VA Hospitals Rate Higher Than Civilian Facilities in New Federal Survey

More than two-thirds of 114 Department of Veterans Affairs facilities received four- or five-star ratings, outperforming private hospitals by 26 percentage points, according to data released Wednesday.

It was the first quality assessment of VA hospitals by the Centers for Medicare & Medicaid Services, a federal agency within the Department of Health and Human Services. CMS publishes annual Overall Quality Star Ratings for hospitals in the U.S. based on mortality rates, patient safety, hospital readmissions, patient experience, and timely and effective care.

Among the 4,654 hospitals CMS assessed nationwide, roughly 10% received five-star ratings and 17% received four-star ratings. Nearly 19% got three stars, 14% received two stars and 5% received the lowest rating, one star. The remaining 34% were not rated -- the result of either not meeting the qualification thresholds or the level of metrics needed to assess them.

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Among VA hospitals, nearly 30% received five stars; 37% received four stars; 15% were given three stars; 11%, two stars; and 8%, or nine facilities, one star.

At least 23 Veterans Health Administration medical centers were not rated by CMS because they did not meet the criteria for inclusion. CMS does not rate facilities that have a low number of cases or incidents that are specific to its assessment criteria.

It also does not assess specialty hospitals, ambulatory surgical centers and some inpatient care facilities, such as psychiatric hospitals.

The high number of four- and five-star marks for Veterans Health Administration hospitals follows another complimentary report released in June by CMS, in which 72% of VA facilities received four- or five-star ratings for patient experience. The measure, known as the Consumer Assessment of Healthcare Providers and Systems, is based on surveys and assesses patient satisfaction with their care.

VA officials said Tuesday that the department has worked with CMS for five years to be included in its annual ratings, participation they said would let veteran patients compare VA facilities with private-sector hospitals.

Gerard Cox, VA's assistant under secretary for health for quality and patient safety, said the department has been working since 2019 to become a "high reliability organization," meaning it has been focused on improving operations, promoting expertise and preventing failure.

He said the high ratings for both CMS databases may be connected to that focus.

"We're pleased to see that these CMS star ratings validate the impact of some of that work, but it also only energizes us further to make sure that we are providing the safest and most effective care to veterans," Cox said in a press call with reporters Tuesday.

Still, the VA had nine facilities that earned a one-star rating, signifying that they performed well below the average for specific measurements such as death rates for patients with heart failure, surgical complications and pneumonia, readmission rates for certain ailments, hospital acquired infections, patient satisfaction and more.

The facilities receiving the lowest rating were the James J. Peters VA Medical Center, Bronx, New York; Bay Pines VA Health Care System and West Palm Beach VA Medical Center, Florida; New Mexico VA Health Care System, Albuquerque; VA Pittsburgh Health Care System; Providence VA Medical Center, Rhode Island; Lt. Col. Luke Weathers Jr. VA Medical Center, Memphis, Tennessee; Overton Brooks VA Medical Center, Shreveport, Louisiana; and VA Caribbean Health Care System, San Juan, Puerto Rico.

Among the criticisms of the rankings is that they don't take into account the socioeconomic status of patients or the surrounding community, which may not have access to routine health care and have worse health outcomes during treatment for acute and chronic conditions.

CMS also crunches the numbers in a way that may put smaller facilities or hospitals that have a low number of cases or incidents that meet its eligibility criteria at a disadvantage when it comes to the ratings.

Nonetheless, VA Under Secretary of Health Dr. Shereef Elnahal said the department, which maintains an internal rating system of its own, has already identified and worked with many of the facilities that need help.

He added that, given that the CMS ratings were based on data from July 2018 to March 2022, those identified as low-performing facilities may already have improved.

"Those in the highest tier of need ended up receiving a lot of assistance and ultimately have gotten better, and [they] may be on the one-star list right now as a result of the data lag phenomenon," Elnahal said during the press conference Tuesday.

The VA hopes those improvements will be "reflected in future iterations of the star ratings," he added.

The VA maintained its own star ratings through late 2019, when it decided to drop them and focus on publishing data on wait times, patient satisfaction ratings, medical services and quality assessments.

After a series of articles was published in USA Today about the internal system, the VA went public with its star ratings but decided three years later that the system was of "little value in helping veterans make informed health decisions," then-VA Secretary Robert Wilkie said in a statement in December 2019.

"Star ratings were developed as an internal tool meant to compare one VA facility to another," Wilkie said at the time. "These ratings do not provide insight as to how our hospitals stack up against nearby non-VA facilities."

The CMS star ratings can be found on the Care Compare website.

In a statement released Wednesday, VA Secretary Denis McDonough said he is proud of the department's performance in the rankings.

"Whenever a veteran entrusts us with their care, they deserve to know that they're getting the very best," McDonough said in the statement. "That's what we strive for in every hospital across the nation, and we will never settle for anything less."

-- Patricia Kime can be reached at Patricia.Kime@Military.com.

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