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Michael E. DeBakey VA Medical Center - Houston, Texas

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What's behind the VA hospital turnaround?

March 16, 2006

Once derided, the system is now the envy of health care administrators

By Robert Bazell
Chief Science & Health Correspondent
NBC News
Updated: 7:33 p.m. ET March 15, 2006

The film "Born on the Fourth of July" portrayed VA medical care as many saw it in the years after the Vietnam War.

VA surgeon Thomas Gauge remembers those times all too well.
The system was overwhelmed," says Dr. Gauge. "It wasn't capable of dealing with the problems that it faced at that time."

But under a major restructuring that began during the Clinton administration, the VA has undergone an amazing transformation. It now offers what several surveys show to be the best medical care in the country.

"The VA health care system in the past few years has been rated exceptionally high in their quality of care," says Peter Gaytan with the American Legion. "And that rating comes from the patients themselves."

Patients like Frank Murino, who first entered the VA system after he was injured in Vietnam in 1968.

"You were a number," he remembers. "You were the last four digits of your Social Security number then."

Murino, like all patients, now has a personal physician who knows him well.

"You got respect today," he says.

And much of the care has shifted from hospital to outpatient services, with an emphasis on prevention — including checkups to prevent complications from diabetes and heart disease.

A big advantage for the VA is electronic medical records. The VA has the largest, and one of the most modern systems in the world.

When a VA patient visits any facility in the country, the records are there. Indeed, after Hurricane Katrina, many VA patients received uninterrupted care even as they were forced to move.

"All of the information I need about any of my patients, including their X-rays and their tests, are always available, always accurate, always there in a legible form," says Gauge.

The electronic records also allow the VA to track its performance — to quickly learn what works and what doesn't — providing what many say could be a model for health care nationwide.

© 2006 MSNBC Interactive

What happened to VA health care?

Posted by Robert Bazell, Chief Science & Health Correspondent (05:57 pm ET, 03/15/06)

We report a story tonight that is going to turn a lot of heads. The Veterans Administration Health Care System, once famously known for horrendous medical care, now offers what many consider the best health care in the nation. I am sure we will hear from many of you who have had difficult times with care at the VA. That is understandable, because the improvement in the VA has occurred relatively recently and inevitably many people will be dissatisfied with their treatment at the hands of any medical provider.

But here is the evidence. In a study two years ago a group of researchers from the RAND Corporation and several medical Centers found that 67 percent of patients in the VA system received “appropriate care” as defined by expert panels on medical practice. Two thirds sounds short of the mark, but in the current issue of the New England Journal of Medicine the same researchers report on a survey of the country that finds only 55 percent of Americans in general are getting appropriate health care. And that number does not vary much with the patients’ level of education or income.

In addition, a telephone survey last January from the University of Michigan found that VA patients rated their satisfaction with care at 83 out of a possible 100 points for inpatient care and 80 out of 100 for outpatient care. By comparison, the same survey found rates of 73 and 75 in the general population. Another indicator comes from the American Legion, which has been surveying its members and finding similar high levels of patient satisfaction.

Indeed, the biggest complaint about the VA system these days is from people who want in. The VA provides unlimited care for service-related injuries and illnesses. but for other problems veterans must fall below a defined income level. As a result, patients at the VA tend to be poorer and sicker than the rest of the population, which makes the improvements all the more remarkable.

What happened? The change began with Dr. Kenneth Kizer, who became undersecretary of health for Veterans Affairs in the Clinton administration and has continued in that role during the Bush administration. The VA changed its emphasis from hospital to outpatient care where possible. It also set up genuine prevention programs. As a result, people with conditions like diabetes get the simple measures that can save enormous misery and thousands of dollars in treatment costs. Every patient is assigned a personal physician and the mandate from headquarters is to treat veterans with the respect and dignity they deserve.

The other big change was a massive shift to electronic medical records. At any VA facility in the country, a doctor or other health professional can access the records of any patient in the system, including lab tests, X-rays and chart notes that can be read easily. The electronic system challenges health providers who seem to be making mistakes, and it allows for a massive collection of data so the VA can know which treatments work and which don’t.

Could the VA system be improved? Of course. Like every government program, it must battle continually for adequate funding. And many aspects of the care could be far better. But the improvements the VA has achieved serve as an example of what government can accomplish in health care –- at a time when much of the rest of health care in America seems to be getting worse.