Helena Independent Record: Fort Harrison gets 2 of 5 stars in secret VA quality ratings

The VA Montana Healthcare System at Fort Harrison received two out of five stars on a secret rating system used by the Department of Veteran Affairs.

USA Today obtained the rankings of 146 medical centers, which had previously been kept private for internal use, and published it on Dec. 7.  

Medical centers are rated each quarter, and USA Today’s data initially included the fourth quarter of 2015. Veteran Affairs subsequently released which medical centers received a one or five star rating in the quarter that ended on June 30, but excluded facilities rated two through four. Fort Harrison was not included in the second set of data. 

The VA determines a rating each quarter based on factors like deaths, complications and wait times. 

Despite the data listing multiple one-star facilities, David Shulkin, VA Undersecretary for Health, told USA Today that 120 of 146 of the VA’s medical centers have shown improvement since he started in July 2015. Shulkin said he worried the data would discourage veterans from seeking care at their local VA facility, but they wouldn’t be able to afford care somewhere else. 

Mike Garcia, Public Affairs Officer for the VA Montana Healthcare System, said the rating system is misleading, and shouldn’t keep Montana veterans from getting care.

He said that if one center moves up in ranking, another center must move down in ranking, even if its performance didn’t change. 

“There will generally never be more than a dozen five-star facilities and never any less than a dozen one-star facilities,” Garcia said.

The way data are collected and reported can misrepresent how well a medical center is doing. Garcia said a significant number of Montana veterans seek mental health care at outside facilities, and billing can take three to six months. When Fort Harrison reports its quarterly data, it often has to report care as incomplete because billing isn’t finalized, not because veterans haven’t received care. 

“There are some imperfections in this rating system where we’re at a bit of a disadvantage,” he said. 

Garcia echoed Undersecretary Shulkin, saying the rating system is given to help medical centers strategize improvement, and it isn’t as simple as customers reviewing a restaurant. Garcia said veterans shouldn’t be discouraged from seeking care at Fort Harrison.

“I would not hesitate for a moment to come get my care here,” he said.

Garcia said the VA Montana was doing well in many areas of care. It is 17th in the nation for ambulatory care services and 27th for health care-associated infections.

But Garcia said there are several areas where Fort Harrison can improve. VA Montana is 126th in the nation for preventable in-hospital complications and 126th and 128th for mental health continuity of care and population coverage, respectively. 

Fort Harrison has been under fire in the past for having the longest wait time for primary care in the state. A report released in Nov. 2015 by U.S. Sen. Jon Tester, D-Mont., showed that veterans were likely to wait 40.4 days for primary care in Helena. The shortest wait time was 1.5 days in Billings, where a $6.3 million center opened in 2014. 

Garcia didn’t provide data specific to Fort Harrison, and said he was unsure of where Tester’s data came from, making it difficult to compare the 2015 report to now. In the 17 VA health care facilities in Montana, 47,000 patients are enrolled. For fiscal year 2016, new patients wait an average of 8.4 days for primary care and established patients wait 5.5 days, Garcia said.

But with the release of data from USA Today, Tester echoed past concerns. 

“This report reveals what we’ve known to be true, we must hold the VA accountable to improve health care for veterans. In Montana’s case, this is a direct reflection of inconsistent leadership at VA Montana. There is a lot of work that needs to be done – like lowering wait times, addressing staffing shortages, increasing transparency, and fixing the Choice Program,” he said in a statement.

Tester has been pushing for Congress to vote on the Veteran’s First Act, which would make it easier for veterans to seek private health care when necessary, give funding flexibility to the VA and establish the VA as primary payer to reduce out-of-pocket costs. The act also includes bills to fill leadership and workforce vacancies in the VA. The act has not been voted on by Congress.

U.S. Sen. Steve Daines, R-Mont., said he was committed to holding the VA accountable to improve care for veterans in Montana. 

“It’s unacceptable to Montana’s veterans that Fort Harrison isn’t performing at the level they deserve. I’m hopeful that the new Montana VA Director can turn things around and make sure our veterans get the best care possible,” he said in an emailed statement. 

Daines is a co-sponsor of legislation to expand protections for whistleblowers, fire poor performing VA officials and restrict their paid administrative leave, and make it easier to hire new employees. 

U.S. Rep. Ryan Zinke, R-Mont., was unavailable for comment.