The VA in SLC Utah is not providing me a referral after their doctors diagnosed me with a rare & potentially fatal condition that 3 outside surgeons recommended surgery for.
I have been unable to work in need of this brain surgery. I went to Congress but the VA could care less. I have email after email between myself and congress & now to the VA Congressional liason who yells at me when I call. I finally went to the white house but after reading this article I don’t have mich hope for the Secretary of VA either. I may just die one day because the VA is playing this gsme, they are not only denying Vets Surgery at the VA, Chief of Staff is denying Vets their right to be referred out to community care when they don’t provide the service. They are violating their own policies. Veterans like me will die because of this. I tried to share my story but no reporters get bsck to me. I have tried for a year to share all of the abuse I have beeb theough at the SLC VA in just one year. It’s sad what people will do to keep their measly government paychecks.
6
It is astounding and absurd that a veterans hospital has medical decision and policy that is placed in the hands of a person in charge of checking corporatesque guidelines . Why is there no Dr in charge???
3
I worked at Roseburg VA as a surgeon and chief of surgery in the past. The from line staff (clerks, nurses, physicians, and technicians) were generally excellent, dedicated, and hard working. Turnover was not due to pay, and many providers earned more than their colleagues in Portland. We had great applicants for positions. People left due to lack of support from administration, retaliation for whistleblowing, or inability to keep up skulls as programs were downsized.
The gaming, hiding patients wait times, and covering up dangerous clinical issues was well known not only to leadership at Roseburg, but also to regional offices (VISN) and to upper level clinical staff at VA central office. They were complicit in these measures that harmed veterans. Fortunately for me, the Office of Special Counsel determined that there was retaliation against me for bringing up deficiencies by Dr. Ranjan, and I was moved up to Portland VA, where care was good and I was treated well.
13
As a surgeon, one that has worked in the VA system and now in a second major university hospital, I can also say that the current emphasis on "metrics" is not only widespread and occurring at all hospitals but is essentially required by many governing entities. Pay for performance, outcome /expected ratios for mortalities and all sorts of data points are now the main emphasis and talking points at most regularly scheduled hospital meetings. While this is important, the main reasons for the development of these metrics are becoming blurred. Instead of emphasizing the need to improve care, the real emphasis is on coding, changing descriptive vocabulary, operating on less ill patients to avoid poor outcomes and paying ridiculous amounts of money to employ an entirely new class of worker whose sole purpose is data collection and reporting. My fear is that there will instead be data manipulation. All hospitals will learn how to play the game sooner or later and the government will then devise a new metric. I did not raise my hand when I took an oath at medical school graduation to not operate on a risky patient just to avoid a 30 day morbidity or mortality.
21
The same problem occurs in teaching. Prestigious schools cherry pick good students while difficult students end up with neophyte teachers in poor schools. A similar solution could work; realize that not all students/patients start out the same.
1
Very sad to learn that numbers are more important than treating an honorable veteran in need of care. Also, the paying of bonuses for not delivering care is absurd and should be stopped. Doctors should have the say over who gets treated. Hope the inspector general and Dr. Shulkin make the appropriate reforms to a system that rewards denying care.
6
Why, and since when have we allowed pencil pushers to override the recommendations of doctors? The Administrators attempt to manipulate their ratings clearly put this veteran's life at risk. The person responsible should be fired, as should whoever decided hospital "ratings" superseded any veterans right to first class health care.
19
Just to add my voice to others and point out this is not an isolated problem, but endemic to the VA, where I worked for a quarter century. Great professionals, but the mangers were a sad set of mediocre careerists (not smart enough to make it in the private sector). The system incentivizes these people to deny care to sick veterans to look good on their pointless metrics (designed by political appointees in DC, far away from any clinical involvement). These are heartless people, without any concern for patient care. Short of totally reforming the system and quadrupling the money spend on the VA, which ain't gonna happen--best to close it down, give vets the same insurance federal employees get to see any medical practitioners they desire. It's what happens in other civilized countries.
15
It's the law!
http://www.veteranslawlibrary.com/files/Veterans_for_Common_Sense_9thCir...
Sadly, with 18+/day suicides the POTUS, Congress, and Pentagon don't want veterans health costs to highlight the real cost of war.
"Remember those who gave first, some everything." - Nobody "volunteered" to be forgotten after their service by ingratitude and ignorance, so many suffer in silence for their service long after the fighting is over.
9
As a physician in a neighboring county this story hits home in more ways than one. The future of healthcare funding is ‘pay for performance’. I nominate this account as Exhibit A on the case against metrics being allowed to influence admissions policies and hospital procedures over the objections of nurses and doctors. The very idea of patients being enrolled in hospice care without consent (or even their knowledge!) makes my hair stand on end.
23
Having worked with state agencies that pay Medicaid, the payer may not be the provider, but they absolutely do dictate what the providers can do, and they actively try to do this. In a normal free market scenario, with other providers especially commercial ones, this is fine.
But to relegate all providers to the same payer? It's a recipe for disaster and an invite to coercion! And for those of you on the left who might balk at options and competition, consider this. I once worked with a deeply red state's office of health and human services. In order to shave costs, they stopped reimbursing elective births that were scheduled by request of the mother, on the premise that women shouldn't be allowed to schedule a delivery, especially when they were on the state's dime. The women were presumably doing this to make sure out of town family could be in town, or for other non medical reasons. But the position of the "insurer" - the state agency - was that they were the largest payer in the state, and could force providers into offering or withholding whatever treatments they wanted to via the power of the purse.
I've never been able to figure out the fetish these types have for controlling the choices of others, and I fully admit this tendency is more present on the left than it is on the increasingly libertarian right, but be warned. Consider the power of single payer in the hands of a religious, right wing government. Are you still interested?
5
Too bad the director can't buy some integrity with his $8120 bonus.
12
Just an FYI for anyone that is interested. Doug Paxton is a Social Worker by profession. He is not medical, and he is the most narcissistic, despotic, megalomaniac you could ever meet. Horrible little man in every way.
7
When I was in medical practice at a nonprofit hospital in a medium size city in the South, the "for profit" hospital across town would not do high risk patient's heart surgery. Those patients were sent to our hospital. We all knew why.
7
This story feels to me like a hit job which relies on the experience of one older gentleman who lives somewhere in rural Oregon (and even at that, it is very superficial).
A question or two to ponder -- where did the gentleman usually get his care? Why was he malnourished and dehydrated? Why was he seeking care at a VA facility? Nothing suggests that he had a health condition related to his service. Does he have Medicare? What about TRICARE (since he appears to be a military retiree)?
You couldn’t be more wrong. I’ve been watching this story unfold for months. I KNOW doctors and nurses who have gone public with their concerns about patient care (and who suddenly saw their shifts cut back), leading Congressman DeFazio to request a formal investigation.
7
The VA treats all medical issues not just Service connected. In the old days it was just Service connected but now we are treated for all ailments. Both my husband and I are both 100 % service connected and we receive 100 % of our medical care at our local VA Medical Center.
2
Can the administrators be fired at V.A. hospitals? Can they be sued? Or do federal laws limit the ability to do that?
Can there be a class action case filed on behalf of all affected veterans?
17
Veterans Administration has been for many years a "marketing agency" whose primary purpose has been to sell the fiction that the USA 'cares' for those who served.
According to the American Enterprise Institute[AEI] caring for veterans is detrimental to the 'readiness' budget.
SOLUTION: Politicians and others who propose using "military forces"[AUMF] should add 10% to the funding for that program.
I.e., USA spent ~$4Trillion since 2001 in Afghan/Iraq, so $400Billion should have gone to veterans. This will put reality in focus and let everyone know that war is not cheap. Sadly the lives of those who gave first are not worth the marketing and political spin all over the media.
The latest 'spin' being the "all-volunteer" forces{...who according to Trump should know what their getting into...} are only entitled to whatever looks good for political media ads.
NEXT: Incestuous Relationship Between Social Security Administration And Veterans Administration That Is Killing Veterans
3
NEXT UP: Veterans Administration's Incestuous Relationship With Social Security
{...wait for it!}
"Disabled vets moved to Social Security by VA, and have to pay back SSA from their benefits."
1
Doug Paxton needs to be fired.
4
This is a sad situation, but is related to medicine and health care as big business. Government can run good hospitals and bad hospitals, as we see in the variation of VA hospitals. Metrics can be useful or harmful, depending on who is using them and for what reason. I suggest congress try Medicaid or have no insurance for a while to experience what that feels like. More compassion and a better distribution of resources would help.
10
A tragedy at the human level; a travesty at an administrative systems level: valuing statistical measurements to met the demands of a theoretical model over human life is just plain criminal incompetence.
Wake up, Veterans Administration. Your task is difficult, but get rid of your "administrative bean counters" with caring human beings!
14
the incompetence is intentional. No honest person would measure quality or efficacy of care in the ways described.
Republicans are seeking to "privatize" vet care instead of properly funding what we have.
12
My original reply is under "James' " comment. What I forgot to add is that the NYTs should do a feature story on the entire business of outcomes analyses and hospital comparisons. It will be eye-opening for the entire country.
29
When did the VA health care system change from being a provider of services for veterans with service-related health problems to being a provider of lifetime free health care for anyone who has spent some time in the military?
5
Under the Clinton Administration
1
As a veteran, which I assume you are not, I find your “observation” laughable. A lifetime of free care? If only!
7
Google that question LIBBY. Apparently you 2 yrs risking his life for our freedom is not good enough for Free health care. Its not FREE service connected or low we do pay copayments on care if those requirements aren't met. Prescriptions too
4
As someone who is familiar with VA bureaucracy, my observation is that the Peter Principle best describes the majority of Directors of VA hospitals who rise up through the ranks to their position. They are often individuals with little or no direct patient experience. VA staff meetings typically consist of strategies to game the system in order to look better than other VAs in the same geographic network. This is because the network (or VISN as it is called) gets a lump sum of money each year and it is divided among the VAs in that network based on a number benchmarks that lend themselves to manipulation. I suspect that this is a widespread practice among VA hospitals.
33
Doctors were required to call an off site nurse. I have never hear of a nurse over ruling a doctor .I want the VA to explain how a nurse over rules a doctor .
18
Checked with you private insurance company of late? Many of the professional "just-say-no" personnel they use overrule doctors daily
19
The doctors that work for the VA do not have to be licensed by a medical board. They only have to graduate from medical school. I guess they do not deserve to be considered when they make command decisions. It is the governments way of allowing the administration to have total control at all times, and they do.
1
incorrect assumption. every VA doctor has to be licensed in at least one state
4
This was terrible to read. I would just say Google a gentleman's name Bill Nutter. He was a Vietnam vet and was a patient a 5 star rated VA I go to. I actually worked there for a little while in the dementia/Alzheimer unit changing sheets and cleaning up and it was really one of the hardest jobs in that these veterans had their service photos outside their doors and you'd look in and see their current state. It was very difficult but I also had the deepest empathy for them as human beings not just being a vet as well. I think in society the elderly are vulnerable in general but it just so happens veterans have done some extraordinary things. There are 5 star doctors/nurses/social workers within the VA but it's been a systematic failure of sorts and hasn't been righted yet. The VA shouldn't be rating themselves either. That's the equivalent of letting children fill out their report cards. Their should be an independent group of healthcare experts approved by Congress to ensure this stuff doesn't continually happen. Independent continual oversight.
17
There is presently an Office of Medical Investigations report being submitted for the Roseburg VA. I am one of the ex-employees that spoke to OMI. I immediately realized that they have no interest in the truth of matters. The investigator kept interrupting me while I was answering questions so I could not fully give my answers after each contemptuous question they asked me. OMI is a VA agency. I sent an email to Congressman DeFazio and asked him how OMI can submit an unbiased, truthful decision when the investigators work for the VA, and they have a vested interest in the outcome. The only reply I got was that they were still conducting interviews. That is not an answer. Everyone has a stake in covering this up. The deaths that occurred in 2014 have not stopped. They still "cook" the books, and do not care. You know, there might be "a death or two." I know Paul Beiring, and how sad I am that he said that. I thought he was a good man. I see now he is just a Lap Dog. There was a death when I worked there due to the Emergency Department in Roseburg turning away a veteran that was sent from Eugene for medical help. He went there, got turned away, and went home that night and died. It was devastating.
5
This is NOT a VA problem, this is a ratings fiasco problem that manifests wherever "ratings" are used to justify rewards and punishments. It pervades healthcare and public schools. in particular.
Ratings are perverse incentives - they lead to what the great quality improvement guru, W. Edwards Deming, called "fake quality improvement." This story is a perfect example of what Deming predicted would happen with a misguided "incentive" system: https://deming.org/deming/deming-the-man.
38
Meh ratings is the poor cover invented for the Congress not funding proper care of the vets they created.
Admins were cooking the books to get raises etc while hiding the fact that existing vet care was underfunded. When the two wars were undertaken 16 years ago funding for the vets it would produce was not increased and for 8 years the government tried to hide the fact of soldiers dying never mind ignoring the fact of disability and lifelong need for care due to injury on the battlefield.
This system is an intentionally bad system to make it seem like the government can't do anything right so that some private entity might be given the work which they will of course do much worse than the underfunded VA has been doing.
13
The problem is Funding! Congress won't fund the proper care of the citizens who sacrifice themselves as soldiers to do Congress bidding. We need Congress to prefund lifetime care for all existing vets. Then for all future war they must prefund lifetime vet care for every soldier that might possibly be needed before any soldier is sent into combat.
It is obvious that the republicans who started the two wars we have been fighting for 16 years have not funded the care of the soldiers they used. There is the real problem with the VA, the republican war mongers chose to go $1.5T into debt to give that money to people who do not need it instead of spending it on the soldiers they sacrificed while turning our Constitution into toilet paper.
Isn't administrative interference one of the metrics watched by quality of care monitors?
Seems to me the first and most logical thing to watch in a crisis that was largely created by administrators who were cooking the books because they were too cowardly to tell the Republican Congress to properly fund the care of the vets instead of trying to stretch the already underfunded existing vet care.
BTW this sort of intentionally incompetent "monitoring" is meant to prove to you that government is the problem. Yes they are that callous. Proper monitoring of efficiency and efficacy is not difficult, in fact it is one of the things Doctors are taught in school.
15
And this folks, is what government run healthcare looks like.
Long wait times, an over-reliance on treating symptoms instead of underlying problems (i.e. the over-prescription of opioids), low morale, gaming a system of metrics to get a bonus, and a lack of concern for your customer or patient because you basically serve a captive consumer base.
As someone who used to be captive to the VA, and who now gets good care from the private sector, there's simply no comparison.
Kudos to the NYT for continuing to cover public sector healthcare dysfunction. I know stories like this puncture the many of the readers' and editorial board's preference for a soviet or socialist style approach to healthcare, but all you have to do is look, and the evidence is there for all to see.
6
I honestly don't understand why veterans aren't given vouchers to see any doctor they like.
Vouchers should be given to all kids in inner-city districts, too (Dallas, Houston, Austin, LA, Baltimore, Newark, DC, Detroit, etc).
3
All American healthcare industry is engaged in gaming the system to maximize profits. This is why our healthcare costs so much. For example, we reimburse procedures much more generously over other aspects of patient care, which is why we do more procedures in the US compared to everywhere else. Also, both government and private payers use various metrics in allocating funds; as a result, healthcare organization and hospitals in the private practice world triage patients, dumping the sickest ones to county hospitals and academic centers.
I agree that competition has the potential to improve quality and decrease costs. Whether the healthcare industry is paid by a single payer or multiple payers does not necessarily impact competition. The payer is not the provider.
Our healthcare system is full of perverse incentives everywhere. It is actually surprising that the system performs as well as it does. After all, from the standpoint of a payer, the ideal outcome for a very sick patient is death.
5
Many of us don’t want “government run” health care, such as a British style system, though much good has been done by that system in delivering health care to all since first established after WWII. It has its problems.
Instead, we want a “single payer” system, replacing today’s hodgepodge of insurance companies each with their own complex policies, their contracts with certain providers but not others, their geographic limits, driven to deny claims or withhold permissions for care by the necessity for profit, for stock price upward movement, and similar non-care considerations. We want to replace it with a single payer funded out of taxes, with minimized administrative costs, no slice taken for profit, and patient choice of provider and facility.
2
Just think about this.
Your parent is old and sick. And according to the doctor, needs to be in a hospital.
And a nurse who has never seen-- will never see--your parent vetoes the decision.
As a result, your parent dies.
How are you going to feel?
13
The best part is, the administrator who's never seen your parent can't be held responsible.
But the doctor can.
Especially, as it turns out, if they're not meeting their institutional metrics.
3
The root of the problem is the health and well being of veterans is and has long been compromised by the budget horse trading that goes on in Congress. Those Congressmen are sooo special!
5
I want to echo what has been said here by several doctors: The practices at the Roseburg VA are much like those admission screenings we see at private hospitals today. Roseburg suffers from the same problems that plague many rural hospitals — aging patient base with complicated medical issues and no outside insurance coverage.
The quality of VA facilities varies by location and its rural facilities have always suffered. My late husband underwent surgery at Roseburg in the 1980s. It was an aging facility with staffing issues then, although the medical care was okay. In contrast, the care at the Puget Sound VA system based in Seattle was what he called "the golden handuff," providing high quality care and access to cutting edge treatments.
14
I would be willing to bet that the people denying care for vets are under 40 and the vets (and patients for other hospitals) being denied care over 65.
3
Agreed. Actually I am 44, and they are doing this to me.
When HMOs began, there were many complaints about gate keeping adminictrative people who override decisions.
Now it appears that off-site nurses are performing the same function at the VA. Overriding doctors' decisions--doctors there with the patients. To meet some target set by administrators.
What do you do when administrative goals kill people? When sound medicine is overridden by numbers?
The practices outlined here are outrageous.
37
Quota systems don't work. Remember "No Child Left Behind" turned teachers and administrators into criminals. Yet, they keep going in that direction, these silly score cards.
But, the bigger problem with the Veterans Administration is our failure to label it the welfare system that it is.
10
An administrator should never be able to over-rule the professional opinion of two physicians when it comes to patient care. That's like asking an accountant how to fix your car.
22
Accountants have overruled mechanics, well, engineers: see GM ignition switch fiasco.
1
My dad receive incredibly compassionate care at the VA hospital in Pablo Alto CA. The doctors were attentive and kind, the nursing staff exceptional. I am saddened to read this report. My dad died at the VA hospice with the attending doc holding his hand.
I cared for my aunt in her last days. Her experience was more like this report. A 90 year old with congestive heart failure and a broken ankle was sent home to her apartment, alone 2 days after surgery. She was not mobile, she could not put weight on her foot and she was confused. They said there was nothing they could do for her until she could put weight on her foot. That was it. It took 2 home health aides to care for her at a cost of $600 a day - for 6 weeks. The hospital social worker had no suggestions. I suppose she had never had this problem before. The doc wouldn't return my calls. She went back to the hospital twice from complications, only to be sent home. She died three weeks after surgery from congestive heart failure. I don't blame the hospital for her death. I blame the hospital for her unnecessary suffering before her death. They were cruel, calculating and careless.
It's sad that VAs are subscribing to such care for our veterans.
8
Not only do some VA hospitals refuse to admit patients who will make them look bad, they also hire doctors who are not fit to practice in the real world because they lost their license. Veterans have put their lives on the line for the US, we should treat them better. There is one bright spot in this refusal to admit; hospitals are very dangerous places full of bacteria, viruses, and fungi that one can catch just by being there. In addition, there are staff errors in drugs or treatment. For some who are refused admission, maybe they are safer at home. At least there, no harm is done.
8
Some Veterans have put their life on the line for us, some haven't. Some voted for Trump and other Republicans who've said all along that they wanted to take away Obamacare and make it more difficult for the average American to get consistent health coverage.
So, I say to Veterans, "If you were NOT wounded or injured in the war or wars, provide your own healthcare coverage (like my Dad and millions of other Veterans) and stop looking to the government for a free ride.
4
What are you talking about? I am a veteran, and the only way I can get care is if I pay for it like I would at any other hospital. You are ignorant of how the VA works. Veterans that do not have a Service Connected injury of some kind cannot get free healthcare.
1
Same thing in urban school districts.
Schools are judged on yearly pass/fail test scores (not how much growth the child has achieved during a school year).
All of the schools that serve low-income kids, kids who don't speak English, kids who don't speak English unless they are at school, kids who move constantly as their parents try to take advantage of first-month-free deals at apartments, etc...all of the schools that serve those kids fail. Teachers and admin are blamed.
As a result, good teachers and admin ditch those schools as soon as they can for suburban schools. The poor kids get stuck with a revolving door of weak teachers, clueless brand-new teachers, and corrupt admin.
13
If your patients are elderly, you are going to have deaths. The metrics in place are wrong. The system needs to be overhauled, we know this, but nothing will changed.
The 80 year old patient needed rehydration, his ribs fixed, some help from social services, etc. This is deplorable
13
By shutting down the hospital would not help the veterans. By firing and ordering the entire hospital administration to pay back their paychecks or go prison would be far better punishment. It is a shame that our President get on air force one and just show up unannounced. We put our lives on the line for our country and a lot of us would do it again only to be treated this way.
Vietnam war vet 3 tours would several times missing in action for awhile this hurts worse then any wound.
Please Mr President do something about this now!
4
I'm very surprised (but pleased) that NYT published this important story, considering that seniors are the demographic most harmed, or killed by this kind of rationing. It would be great if NYT published an article about Obama's IPAB, as well.
3
These type of policies are not exclusive to VA Hospitals. They are practiced in most for-profit hospitals in the country.. If you look up the directors of the hospital, you find a person with an MBA and not any medical education. It is really difficult for some who is older to find good medical care.
30
@mary Another problem for seniors and their families is the complete lack of legal recourse when neglect or malpractice harms a senior patient. No attorney will help a low income senior or his/her family, because the lawyer will not be able to recover enough in lost income to make the case worth his or her while. Hospitals and "health care providers" know this and therefore have no incentive to provide decent care.
@me- I know a well-off senior who had knee replacement surgery at a well known hospital. After getting a MRSA infection, he ended up with a long rod in his leg from his thigh to his ankle and a shoe with a three inch sole. He couldn't bend his leg and it was still much too short so he limped badly. The lawyer told him that the hospital would just drag it out till he died so don't bother to sue.
3
The rating of hospitals in general (not just VA hospitals) has also contributed to the opioid crisis. Concern for garnering positive ratings has led to overprescribing pain medication.
40
Please remember this fact: Early in the Obama Administration, the POTUS and his health care Tsar, Ezekiel Emanuel, stated that seniors are a waste of health care resources and should be given "a pill" instead of more costly surgery. So, that is what happened. Now people are surprised by the so called "opioid epidemic"?
2
Can you give the source for this charge?
1
The DEA stepped in and changed the opioid laws in 2014. We had veterans committing suicide because they were not being titrated by VA prescribers, but were being cut off cold turkey. I took one of the phone calls from the police for one of our patients. Bad day.
"The U.S. Drug Enforcement Administration is going ahead with plans to reduce the supply of many opioid painkillers by 20 percent next year. That’s in addition to steep cuts in opioid production quotas the agency imposed in 2017.
In a notice quietly published this week in the Federal Register, the DEA said it would reduce the supply of many commonly prescribed Schedule II opioid painkillers, including oxycodone, hydrocodone, oxymorphone, hydromorphone, morphine, codeine, and fentanyl. The agency said demand for the medications had dropped."
https://www.painnewsnetwork.org/stories/2017/11/10/dea-cutting-rx-opioid...
I live in a small city. (Asheville, NC). The VA here is a teaching hospital with residents from Duke University among other institutions. The care has been excellent and I have had many health issues. The sad fact is some patients are beyond the care of a medical facility. Surgery would be highly risky, ineffective and may ultimately lead to more suffering for the patient. These cases are sent to palliative or hospice care where a patient's misery can be alleviated and they can pass away naturally and at peace.
My experience with the VA has been excellent and in many cases superior to the private system. I have encountered caring support staff and doctors. Remember that right now we are hearing only the bad or distorted things.
13
With today's pain killers, suffering is really no longer necessary to live, and the reality is that it IS now possible to keep patients alive longer than the public realizes. But hospitals and hospices do not want to do that. "Palliative care" is a euphemism for euthanasia.
Glenn, I. too, have received excellent care at the Asheville VA.
Every veteran I know who receives treatment, there, has praised the facility
and its wonderful, caring, friendly medical, maintenance and administrative personnel.
Each person I have encountered, for many years, has given me the impression that they are pleased and proud to provide a wonderful facility in which to practice medicine. They have saved my life and relieved as much of the pain as possible from the injuries I received.
Their friendly, easy-going manner reflects confidence in their abilities as they go about performing sometimes difficult technical jobs.
The esprit de corps reflects greatly on the administrators.
As you have gathered I am very pleased with their treatment and proud of them. They prove it can be done, honorably.
But, I have nothing but contempt for Paxton and those of his ilk who would allow a nurse to override a doctor's orders. They are heartless! They should be prosecuted for fraud.
Career military personnel expect strict accountability. We lived it.
1
This is not distorted. Count yourself blessed that you have access to a "good" VA, and they do exist. I recently spoke to a woman that transferred from the Reno VA to the Roseburg VA. I asked her what the Reno VA is like. She said it is awesome. She resigned from the Roseburg VA after only 2 months of working there. The Roseburg VA is the worst in the nation. Sad to say, but true. There are good people there trying to do a good job, but the administration is heartless and self-serving, ie. $8,120 bonus while veterans are being refused service. On top of that, Doug Paxton is a veteran. I have first-hand knowledge, and I assure you, this story does not cover a quarter of the "bad" that is going on there.
As a physician, I wanted to make your readers aware that this issue is in no way limited to the VA system. The role of physicians is to care for the patient and (in an ideal world) the role of administrators would be to HELP physicians and nurses care for patients. Unfortunately most administrators (hospital, insurance company, and gov't) seem to believe their job is to increase their profits, secure their jobs, increase the regulatory paperwork for physicians and nurses, hire more administrators and fewer clinicians, decrease the time available for each patient and figure out ways to manipulate arbitrary scoring criteria.
96
But as another physician, while what you say is basically true, most hospitals do not go nearly as far as this VA hospital did.
1
Same thing in school districts.
In urban districts, like Dallas, teachers get the student equivalent of the sickest patients. And then we get blamed when a student who speaks little English or won't wear their glasses or gets kept up late night after night by domestic violence, etc fails the state test. Our superintendent, all of the consultants, the principals, etc are never fired or fined--just the teachers.
Teacher pay in Dallas is capped at approx $56K regardless of effectiveness/student test scores (starting pay is about $51K). If a teacher wants an increase, the teacher must submit a LENGTHY application to a panel of people who were never in the classroom or who ditched the classroom--and there's a limit on how many applications can be approved (the limit probably doesn't apply to friends of the panel or school board).
So instead, effective teachers just quit and get snapped up by the suburban districts who don't use the pay-for-performance model.
The kids, like the patients, lose. The bureaucrats and upper management never lose. I tell all new teachers to quit and get out. Most do once they see how the system is stacked against kids and teachers.
33
As a surgeon, one that has worked in the VA system and now in my second major university hospital, I can also say that the current emphasis on "metrics" is not only widespread and occurring at all hospitals but is essentially required by governing bodies. "Pay for performance ", outcome/expected ratios for mortalities and all sorts of data points are now the main emphasis and is usually the main talking point at regular hospital meetings. While this is important, the main reasons for doing so are becoming blurred. Instead of emphasizing the need to improve care, the real emphasis is on correct coding, changing vocabulary, operating on less ill patients, avoiding risk, and paying ridiculous amounts of money to hire an entirely new class of worker whose sole purpose is data collection and reporting. My fear is that there is instead data manipulation. All hospitals will learn how to play the game sooner or later and the government will then devise a new metric. I did not raise my hand and take an oath at medical school graduation to not operate on a risky patient just to avoid a 30 day morbidity or mortality.
27
Being a patient at a VA hurts a patient. Unless you live in a large city with a VA that is connected to a university medical school for example you will get appallingly bad care. Across the board.
3
Remember how efficient everything was going to be when all doctors were employed, and salaried, and how much cost savings there were going to be?
Well, this is the dark side of the loss of physician autonomy. Someone (a nurse) with less training, who has never seen you, making decisions for you based on cost, over the phone, overrruling your doctor, who is now just another salaried employee who has no real say, who is sitting at your actual bedside and actually treating you. It's just going to get worse.
52
The Veteran's Hospital system seems to function as a dysfunctional entity. Who are these administrators, that they can deny care in search of "outcomes" that bring them cash bonuses? Hospital evaluations should not be grounded in cash.
15
It's a safe bet that the administrators are all under 45.
It is a dysfunctional entity because it is not given enough funding to be functional as it should.
3
Really? I worked there, and I guarantee that if you gave them more money they would only find a way to spend it on furniture, vehicles, green houses (they have one), a new wing that has 6 beds (yep), or bigger bonuses for their awesome performance. They have the providers there, they pay them big salaries. They ARE NOT ADMITTING PATIENTS! It would skew their metrics. There are open beds that they are not filling with needy veterans. They lost 5 doctors in a week. Why? Because they are unethical, and any intelligent physician can see right away that if you expose yourself to the present brutal regime at the Roseburg VA you are going to suffer, just like veterans are.
Continue to score every hospital! For the safety and protection of potential patients, INCLUDE the number of high risk admission rejects along with the total score of every hospital. A good hospital should be able to handle these situations.
7
Scoring creates a competition mentality that a wise, contemplative person doesn't want in hospitals or schools that must serve whomever walks through the door.
Scoring/ranking/competition ENSURES that the weakest patients/students will be seen as liabilities to be avoided by people who need to keep their jobs so they can pay their bills.
If that consequence is okay with Americans, by all means: score every hospital, every doctor, every school, every teacher, every policeman...every first-line public servant. Just don't complain about the results.
7
Great. Your tax dollars at work.
2
Unbelievable, can we stop dehumanizing ourselves? this kind hospitals should be shut down.
5
Hospitals like this are nothing more than the predictable consequence of completely unreasonable demands and expectations dreamed up by a bunch of bureaucrats with MBAs.
Where was the outrage when the carrot-stick system was implemented?
Where was the outrage when the potential for financial bonuses was allowed to corrupt healthcare like it's a business? I believe Obamacare is filled with financial bonus "incentives" too. Financial incentives are poison to systems.
People need to start thinking through things and getting all sides, not just the "I only listen to liberals" side of things.
9
What makes you think this is a liberal approach to public goods management? It is very similar to No Child Left Behind and other ratings systems based on testing that conservatives favor for schools and what the Republican Medicare Advantage program put in place for those plans. I know plenty of liberals who support these kinds of incentive systems but conservatives are much more likely to favor them in my experience.
6
Please google "IPAB" and "Macra". Also investigate incentives for hospices to get rid of patients (suspiciously) early to maximize profit.