LeRoy Collins Commentary 84

Commentary #84
20 August 2007

The largest and best healthcare system in the world.

Beating up on the U.S. Department of Veterans' Affairs (the "VA") has been popular in the media ever since the Walter Reed Army Medical Center "VA Hospital" incident (Walter Reed is NOT a VA hospital) reported in the past year. This story has demoralized so many Americans, like me, who believe our Veterans deserve the best care the Nation can afford. So I thought it was refreshing to find a writer who has crafted a good story regarding VA health care (story attached).

Since I became Executive Director of the Florida Department of Veterans' Affairs, I have visited most of the VA health facilities in Florida. I am also on the Board of Tampa General Hospital, so I have evolved rapidly in my lay exposure to hospitals. My witness to The VA facilities, physicians, staffs, and Veteran patients who use the VA services has been a pleasant surprise.

The VA is the largest and the most robustly-equipped healthcare system in the World. Furthermore, the patient record-keeping is arguably the best in the healthcare industry, worldwide...remarkable for being so large. But do not take my word for it; read the attached. /s/ LeRoy Collins, Jr.



WASHINGTON -- VA's health care delivery system is a model for the rest of America and offers solutions to the country's health care crisis, according to the author of a recently published book entitled "Best Care Anywhere: Why VA Health Care Is Better Than Yours."

"I believe that within 10 years, the evidence-based, patient-centered, VistA-driven model of care pioneered by the VA will be the delivery device by which most Americans and many foreigners as well receive their care," said Phillip Longman, the book's author and a former economic journalist who is now a resident scholar at the Washington-based think tank, New America Foundation.

In a recent speech, Longman told a meeting of VA Central Office employees that VA faces a number of challenges in the years ahead, most notably the possibility of competition for funding from other programs such as Social Security and Medicaid and from the private sector.

"Despite these challenges, I believe that VA's glory days are still ahead," Longman said.

Longman began researching health care as a free-lance writer for Fortune magazine which commissioned him to find who was doing the most to modernize health care in the U.S. The assignment was especially important to him because he had lost his wife, Robin, to breast cancer five years earlier, and she had experienced significant difficulties with the care she received.

While doing his research, Longman read a number of articles praising VA for the innovations the Department had made in the last ten years. Pursuing the issue further, he discovered that VA had completely changed its image from what the public saw through vehicles such as the movie, "Born on the Fourth of July." Fortune eventually cancelled the assignment, but Longman's research continued and became the basis for an article he wrote for Washington Monthly magazine and for his book.

Longman noted that in recent years VA health care has received numerous accolades from well-respected independent expert organizations, including the American Consumer Satisfaction Index and the Innovations in Government Award from Harvard University.

In conducting his research, Longman visited a number of VA facilities and talked with numerous doctors, nurses and other VA employees. Among those he interviewed and featured in the book were the so-called "Hard Hats," a loose underground network of pioneering VA doctors, pharmacists and technicians who, beginning in the 1970s, wrote the software that became VistA, the VA's world class system of electronic health records.

"VistA is a process, not a product," Longman said, noting that one of the chief reasons for the system's success is that the ideas for the computer programs were developed by doctors and other medical professionals.

. Longman said the "hard hats" represented a revolution from below that set the stage for the decision to implement VistA throughout VHA that was led by Dr. Kenneth Kizer when he became Under Secretary for Health in 1995. Longman said Dr. Kizer's legacy is a model system veterans groups and health care experts now applaud.

He said that in addition to its innovative use of technology for medical purposes, VA is successful because it has a near life-long relationship with its patients, beginning when they leave the service and lasting until the end of life - including long-term nursing home care.

This gives VA incentives for investing in prevention, evidence-based medicine and effective disease management that are weak or lacking in other health care systems.

For example, if VA does not effectively manage its diabetes care, patients may require expensive care such as dialysis or amputations. This provides a financial incentive for preventive care.

"These incentives for quality care are lacking elsewhere in the health care system," Longman said.

Outside VA, the benefits of investing in electronic medical records or in preventive medicine wind up going not to the health care system but to other competitors. In short, from the provider's view, there is little or no business case for quality.

Longman said VA has proven it can be successful because its system of care gives the provider a stake in the patient's long-term interest.

Longman's book lays out a plan-his own, not the Department's--to expand the VA model of care, first to cover all veterans and then to cover all their family members. He said there is a good case for merging the military health care system into the VA, which could be expedited because of plans to close some military bases and hospitals.

Longman's long-range plan would be to expand the system to other target publics, such as those on Medicaid or Medicare, and providing coverage for the 47 million people in the United States who do not have health insurance.

"After seeing what the VA can do, I believe the health care crisis is solvable," Longman said.


/s/ LeRoy Collins, Jr.


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