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VA Transforms Health Care

By Linda D. Kozaryn
American Forces Press Service

WASHINGTON, Dec. 27, 2000 – Veterans' health care is now more accessible, efficient and patient-centered, according to Thomas L. Garthwaite, undersecretary for health at the Department of Veteran Affairs.

"In the last six years, the VA has changed dramatically," he said in a recent interview with American Forces Press Service. Today, he noted, the VA has the data to prove it provides as good quality care as in any health care system.

The VA has changed from a hospital-based system to a primarily outpatient system, Garthwaite said. The ratio of outpatient visits to inpatient admissions in 1995 was 29- to-1. By 1999 it was 48-to-1.

"We've gone from mostly an inpatient setting where we treat illness in its latter stages to a system focused on prevention of disease, early detection, health promotion and easier access," he said.

VA officials also introduced performance measures to ensure administrators and clinicians focused on the same goals. "What we've tried to do is determine what's important to patients, measure it and reward that," Garthwaite said.

As a result, the department has treated more veterans, improved quality and patient satisfaction and reduced the cost of care per veteran served by more than 20 percent. VA officials call the department a leader in patient safety, computerized patient record keeping, surgical quality assessment, rehabilitation, mental health care and medical research.

"We have one of the best immunization rates in the country, the best use of aspirin and beta blockers after heart attacks, and some of the best cancer screening data," Garthwaite said. "We're not just trying to say we're better, we're trying to show people. We look for other health care systems to compare ourselves against."

VA health care facilities provide medical, surgical and rehabilitative care for about 3.7 million people each year. From 1997 to 1999, with 20,000 fewer employees and a budget that increased only minimally compared to inflation, VA cared for an additional 500,000 veterans.

"We opened the doors of eligibility and half a million people walked in -- they didn't run the other way," Garthwaite stressed. "And people keep coming back. The evidence indicates that they're largely satisfied with our service."

The VA now operates 173 hospitals with at least one in each of the 48 contiguous states, Puerto Rico and the District of Columbia. It also operates more than 650 ambulatory care and community-based outpatient clinics, 134 nursing homes, 40 domiciliaries, 206 readjustment counseling centers and 73 home health care programs.

In fiscal 2000, the VA treated more than 670,000 patients in VA hospitals, 110,000 in nursing homes and 26,000 in domiciliaries. VA's outpatient clinics registered more than 37 million visits.

"We've closed over half the inpatient beds while at the same time seeing half a million more people," Garthwaite said. VA officials restructured the medical system into 22 integrated networks that pool resources to meet local needs in the most cost-effective manner.

By decreasing the amount of inpatient care, Garthwaite said, VA officials could put more resources into community- based facilities. About 300 new community-based outpatient clinics are now located closer to veterans, requiring less driving and effort to reach them.

"Health care is local," he stressed. "It needs to be closer to where people live. You can't expect to get your hypertension treated by someone 200 miles away. It's worth driving for brain surgery or heart surgery, but is it really worth driving that far to have your blood sugar checked or a physical exam or get a prescription for your cold?"

VA officials have also worked to reduce red tape. From fiscal 1995 to fiscal 1999, they eliminated nearly 2,800 VA forms. They scanned their remaining forms onto a CD, which was then distributed to field facilities. Forms are also now available on the Internet.

"We've taken a long form and now call it '1010EZ,'" Garthwaite said. "It's much easier and it's now up on the Web if you want to file electronically. We're trying every way we can to minimize that look and feel of government bureaucracy and make it effective and efficient."

A 1999 survey commissioned by the National Partnership for Reinventing Government found that veterans who use VA hospitals and clinics were increasingly satisfied with VA health care. Eighty percent of VA health care users were more satisfied than two years earlier.

The survey confirmed that administrative changes have led to better health care and greater satisfaction among the veterans the VA serves, Garthwaite said. "This survey gives us solid information as we plan further improvements in VA health care for veterans," he said.

VA's emphasis on reporting and correcting medical errors makes it a national leader in patient safety programs. VA approaches safety with a broad strategy that includes error prevention and reduction, education and research, he said. VA has pioneered a bar code system for administering medication that cuts medical errors by two-thirds, for example.

VA's emphasis on patient safety and ensuring consistently reliable, high-quality care has resulted in improvements that meet or exceed national standards, according to Garthwaite. At a Dec. 7, 2000, National Forum on Quality Improvement in Health Care, attended by 3,000 health care professionals, Dr. Donald M. Berwick, a leader in the field, cited the VA as a positive example.

"We've worked with his institute to do some of our quality initiatives, so he's gotten to know us a little better, seen some of our data and seen what we've done," Garthwaite said.

VA is also affiliated with 107 medical schools, 54 dental schools and more than 1,140 other schools across the country, he noted. More than half of all practicing physicians in the United States have had part of their professional education in the VA health care system. Each year, approximately 100,000 health professionals receive training in VA medical centers.

VA clinical staff are among the best doctors in America, Garthwaite said, and VA medical facilities are at the forefront of treatment technology.

"We did over 300,000 consultations across the airwaves last year. We most recently saw that demonstrated with a patient in Missoula, Montana, who was able to have a clinic visit with a psychiatrist in Fort Harrison. We were able to provide specialized care in a relatively remote area without having anyone travel."

The VA also does about a billion dollars in research every year and continues to make major discoveries, Garthwaite noted.

"A lot of people don't know that the mathematics behind MRI and CT scans was a VA discovery," he said. "More recently, we discovered a gene for schizophrenia. There's some interesting research work going on in Alzheimer's and a variety of other areas."

The VA also does research on AIDS, alcoholism, aging, rehabilitation and other medical woes. Clinical trials have led to such therapies as aspirin for heart patients, surgical treatment to reduce risk of stroke and treatment options for prostate cancer.

VA researchers involved in Persian Gulf-related projects have established three environmental hazards research centers. This year, VA officials announced plans to establish a research center to investigate potential environmental reproductive hazards of military service.

All in all, Garthwaite concluded, the VA has come a long way. "We're not your father's VA," he said.

For more information on VA health care go to: www.va.gov.

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Click photo for screen-resolution imageToday, the Department of Veterans Affairs is a leader in patient safety, computerized patient record keeping, surgical quality assessment, rehabilitation, mental health care and medical research. Photo courtesy of Veterans Health Affairs.   
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Click photo for screen-resolution imageThe VA operates 173 hospitals with at least one in each of the 48 contiguous states, Puerto Rico and the District of Columbia. It also operates more than 650 ambulatory care and community-based outpatient clinics, 134 nursing homes, 40 domiciliaries, 206 readjustment counseling centers and 73 home health care programs. Photo courtesy of Veterans Health Affairs  
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Click photo for screen-resolution imageIn the past, the Department of Veterans Affairprimarily provided health care at veterans hospitals. In the last five years, the department has switched to providing more accessible service at community outpatient clinics. Photo courtesy of Veterans Health Affairs.  
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