[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.
____________________