As we kick off the new 2008 commentary
season, it's time to rock and roll
on the issues.

After all the pleading and the
press releases and the promises
to the Senate that he would NOT
be using "business as usual", it
seems that Dr. James Peake, VA's
very own all newly designated
Secretary, has stepped in his
first mudhole of "business as usual".

Glaring right into the faces
of Veterans coming into www.VA.gov,
the official website for the VA
agency, there sits a deceptive
and screwball attempt to indulge
in the very same Republican website
propaganda that we have seen all
along from VA Secretary's past.
If this is our first clue about
what is ahead out of this guy,
then everybody duck and run for
cover right here and now.

Openly bragging that the Congressional
Budget Office (CBO) has somehow
given to the VA Hospital system
a glaring endorsement and high fives
in a recent CBO review report, well
wouldn't ya know it --- that darned
ole Vets For Justice went in and
took a REAL look and Uh-Oh! this
is NOT at all what the CBO has said.

The interim report summary in fact,
was somewhere between borderline
criticism and just plain silent on
the controversies.

Using cut and paste, here is the
entirety of the CBO release below,
and when compared to the VA's
website wrantings, one can say
that a Rebel Yell of "deceptive
practices" are in order.

This is classic of how the VA agency
has always tried to jerk Veterans
around with their revolving doors
of propaganda. We've seen it all
before, (yawn), and can only wonder
when it will end.

Also of note in this CBO release
is the member from the Institute
of Medicine who appears to not
know a single thing about the
official Findings report the IOM
just finished issuing to the Veterans
Disability Benefits Commission
a few months ago, which are just
now facing resurrections at the
2008 congressional hearings coming
up. IOM needs to protect itself
from too many out-front people
who are not adequately in touch
with prior Findings reports that
the IOM has already issued on
matters of the VA. Putting on a
unified front apparently needs
some TLC at the Institute of
Medicine.

To that end, anyone with good
literacy skills and half a working
brain can do the comparisons between
the REAL (CBO) release below,
and the Happy Face version that
now sits at the VA official website.

In fact, the (CBO) person who
wrote the release is NOT even a
licensed medical doctor herself,
and is a FORMER VA employee (perhaps
using this opportunity to get some
of the blame and guilty conscious
off of her own back).

No, Dr. Peake, all the wishful
thinking in the world will NOT
cause the Republican dust fairy
to come and wave her magic wand
and make all of your "business
as usual" come true. Us Veterans
are smart enough to go look, and
yes we do know how to use the Internet
thank you. Try something new.


___________________________________


ACTUAL TEXT OF THE CBO RELEASE
REFERRED TO BY THE VA WEBSITE

___________________________________

VA health system: interim report


CBO just released an interim report on the VA health system. VA’s health care program has attracted lots of attention, and as part of CBO’s ongoing effort to expand our health-related activities, we are examining the evidence on the VA system — along with what lessons, if any, it may hold for other parts of the health care system.

In general, VA’s experience underscores the potential for improving performance in a large and relatively integrated system through a sustained and comprehensive effort that involves indicators of quality, financial incentives that are aligned with those objectives, and the use of health information technology. It is important to note, though, that the combination of these factors — a large, relatively integrated system; well-designed incentives; performance measurement; and health information technology — likely creates much more substantial opportunities for improvement than any of the pieces taken by themselves. The applicability of VA’s experience to other parts of the health system, which often have a much different structure than the VA system, is therefore unclear and will be explored in CBO’s final report (which will be published next year).

A few highlights of today’s interim report:

On the quality of care delivered, VA tracks the quality of its medical care primarily through various process and satisfaction indicators (e.g., adherence to clinical guidelines and waiting times for access to services). These measures have generally improved in recent years.

CBO was unable, however, to identify directly comparable scores for other health care providers because the composite indexes used at the VA are not used elsewhere. In 2008, VA is planning to adopt more quality measures that are used industrywide, making it easier to compare with other parts of the health system.
The published literature includes a number of studies that analyze the quality of VA’s health care. Although the studies face various challenges in comparing the VA system to other health care providers, they generally conclude that the VA’s performance has improved following the re-engineering of its system during the 1990s — and that it is now relatively good in adherence to clinical guidelines.

The VA has implemented a capitation-based budget system called Veterans Equitable Resource Allocation (VERA).
Under that system, networks were initially given a fixed amount per enrolled veteran for “basic care” patients, and a higher fixed amount per enrollee for “complex care” patients. VERA has since been modified a number of times to define patient groups in greater detail, but retains its basic structure as a capitated budgeting system.

VERA was designed to provide managers with incentives to provide care to patients in the most cost-effective and medically appropriate settings. Because the budget allocated to a facility does not depend on the number of procedures performed, facilities do not have incentives to increase their capacity to produce billable services.

For every patient, VA also has an electronic health record in its Veterans Health Information Systems and Technology Architecture (VistA) health information system. VistA is integral to VA’s system for providing care and its management of providers and executives.
VistA is often cited by VA officials as a key to the department’s efforts to achieve high quality ratings and in helping to control medical care costs.

VA may be uniquely positioned to take advantage of health IT’s potential. Independent providers, who interact with a variety of insurance systems, may have a harder time realizing those benefits given challenges with interoperability, the standardization of formats and records, privacy, ownership and control, and the education of and compliance by providers.

An electronic health record is most useful when it contains all relevant medical information about a patient, including treatments or examinations received by outside providers. And even VistA has only a very limited ability to interact directly with or use information from other EHR systems, despite the fact that many VA patients receive a substantial portion of their care outside the department’s system.

The interim report was written by Allison Percy, a Principal Analyst in the National Security Division of the Congressional Budget Office. Her areas of expertise include military health care, veterans’ medical care, and veterans’ disability compensation.Before joining CBO in 2001, Allison was a postdoctoral fellow with the Department of Veterans Affairs in Philadelphia. She received her Ph.D. in health economics from the Wharton School at the University of Pennsylvania in 2000. Her dissertation examined the effect of regulatory reforms on health insurance markets. While in graduate school, she also conducted research on medical savings accounts and pharmaceutical productivity. Before pursuing her doctorate, she worked as a health financing analyst for John Snow, Inc., an international public health consulting firm, under contracts with the U.S. Agency for International Development, the Asian Development Bank, the World Bank, and others.

____________________________________________




Here is the pending LINK release at
www.VA.gov and let's all see if
there is a match here between the
2 deceptive worlds !

http://www1.va.gov/opa/pressrel/pressrelease.cfm?id=1443



THE LINK TO THE ACTUAL POST
BY THE CONGRESSIONAL BUDGET OFFICE.

http://cboblog.cbo.gov/?p=47