VA Solutions Should Start With Transparency

The Veterans Affairs (VA) hospital scandal had policymakers calling for VA Secretary Eric Shinseki's head, and they got it, when President Obama accepted the Secretary's resignation.

Some policymakers are also calling for privatizing VA hospitals, allowing them to be owned and operated by the same entities that own and operate the hospitals the rest of us use. This idea assumes the hospital community as a whole performs better than the VA, and the sad truth, is we don't have any evidence of that. We know that on average, other hospitals are not doing a great job. Upwards of 500 people each day die from preventable errors in American hospitals, one in 20 admitted patients will get an infection, and one in four medicare inpatients suffers some form of harm unrelated to the reason they went to the hospital in the first place. Evidence suggests waiting lists like the VA's may be common, as well.

So how does the VA compare? We don't know. We don't have much data publicly available to begin with, and we have virtually nothing that compares VA hospitals with other American hospitals.

To be clear, data is being collected -- it's just not typically available to humble souls like you and me and the rest of the American citizenry. Hospitals get accredited to receive Medicare and Medicaid payments, but accreditation reports are not made public by hospital. Health plans collect claims data, but most of that is never released to the public. Finally, the Centers for Disease Control, the Centers for Medicare and Medicaid Services, and other federal agencies collect reams of data, but much of it is not made public, either.

This dearth of information is why purchasers of health care formed my organization (The Leapfrog Group), to ask hospitals to report on data they can't get anywhere else. Their support means it's free for hospitals to publicly report and free for consumers to access information about hospitals in their community. But only about a third of hospitals participate.

The Bush Administration tried to improve public reporting when they launched a website called "Hospital Compare" and required hospitals receiving Medicare payments to publicly report on a handful of important safety measures. Most of us think it's obvious that hospitals should reveal problems like infection rates for the enormous amount of Medicare money they receive, but in fact, this was a bold policy breakthrough.

The Bush rule is bold, but thanks to complex and unconvincing bureaucratic reasons, thousands of hospitals are exempt from it -- including all VA hospitals. Other exempt hospitals include cancer hospitals, children's hospitals, critical access hospitals and (weirdly) all hospitals in the State of Maryland.

The Obama administration maintained all those exemptions, including for VA hospitals. In fairness, though, VA hospitals have been transparent by reporting their own set of measures and making that available to the public for free. But the measures they report are not the same ones reported by general hospitals, which means comparisons are limited.

So before we jump to privatize VA hospitals, let's publicize them. We need to know how they are doing in comparison to private sector hospitals -- and vice versa. That means ending the exemptions that give the VA (and thousands of other hospitals) a pass from common-sense rules on public reporting. Sunshine is the best disinfectant, and it's time to shine a light on VA hospitals -- and every other hospital to which Americans entrust their lives.

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