VA overselling its medical care

A McClatchy Newspapers study finds that although the health system has improved, it isn't as good as officials say

WASHINGTON -- The Department of Veterans Affairs has habitually exaggerated the record of its medical system, inflating its achievements in ways that make it appear more successful than it is, a McClatchy Newspapers study shows.

While the VA's health system has gotten good marks for a transformation it's undertaken over the past decade, the department also has a habit of overselling its progress in ways that assure Congress and others that the agency has enough resources to care for the nation's soldiers.

The assurances have come at a difficult time for the agency, as a surge in mental health ailments among returning veterans over the last few years has strained the system and a spate of high-profile problems with caring for veterans in the VA and the Department of Defense's Walter Reed Army Medical Center has provoked heightened public scrutiny.

A review by McClatchy of the quality measures the VA itself commonly cites found that:

* The agency has touted how quickly veterans get in for appointments, but its own inspector general found that scheduling records have been manipulated repeatedly.

* The VA boasted that its customer service ratings are 10 points higher than those of private-sector hospitals, but the survey it cited shows a far smaller gap.

* Officials repeatedly have said that a pivotal health-quality study ranked the agency's health care "higher than any other health-care system in this country." However, the study they cited wasn't designed to do that.

In general, the VA has highlighted what it says are superior conditions in its health system. Over the last 10 years, the agency has remade itself, boosting outpatient and preventive care in a growing network of outpatient clinics. It has received glowing news coverage for the transformation.

"Today we're positioned as an internationally respected force in health-care delivery, leading private and government providers across every measure," Secretary James Nicholson said in a 2005 speech. "And we can prove it."

On key issues of access, satisfaction and quality of care, however, other data contradict the agency's statements.

Consider how returning soldiers with post-traumatic stress disorder are cared for. The VA's top health official, Dr. Michael Kussman, was asked in March about the agency's resources for PTSD. He said the VA had boosted PTSD treatment teams in its facilities.

"There are over 200 of them," he told a congressional subcommittee. He indicated that they were in all of the agency's 155 hospitals.

When McClatchy asked for more detail, the VA said that about 40 hospitals didn't have the specialized units known as "PTSD clinical teams." Committees in the House of Representatives and the Senate and experts within the VA have encouraged the agency to put those teams into every hospital.

Experts inside and outside the VA point to studies showing the agency does a good job, particularly with preventive care, and that it compares favorably with the private sector. While that may be true, McClatchy also found top VA officials buffing those respectable results in ways that the evidence doesn't support.

Access

Nicholson told Congress in February about the VA's "exceptional performance" in getting veterans in to see doctors. In 2006, the VA said 95 percent of its appointments "occurred within 30 days of the patient's desired date." In previous years, Nicholson and other VA officials have touted the department's record on this issue.

Evidence from the VA itself indicates the record might be inflated.

According to a 2005 report from the agency's inspector general, VA schedulers routinely put the wrong requested appointment dates into the system, often making waiting times appear to evaporate. In many cases, the scheduler checked for the next available time slot and declared it the patient's "desired date."