Politco recently wrote:
Defense Secretary Chuck Hagel ordered a "comprehensive review" of the military health system on Tuesday night as The New York Times reported the deaths of two young patients who were treated at an Army hospital.
The Army removed the commander at Womack Army Medical Center at Fort Bragg, N.C., and suspended three other officials there, the Times reported, after two people in their 20s died after visiting the hospital's emergency department within the past two weeks.
The Pentagon said Hagel's review was unrelated -- spurred instead by the parallel reviews inside the Department of Veterans Affairs. VA hospital officials have been accused of using secret waiting lists and other techniques to keep veterans waiting for care -- wait times that may have contributed to the deaths of some vets.
Hagel wants to confirm the Defense Department does not have problems similar to those of the VA, said Pentagon press secretary Rear Adm. John Kirby.
Here we go, again.
Now it is not only the VA but also the military health system that appears to have serious flaws. In fact, the VA mess continues to grow, Inspectors at Philadelphia's VA benefits center in June found mail bins brimming with claims and associated evidence dating to 2011 that had not been electronically scanned.
They also found evidence that staffers at the Philadelphia regional office were manipulating dates to make old claims appear newer.
It is yet to be known what Mr. Hagel's investigation will reveal.
But, what are our options, really? Congress is suggesting sending veterans to regular healthcare facilities outside of the VA. The Military Health System may conclude the same. But many of those same private facilities are also hopelessly inefficient too. In fact, some studies suggest that up to 400,000 patients in this country die every year because of medical errors in civilian hospitals. Are we really doing them a favor by sending them there to receive care in the private sector of medicine?
The Canary in the Coalmine
In a strange way, the VA and military health system problems might actually help American medicine leaders figure out the way forward. The crisis has raised flags and drawn attention to the problems with how we deliver healthcare overall.
The quality problems in health care are well documented. The Department of Health and Human Services' Inspector General estimates that 15,000 Medicare beneficiaries die every month due in part or whole to medical error. Centers for Medicare and Medicaid Services officials have tried to focus attention on quality by tracking hospital readmissions.
Just this month, Medicare published data showing that on average 21 percent of these patients are readmitted within 30 days -- resulting in new costs for do-over care. These rates have remained unchanged despite large Medicare grants to study the issue and threats to hospitals that do not improve. In fact, as mandated by the Affordable Care Act, Medicare will now penalize hospitals that have high readmission rates. That might be helpful except for the fact that hospitals will still make more money off the readmissions from other payors than they will pay in penalties to Medicare.
Simply put, the system as it currently exists, rewards poor quality.
And, along with the human toll, there are financial consequences. Without an overhaul of the way healthcare is delivered, it will someday bankrupt the nation. We have to come to grips with the awful truth: Poor quality and wasteful practices have built up over the decades and become systemic.
In order to make the kind of substantive changes that will save us from bankruptcy, provide treatment for everyone, and stop killing people through error, we need to make revolutionary changes. As patients, we must demand the quality and cost records of our healthcare providers. Patients must take back some of the authority and power we have given doctors and hospitals. Employers and the government payors must start paying providers for health instead of treatment.
Patients should be clamoring for change. But the sad truth is, patients do not ask because they have been kept in the dark regarding the actual quality performance of their doctors and hospitals. A News magazine or a doctor and his friends may call him "The Best Oncologist in the Country", but that doesn't necessarily make it true. In truth, there is no way to know who is "best" because providers and insurers so jealously guard information on quality outcomes. A few states including Wisconsin and California are breaking with this tradition. Physician and hospital performance measures are readily available to the public in these states. It's clear which doctor group and hospital are the best at caring for people that have diabetes, heart disease, and other conditions. And it's all easily accessible on the internet.
But we have a long way to go. For example, before I would select a hospital for chemotherapy or a knee replacement, I would want to know how many medication errors occurred in that hospital yesterday; the surgeon's rate of infection and the hospital's, too; and the average number of weeks it takes this surgeon's patients to fully recover and how that compares to the national average. Even in California and Wisconsin, patients will not find this information in advance of making such an important decision. Sadly, it's infinitely easier to get information about buying your next washing machine or automobile.
To create a system in which doctors and hospitals are paid to keep us well, where the focus is on patients instead of doctors, we must not be timid. We must demand transparency, first. We must insist that data surrounding healthcare outcomes -- from surgery and asthma care to chemotherapy treatment and joint replacement recovery -- belong to all of us and that reports are clear and timely. Only with knowledge can we hope to improve quality.
Then, we need to have doctors paid according to patient outcomes, not by procedures. Perhaps most importantly, providers need to change the focus of their care processes from the doctor's convenience to the needs of the patients. None of this can happen, however, until we know the absolute and unvarnished truth about healthcare quality.
I have great confidence the outstanding leaders in the military health system and I do believe that the VA will overhaul how they do things. I'm not as confident regarding the private sector. Maybe we in the private sector will someday take a lesson from those whose mission is "To care for him who shall have borne the battle."