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Press Room: Press Releases

May 3, 2001

VETERANS' COMMITTEE STAFF REPORT FINDS INCONSISTENT SERVICES AND QUALITY IN VA'S COMMUNITY CLINICS

-- Rockefeller Urges Closer Oversight by VA --

WASHINGTON, D.C. -- Over the last 5 years, the Department of Veterans Affairs (VA) has rapidly expanded the number of VA community-based outpatient clinics without ensuring the quality and consistency of care provided there, according to a Senate Committee on Veterans’ Affairs staff report released today.

The report was prepared by the Democratic staff of the Senate Committee on Veterans’ Affairs at the request of the Committee’s Ranking Member, Senator Jay Rockefeller (D-WV). The staff surveyed more than 200 VA community-based outpatient clinics nationwide to assess the success, capacity, and quality of care in these clinics. The analysis comes 5 years after Congress encouraged the VA to shift its emphasis from providing hospital-based care to treating more veterans in outpatient settings.

"I am enormously pleased that VA has opened community clinics in West Virginia and throughout the country," Senator Rockefeller said. "It is critical to bring health care services closer to veterans, especially as our veterans population continues to age. But it is not sufficient merely to increase the accessibility of care -- we must also ensure that veterans receive the highest quality of care possible. Just as I fought to secure outpatient clinics for veterans, I will fight to ensure that these clinics are the very best that they can be."

Responsibility for activation, operation, and oversight of the clinics rests with VA’s regional network directors. In the past 5 years, more than 250 clinics have been activated.

The report concludes that, although all clinics indicated they offer primary care, services varied widely by clinic and by geographic location. The report also found --

• The staff-to-patient ratio varied widely among clinics. For example, some clinics reported employing the equivalent of 15 full-time health care providers for a workload of about 10,000 patients per year, while other clinics saw a similar number of patients with less than half that staff.

• Clinics have not adequately offset the loss of VA inpatient mental health care programs by increasing access to outpatient mental health care. Historically, 20 percent of VA’s patients have sought mental health care services. Less than half of the clinics surveyed reported offering even minimal mental health care, and less than 1 percent of the staff identified themselves as mental health care professionals.

• The lack of a coherent system for collecting, monitoring, and analyzing quality of care data prevents evaluation of the success of VA’s outpatient clinics. Without a consistent system for measuring health outcomes, it is impossible to assess the quality of care given by VA- or contractor-operated clinics.

• Community clinics have not necessarily eliminated long waiting times to obtain an appointment and to receive treatment, in accordance with VA goals. Waiting times for an appointment for primary care ranged from 30 to 150 days in several areas of the country.

• More than 60% of the community clinics lacked equipment and personnel to respond to a cardiac emergency, an issue of patient safety.

The report concludes that the wide variety of operational standards described by clinic staff resulted from variations in local management, rather than from any deliberate attempts to meet specific community needs.

"Oversight by VA headquarters and by Congress is essential to ensuring that any veteran, regardless of location, who seeks primary care at a VA outpatient clinic can expect a baseline level of services," said Rockefeller. "If necessary, I will introduce legislation to guide VA to devise clear and unequivocal minimum standards for outpatient care."

A copy of the Democratic Staff report has been transmitted to VA Secretary Anthony Principi for his review and comment.