A Veterans Administration hospital in Roseburg, Oregon, raised its quality of care rating from one star (out of five) to two stars by manipulating the data at the expense of patients, according to a report. They did so by refusing care for acute patients whose outcomes were less likely to be positive. If risky patients were admitted at all, they were often quickly assigned to other facilities to minimize the risk of an adverse result happening on the watch of the VA hospital.
The article sheds light on murky practices by some hospital administrators in the face of continued news reports showing that veterans are receiving lower quality care than they were promised. In the case of the rural VA hospital in Oregon, the increase in ratings meant performance bonuses for administrators in charge.
In response to the waiting list scandal, the VA implemented a new grading policy for its facilities in 2014 to incentivize improvements in the quality of care provided. Hospitals and clinics are graded on a scale of 1 to 5 on dozens of metrics. The Roseburg, Oregon, hospital was able to show rapid improvement in its rating, making it a “rising star” in the VA system.
They accomplished these results, in many cases, by refusing care to patients whose outcomes were likely to make them look bad.
According to several hospital employees interviewed for the article, in 2016 the Roseburg hospital began using the following practices to manipulate its quality of care results:
- Refusing care to patients, or referring them to private hospitals
- Admitting only the lowest-risk cases
- Transferring patients to private hospitals as soon as possible (at government expense)
- Listing patients under the wrong diagnosis to avoid reflecting badly on the statistics related to preventative care
- Coercing patients to be admitted as hospice patients to avoid a statistical penalty if they died within 30 days
These practices led to less than fifty percent of beds being filled at any given time, according to one employee. The statistical manipulation has papered over systemic issues of high turnover among doctors and nurses. The problem of turnover is so bad that several lab tests that showed positive cancer screenings went un-reviewed, as the physicians who ordered the tests had left the facility, leaving the position vacant.
This new report follows an October investigation into retaliation against whistleblowers at the Roseburg facility. Several employees claimed that leadership at the Roseburg VA hospital was so bad that doctors and nurses were transferring in large numbers to the Eugene facility, leaving patients in Roseburg without adequate care. The Department of Veterans Affairs agreed to investigate only after repeated demands by Congressman Peter DeFazio (D-Ore.). A report on this investigation was due by the end of 2017 but has yet to be released.
This manipulation appears to be system-wide, if a new General Accounting Office report is any indication. The GAO report was released this fall, and blasts the VA for the way it presents the quality of care results on its website:
Until VA can provide information on a broader range of health care measures and services and present this information in a way that is easily accessible and understandable, VA cannot ensure that its website is functioning as intended in helping veterans make informed choices about their care.