A lack of transparency at the Veterans Affairs Department hinders efforts by the government — and Congress — to understand how the health services provided by VA compare to the private sector on quality and cost, federal budget experts say.

According to the Congressional Budget Office, efforts to obtain data from the Veterans Health Administration and the Veterans Benefit Administration to measure VA health care against other organizations have been hampered by "limited data provided to Congress and the public about costs and operational performance."

Although some studies indicate VA treatment is less costly than care provided in private hospitals and clinics, the CBO's Matthew Goldberg said that "limited evidence and substantial uncertainty make it difficult for" his organization "to reach firm conclusions about those relative costs."

That information is necessary, added Goldberg, deputy assistant director for CBO's national security division, to determine whether it would be cheaper to expand veterans' access to health care by increasing the size of the VHA or sending more veterans to civilian care.

"CBO [has been asked to] estimate the budgetary effects of the Veterans Access, Choice and Accountability Act. ... Among the many analytical challenges in conducting those studies are the problems CBO sometimes encounters in obtaining appropriate data from VHA or VBA," Goldberg told members of a House Veterans' Affairs Committee health panel on Wednesday.

VA's $57 billion medical budget provides funding to care for nearly 9.3 million of the nation's 22 million veterans. In 2014, Congress passed a massive veterans bill adding $17 billion to that amount to reduce wait times and improve veterans' access to health care.

Subcommittee chair and medical doctor Rep. Dan Benishek, R-Mich., expressed concerns over accountability and transparency, saying VA should be more forthcoming about how it spends its current funds and will spend the additional funding.

"It became painfully apparent to me last year that VHA was either unable or unwilling to provide basic information about the services it provides," Benishek said.

VA was rocked last year by scandal over lengthy patient wait times and data manipulation at many medical facilities that hid the true extent of the problem — malfeasance that resulted in the resignation of VA Secretary Eric Shinseki and the early retirement of Undersecretary for Health Affairs Dr. Robert Petzel.

New VA Secretary Robert McDonald has pledged to increase transparency across the department, and at the hearing, Dr. James Tuchschmidt, acting principal deputy undersecretary for health, did his part to support that effort, telling House members VA would begin producing an annual report on its health system similar to the one the Defense Department generates on its health services.

"I understand we used to [produce a report]. I don't know what happened, but we will produce an annual report. You have my commitment today," Tuchschmidt said.

Like the DoD report, the VA report may include operating statistics, usage data, trend data, demographics and analysis of inpatient, outpatient and pharmacy services.

But even with the information consolidated in one place, comparing the VA system with other health systems likely will remain difficult because of VA's uniqueness, Tuchschmidt said.

"The VHA system is designed to serve a certain population. They suffer from a disease burden higher than the general population. More than 40 percent have a major mental health diagnosis. … VA provides a large social support system to patients that fall outside the typical scope of health care provided outside in the private sector — caregiver support, helping the homeless, travel payments to get patients to their appointments. These are all examples of our mission to address the total health of our population, not simply care for illness and disease," Tuchschmidt said.

CBO's Goldberg suggested that the new annual report contain information useful to the beneficiary as well as the department itself — case data and information on individual treatment to shed light on the work at VA — as well as detailed information for analysts on staffing, compensation, patient use, treatment costs and more.

Benishek said a comprehensive report would help guide the committee in understanding VA's budget needs as well as its management of taxpayer dollars.

"I worked at VA for 20 years off and on. I realize that VA provides care that can't be duplicated in the private sector. But we need to have some idea for the total money we are spending at VA to provide care for veterans," Benishek said.

California Rep. Julie Brownley, the highest ranking Democrat on the subcommittee, agreed that transparency is needed regarding VHA spending but added that even with it, comparing costs to the private sector would be difficult.

"I think we should focus on improving access to veterans health care, ensuring that veterans receive the best care possible, and continue to hold important oversight hearings on the quality and safety of the care provided to veterans," Brownley said.

About Patricia Kime

Patricia Kime is a senior writer covering military and veterans health care, medicine and personnel issues.

Share:
In Other News
Load More