Copyright © 2016 Albuquerque Journal
The Raymond G. Murphy VA Medical Center in Albuquerque, responsible for the health care of about 58,000 veterans, was among the 10 lowest-ranking VA hospitals in the country, according to a closely held quarterly report made public last week.
Last week, USA Today published ratings the Veterans Affairs Department uses to rank all 146 of its medical centers quarterly. Known as Strategic Analytics for Improvement and Learning, or SAIL reports, they are based on numerous factors, including wait times for appointments, death and infection rates, patient and employee satisfaction, access to care and occurrences of avoidable complications.
But Andrew Welch, director of the New Mexico VA Health Care System, said the ranking for the Raymond G. Murphy Medical Center, which covered the quarter that ended June 30, does not tell a complete story about the quality of care provided to area veterans, nor are such reports designed to compare VA hospitals with other hospitals.
“The bottom line is that veterans receiving care within the New Mexico VA Health Care System should feel very comfortable and confident about their VA health care,” Welch said this week. “We have the outcomes to show that we’re providing high-quality care.”
After USA Today obtained the rankings for the last quarter of 2015, VA Undersecretary for Health David Shulkin provided rankings for the second quarter of this year, the most recent available.
Shulkin cautioned veterans and others against using the star ratings to compare hospitals, saying they are designed solely to track progress at major VA medical centers.
VA officials have refused to make the full rankings public, saying they are internal documents used to determine which facilities are improving and which are not. The rankings go from five stars, representing the best on the list, to one star, the lowest ranking.
The Murphy center and nine other VA hospitals throughout the U.S. received one star. Seventeen VA hospitals, mostly in the eastern U.S., received five stars. The VA refused to provide rankings for two-, three- and four-star hospitals.
Like Shulkin, Welch said veterans should not base health care decisions on SAIL reports.
“In the SAIL/Star rating system, if one VA hospital improves in performance, then another will drop in performance,” Welch said. “By design, there will always be a distribution of VA hospitals between one and five stars. The rating system was not designed to compare VA hospitals to non-VA or private sector hospitals and is not intended for the use of veterans to make health care choices.”
Welch said the Murphy center has shown improvement in some areas but also has identified areas needing improvement.
He said notable improvements have been made in primary care appointment wait times, mortality rates and length of hospital stays.
There’s been “modest performance improvements,” he said, in employee satisfaction, access to urgent specialty care appointments and a widely used set of outpatient performance measures known as HEDIS, or Healthcare Effectiveness Data and Information Set.
Welch said the Murphy center has ranked high in patient satisfaction for the past four quarters, based on independent patient surveys.
Dr. Jim Goff, the center’s chief of staff, said weekly reports on appointment wait times show that 93 percent of veterans seeking an appointment get it within the VA’s benchmark 30-day period. “Overall, we’re doing pretty well,” Goff said.
Areas where the hospital needs to improve, he said, include infection rates, mental health care, cardiovascular readmissions, access to routine and urgent primary care appointments and telephone response times.
According to the most recent SAIL report, it takes about 6½ minutes for a caller to get through to the hospital’s call center. The VA benchmark for such calls is about 21 seconds.
Welch said the hospital’s on-campus call center, which has seven employees, is working to hire additional people. During peak hours, the call center routes some calls to other VA centers.
“We don’t necessarily wait for the SAIL reports to tell us these things. … We have improvement teams that are working on almost everything in the SAIL reports, mostly in real time,” Welch said.
“The challenge with SAIL is that you have to improve and keep improving. … The bar keeps getting higher and higher,” he said.
That’s not only good for veterans care, Welch said, but it helps narrow the gap between one-star and five-star hospitals.
And because some of the metrics are measured annually rather than quarterly, he said, it sometimes takes multiple quarters for the higher ratings to appear on the SAIL report.
“We can’t improve everything at one time, so we focus on a few metrics at a time,” he said.