Despite historic changes in policy originating at the highest levels in Washington D.C., and numerous, publicized number-skewing controversies at VA facilities across the nation, it seems that many veterans are still paying the price of a beleaguered health care system struggling to keep up with demand on limited resources. The latest controversy is based out of a VA hospital in rural Oregon, where hospital administrators – determined to lift their patient care ratings – found ways to cherry pick who would be admitted into their facility, despite rows of empty beds.

Another Scandal in VA Hospital Rankings

Doctors at the Roseburg Veterans Administration Medical Center are now speaking out with numerous stories of being overruled in judgment calls of who should be admitted for care, instead being forced to defer to an offsite nurse who reviewed each case against a rubric of risk factors. The “administration” then made decisions that either transferred the riskier cases to a different VA facility or private hospital, or sent the veteran home. The reasoning was that having fewer patients with less-risky problems would result in fewer accidents and less room for errors, both of which would hurt the facility’s quality of care ratings.

According to the New York Times, these changes raised the facility’s ranking a full star in 2016 alone (facilities are ranked from one star to five stars). Increasing the ranking from one star to two also coincidentally resulted in its director earning an $8,120 bonus. Administrators for the Roseburg VA hospital cite the belief that the facility was not staffed to care for a large number of patients, deeming the admission reduction necessary. Doctors in the hospital’s ER, however, raised massive concerns that the new rules left many deserving veterans untreated as their own decisions were overruled by the administration on a regular basis.

Additionally, the Times reports, other “tactics” were strongly suggested and enforced, including how doctors were directed to categorize or diagnose certain conditions so that they would reflect more positively on the facility’s metrics. Other times, doctors were strongly encouraged to incorrectly admit certain veterans as hospice patients, since hospitals were judged on how many non-hospice patients died there within a 30-day period. Other patients were transferred away as quickly as possible to other VA facilities, nursing homes or private hospitals (the cost of these often-expensive transfers did not come out of Roseburg’s budget but was billed to the U.S. government).

These types of manipulations left many Roseburg doctors feeling not only disgruntled but also culpable in the resulting lack of care for many veterans visiting the rural facility. However, administrators stood by their directive to be more restrictive on admissions, citing that the facility simply was too understaffed to care for many of the veterans coming to the hospital. In fact, in 2015 alone, the facility lost more than 73% of its primary care doctors. Finally, at the end of 2017, enough hospital employees complained to their congressman, Peter DeFazio, who brought the issue to the floor of the House of Representatives, calling for a full investigation.

The number-cooking going on at Roseburg is reminiscent of the scandal that broke in Phoenix in 2014, where a VA hospital struggling to meet requirements on how quickly appointments must be made began keeping offline lists of patients so that they would not be reflected in metrics. Subsequently, more than 12,000 VA patients were left waiting months for appointments, with some even passing away while waiting.

In response to the scandal, the VA established the Veterans Choice Program (VCP), which allowed veterans to see a private health care provider rather than a VA provider, if they met certain criteria involving how long it would be to see a VA doctor and how far they live from a VA facility. Unfortunately, the emergency budget that was set to fund the VCP were used up much more quickly than estimated, requiring President Trump to greenlight additional emergency funds to keep the program going into 2018.

The Trump administration is currently working with the VA to figure out ways to fix – or at least improve – the massive infrastructure that is meant to care for the nation’s heroes. President Trump has, in fact, recently signed the Forever GI Bill, which extended GI Bill benefits for a longer amount of time, as well as the VA Accountability Act, which makes it easier to fire misbehaving VA officials. Additionally, the Veterans Appeals Improvement and Modernization Act of 2017 introduces three new ways for veterans to speed up a dispute of their disability claim.

However, much works remains to be addressed. Ideally, in the very near future, veterans will stop being the ones to ultimately pay the price for a system in which those with motivation can manipulate and skew important quality metrics, to the detriment of patients they are meant to serve.

Written by Megan Hammons