VA hospitals still an excellent choice for veterans

As the first anniversary of MISSION Act implementation approaches, the Department of Veterans Affairs (VA) is in an entirely unexpected position. While the MISSION Act of 2018 broadened the criteria by which veterans can seek non-VA care with the intention of reducing wait times and increasing choice for veterans, VA was instead asked to be willing to open its doors to civilians when the pandemic hit.

The need for VA to step in to support the civilian health care sector was particularly concerning given that veterans represent a population at increased risk from the novel coronavirus: 75 percent of veterans are over age 50, with 34 percent of those over the age of 70, and younger veterans may have been exposed to toxins that harm and thus compromise the lungs. Many of these veterans depend on VA full-service medical centers for care, even as non-VA options have been expanded under the MISSION Act.

When faced with choices between restaurants, hotels, or retail products, many of us turn to user reviews — but that type of information is harder for the average patient to find or understand when it comes to choosing where to get health care. And according to our new research, public perception of VA medical center care is often discordant with the actual high quality of that care.

Previous research had shown that at the system level, VA provides higher quality care on many measures than non-VA facilities. VA’s now-dropped star rating system compared VA hospitals with one another, which is not helpful for veterans trying to choose between local VA and non-VA care.

In our new research, Center for a New American Security (CNAS) and the Military Family Research Institute at Purdue University (MFRI) wanted to know how well VA medical centers perform in comparison to nearby hospitals, specifically those likely to be chosen by veterans if they should experience a long wait time at their local VA. In other words, we wanted to know if we compared hospitals both one-to-one and in aggregate, how did VA hospitals and their non-VA counterparts compare?

We compared 125 VA full-service medical centers to a similar local hospital. Our comparator facilities were those that were close to the VA medical center and similar in size, functionality (ownership and teaching status), and rurality measures. We compared the medical centers on seven measures commonly used to assess hospital quality. These included both clinical quality (inpatient flu immunization, surgical deaths, MRSA infections, and catheter-associated urinary tract infections) and patient experience (ability to transition home, overall hospital rating, and willingness to recommend the hospital). All of this information is publicly available; however, it is difficult for most people to navigate the websites that catalogue these measures of care, determine which of the dozens of metrics are good stand-ins for overall care quality, and know that they are making a reasonably good apples-to-apples comparison.

When comparing the entire group of VA medical centers to the entire group of comparators, VA medical centers as a whole performed the same or better than non-VA medical centers on 3 of the 4 clinical measures (surgical deaths, catheter-associated urinary tract infections, and MRSA infections) and 2 of the 3 patient experience measures (care transition and hospital recommendation). Importantly, a majority of VA medical centers performed the same or better on average than their comparator on all but one of the seven quality measures (inpatient flu vaccination) when comparing the medical centers one-to-one.

To be sure, no system or hospital is perfect; individual providers can make mistakes and the environment of care is not equally welcoming for all patients. However, eligible veterans overall should feel comfortable going to their local VA medical center, where they are likely to get high-quality care. In this time of deep anxiety about health and health care, we hope the results of this research will be reassuring to those who have served our nation.

Jill Inderstrodt, PhD, MPH is Associate Professor in the School of Arts, Sciences, and Education at Ivy Tech Community College in Indianapolis. Her research examines intersections of health disparities, public health, and family communication. Her research can be found in Nursing Research, Journal of Community Health, and Health Care for Women International. She is a two-time Peace Corps volunteer, having served in South Africa (’03-’05) and Jamaica (’10-’11) and a former intern with the Military Family Research Institute.

Kayla Williams is a Senior Fellow and Director of the Military, Veterans, and Society Program at the Center for a New American Security. She previously served two years as Director of the Center for Women Veterans at the Department of Veterans Affairs, serving as primary advisor to the Secretary on policies, programs and legislation affecting women veterans. Prior to that, she worked at the RAND Corporation, where she did research related to veteran health needs and benefits, international security and intelligence policy. She is the author of “Love My Rifle More Than You: Young and Female in the U.S. Army,” a memoir of her deployment to Iraq.