The government’s not-so-dirty, not-so-little secret
By John Whittlesey
(This is the second part of a two-part blog)
The second “ah-ha” moment happened on the drive to work recently. A story on NPR discussed the recent announcement that the VA would become the first health system nationwide to develop and implement new methods of classification and monitoring to decide where various inpatient surgeries should be performed. (This decision was the result of a highly-publicized story of nine deaths in one year at a single VA facility in Marion, Ill. This occurred several years ago, and forced the VA to reassess how and where it was providing care.)
Essentially, this resulted in three levels of surgical procedures – standard, intermediate, and critical. Based on the resources available, infrastructure, volumes, outcomes, and several other criteria, each VA hospital is classified to provide care on one of these levels. Each of the VA’s 21 hospital networks has developed a surgical strategic plan to ensure that veterans receive needed care during the implementation process. (In reality, there were very few changes in terms of which facilities could still perform critical procedures.)
Again, this sounds like a good business decision to standardize care to ensure the best patient outcomes and efficient use of scarce clinical resources. If this were done in the private sector, I doubt it would go unnoticed or without a long and expensive series of congressional hearings. Interestingly enough, the VA’s surgical review program is expected to be expanded to include standards for outpatient surgery in the future. Here’s the link to a related article by Janice Simmons in HealthLeaders Media, explaining more about the program.
Similarly, Don Berwick’s ”Triple Aim” concept to consolidate and integrate delivery models based on improving the experience of care, improving the health of populations, and reducing the per-capita costs of healthcare may be the model that the private sector can adopt over time. If he’s successfully instated as President Obama’s new head of CMS, it may have a chance. Read Berwick’s full article here on the Triple Aim.
So, could the VA be getting the jump on the rest of the country by adopting a uniform delivery model across the continuum of care, focused on preventative and chronic care? No one seems to be crying foul about socialized medicine and a government conspiracy to take over the healthcare systems here. This may be the largest non-secret in the government today.
John Whittlesey is an HMC Principal
