Due to the recent appearance of oversight issues in the national veterans’ healthcare program, the Senate Subcommittee on Veterans’ Affairs convened a hearing chaired by Senator Daniel Akaka (D-HI).
The committee room was practically abandoned, except for Chairman Akaka and Ranking (minority) Member Sen. Richard Burr (R-NC). “We know of several instances of poor care,” Sen. Akaka said, accusing the administrators of “putting veterans at risk for infectious diseases.”
According to Sen. Akaka, Congress had “subcontracted with an outside entity with the expectation that good care will be provided. Good care was not provided.”
Sen. Burr echoed Sen. Akaka’s indictments, using the example of a Navy Vet by the name of Michael Priest who had been told that he’d contracted Hepatitis B and HIV, only to have this diagnosis declared invalid later. “Simply put, this is an unacceptable way to treat our veterans or their families,” Sen. Burr said. “When veterans have lost their confidence in the VA, then we have lost confidence in those who fought for us…There is no possible justification as to why this has not been corrected. The warning signs were there.”
After short statements from committee members Arlen Specter (D-PA), Jon Tester (D-MT) and Johnny Isakson (R-GA), Sen. Akaka turned to the first round of witnesses, most of whom focused on possible avenues of improvement for veterans’ healthcare quality management. Dr. Thomas Nolan, of the Institute for Healthcare Improvement, outlined six areas along which performance should be evaluated—“safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity” and suggested that a greater degree of “quality planning” was needed. Tactics by which this “planning” could be accomplished included “designing processes capable of being executed reliably to meet the needs of customers or produce the desired outcomes,” and “training and certifying people in the skills necessary to do the work. In health care, professional licensure and board certification are ways in which this happens.”
Dr. Robert Wise, Vice President of Standards and Survey Methods at the Joint Commission, described some of the differences between the VA health care organizations and other systems. According to Dr. Wise, three of the VA’s five “positive attributes” included some form of government centralization or standardization (or both), those being “a centralized, integrated health care system allowing coordination of care,” “A standardized credentialing and privileging process for the appointment of medical staff,” and “the ability to standardize medical equipment through centralized purchasing.” In making constructive suggestions, Dr. Wise stressed the importance of “a culture of safety” and “public access to a robust complaint process.”
Yet despite making plentiful suggestions, none of the witnesses offered any advice on implementation. None of the witness’ prepared statements included the word “funding” and only Dr. Nolan mentioned “cost” in an assurance to the subcommittee that his organization’s suggestions would “reduce per capita cost,” but never explaining anywhere in his comments how this would be achieved.