2012. Comparison of Quality
of Care in the VA and Medicare Fee for Service
AK Jha, Office of Quality and Performance, VA Central Office, JB Perlin, Office of Quality and Peformance, VA Central Office, KW Kizer, National Quality Forum, RA Dudley, Institute for Health Policy Studies, University of California, San Francisco
Objectives: In the
mid-1990s, the Department of Veterans Affairs (VA) health care system launched a
re-engineering effort to improve its quality of care, among other things.
We sought to determine how the quality of care provided by VA after
implementation of the major changes compared to Medicare fee-for-service (FFS).
Methods: We compared data
for preventive, acute and chronic care in VA with data from Medicare
fee-for-service using quality indicators having similar data collection and
sampling methods. Patients were sampled during the years 1997 through 1999. VA
data were obtained from the External Peer Review Program (EPRP) and Medicare
data were obtained from several published sources including patient surveys and
chart review. VA data were restricted to patients over the age of 65 years to
ensure comparability with the Medicare population. egional VA and Medicare performances were analyzed to assess
Results: We found nine
quality indicators for which VA and Medicare utilize comparable data methods.
When compared to Medicare fee-for-service, VA scores were significantly better
for all nine quality indicators, and clinically far superior in eight of the
nine. The smallest difference was in the rate of retinal exams among diabetics
(absolute difference = 4%, p<0.001) and the largest difference was in the
rate of mammography (absolute difference = 33%, p<0.001). For the eight
quality indicators in which VA performed much better than Medicare, VA
performance was superior in nearly all regions of the country. Rates of diabetic
eye exams were similar for VA and Medicare across the United States.
Conclusions: When standard quality of care indicators were compared for VA and Medicare FFS, VA’s performance was substantially better nationally and within all U.S. regions. The findings were consistent across several venues of clinical care, including outpatient chronic care, inpatient acute care, and preventive care.
Impact: VA’s high quality of care across the clinical spectrum is likely due to implementation of systems changes, which included a redesign of the health delivery system to be safe, patient-centered, quality focused, effective, equitable and timely, using information management technology, performance measurement, reporting and accountability. VA’s improved performance may provide insights for other organizations seeking to improve quality.