26 Mar Vet Hospital Director Replaced Amid Ratings Controversy
Rating hospitals based on performance sounds like a great idea. Actually turning this goal into an actionable strategy, however, can create problems. For instance, what metrics will inspectors use to tell if the facilities are truly providing a good experience and positive health outcomes?
[/fusion_text][fusion_text]Issues with the Department of Veterans Affairs’ hospital rating system recently came to a head in rural Roseburg, Oregon, where efforts to climb the VA’s rankings were found to be harming patients rather than improving their situation. The scandal has already brought down the hospital’s administrator and raised questions about potential exploitation of care rating metrics.
A High-Profile Replacement
As The New York Times reported at the beginning of February, the VA has removed Douglas Paxton from his role overseeing Roseburg Veterans Administration Medical Center. Practices carried out under Paxton’s watch helped the hospital rise in VA rankings at the expense of the actual health or the safety of patients. One particularly egregious example is turning patients away and refusing care, even when doctors believed they should receive treatment.
Another Times report from January focused on these questionable activities, including administrators’ refusal to admit patients suffering from serious ailments and injuries. The leadership appeared to realize that it could raise its ratings by taking in fewer people, which then reduced negative health outcomes. In one instance, an 81-year-old Vietnam veteran suffering from broken ribs was sent home rather than admitted. Two doctors believed he should stay at the hospital, but the administration turned him away.
These efforts made by leadership to game the VA rating system got them results at the cost of actual patient care. Hospitalist Dr. Steven Blum told the Times that the facility often sits half empty, while patients are either transferred or sent home.
Now, with an investigation pending, former director Paxton has been transferred to another hospital to serve as an assistant director. If an ongoing investigation finds he acted wrongly, he and potentially others could lose their jobs altogether. The Times reported that all low-rated hospitals are now receiving strict oversight to make sure no such dishonesty occurs again.
Examining The Starred Rating System
It’s worth taking a moment to consider why VA ratings are important enough for administrators to think about manipulating the system. The Strategic Analytics for Improvement and Learning, also known as SAIL, is an annual rating of how much a hospital has improved in the past year, from one to five stars. According to an article from New Hampshire Public Radio, officials noted peculiarities of the system, namely that hospitals were rated on their ability to improve, which is not what the average person is used to with a starred rating system. Top hospitals could get one-star ratings if they don’t change much from one year to the next, and poorer-quality hospitals could receive four- or five-star ratings for improving a lot, even if there’s much about their facilities that still requires attention.
The VA has become wary of the potential for scandal and eager to improve its transparency. After a 2014 scandal involving hospital wait times in Phoenix, Arizona, VA leadership has been applying pressure to low-rated facilities. Incidentally, the same hospital that started the controversy in 2014 received a one-star rating in 2017. In total, 14 hospitals received one-star ratings in fiscal year 2017, according to the VA.
Will 2018 bring more improvement and better quality of care for veterans? Or will it bring only more controversy and exploitation?