than patients in the national sample to receive 
     recommended care for conditions related to those on which 
     performance is measured. For example, VA outperformed the 
     national sample on administering influenza vaccinations, a 
     process on which the system tracks performance. However, it 
     also outpaced the national sample on other, related 
     immunization and preventive care processes that are not 
     measured. This provides strong evidence that, if one tracks 
     quality, it will improve not only in the area tracked but 
     overall as well.


               these results have important implications

       The implications of this study go far beyond differences in 
     quality of care between the VA and other health care systems. 
     The research shows that it is possible to improve quality of 
     care and that specific improvement initiatives play an 
     important role. First, health care leaders must embrace and 
     implement information technology systems that support 
     coordinated health care. Second, they should adopt monitoring 
     systems that measure performance and hold managers 
     accountable for providing recommended care. If other health 
     care providers followed the VA's lead, it would be a major 
     step toward improving the quality of care across the U.S. 
     health care system.

     THE VA OUTPERFORMS THE NATIONAL SAMPLE ON NEARLY EVERY MEASURE
------------------------------------------------------------------------
                                                  National
         Health indicator            VA score      sample     Difference
                                                   score
------------------------------------------------------------------------
Overall..........................           67           51           16
Chronic care.....................           72           59           13
Chronic obstructive pulmonary               69           59           10
 disease.........................
Coronary artery disease..........           73           70            3
Depression.......................           80           62           18
Diabetes.........................           70           57           13
Hyperlipidemia...................           64           53           11
Hypertension.....................           78           65           13
Osteoarthritis...................           65           57            8
Preventive care..................           64           44           20
Acute care.......................           53           55           -2
Screening........................           68           46           22
Diagnosis........................           73           61           12
Treatment........................           56           41           15
Follow-up........................           72           58           14
VA-targeted performance measures.           67           43           24
VA-target-related performance               70           58           12
 measures........................
Measures unrelated to VA targets.           55           50            5
------------------------------------------------------------------------

  Mr. AKAKA. Mr. President, I yield the floor and I suggest the absence 
of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll. The legislative 
clerk proceeded to call the roll.
  Mr. DURBIN. Mr. President, I ask unanimous consent that the order for 
the quorum call be dispensed with.
  The PRESIDING OFFICER. Without objection, it is so ordered.

                          ____________________