Monday, May 19, 2014

The Veterans Administration Scandal: Implications for Health Reform and A Call for Clinical Research Into the Reported Death Rate

As the Population Health Blog understands it, dozens of veterans died while waiting for outpatient appointments at the Phoenix Veterans Administration (VA) Hospital.  Approximately 1500 vets were assigned to an "off-the-books" waiting list that made the clinics' official waiting times appear shorter than they really were. Because waiting times are an important feature of health care quality, the VA was probably holding its local administrators responsible for routinely measuring and reporting them up the chain of command.  If reports are true, instead of using their increased budgetary resources to provide more care, the Phoenix bureaucrats allegedly responded by gaming the system.

And the scandal is flourishing.  Investigations suggest other VA hospitals may have also adopted the same wait-list legerdemain.  A senior D.C. official resigned fast-tracked his already scheduled retirement. The VA Inspector General's investigation prejudgment is that none of the deaths can be attributed to delays in care. You can't make this stuff up.

"Good grief!" says the PHB.  Numerous articles like this, this and this had convinced lay writers, impressive policy wonks and countless physicians that this version of government run health care was not only the greatest thing since the invention of Medicare, but a model for U.S. health care reform.

Not any more.

That's why the implications of this extend far beyond a huge stain on the VA's reputation.  Once again, taxpayers are witnessing another failure of big government. While this has nothing to do with Obamacare, voters have another reason to doubt Washington's ability to competently deliver on its health care promises.

In the meantime, the PHB offers the VA plutocrats one approach to figuring out if the waiting lists were associated with higher death rates.  It's possible, thinks the PHB, to use propensity score matching within the VA's much-admired electronic health record system to retrospectively create a cohort of patients that were similar in every way except for being on the wait list.  A similar death rate in that group - demonstrated by unbiased scientists outside the control of the VA - would go a long way toward reassuring all of us that this debacle was limited to customer service.      

Image from Wikipedia

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