The Department of Veterans Affairs is planning an "aggressive" campaign to improve care at its lowest performing facilities, including a VA hospital in Tennessee where veterans and their families liken psychiatric care to a prison.
The VA announced a four-point approach to improving care at the 15 facilities that currently have one star in its quality ratings:
- Appoint a national leader for improvement. Peter Almenoff, M.D., who currently serves as director of the VA's Office of Reporting, Analytics, Performance, Improvement and Deployment, will oversee quality improvements at the 15 hospitals.
- Identify and set individualized goals. The VA will use clinical performance indicators to determine each hospital's individual needs and set goals from that data.
- Provide additional resources. The VA will deploy teams of improvement coaches to hospitals that need extra support and guidance.
- Hold hospitals accountable. VA leadership will review quarterly reports on improvement at the hospitals, and will step in when needed, including to make leadership changes.
"We will employ tight timelines for facilities to demonstrate improvement, and if low performance persists, we will make swift changes—including replacing facility leaders—until we achieve the rapid improvements that veterans and taxpayers expect from VA," Secretary David Shulkin, M.D., said in the announcement.
One of the VA's first actions under the new reforms is leadership change at Roseburg Veterans Administration Medical Center in Oregon, the agency announced. Doug Paxton, the hospital's director, will step down effective Feb. 4, and will be replaced by David Whitmer, the current chief operating officer at Sunshine Health Network in St. Petersburg, Florida.
The hospital, in addition to earning low marks on the VA's quality ratings, came under fire last month after a number of clinicians submitted a letter to The New York Times alleging that hospital administrators cherry-pick patients to boost quality metrics.
Carolyn Clancy, M.D., executive in charge of the Veterans Administration, said in the announcement that the leadership change was "necessary as a step to improve care" for patients at Roseburg. Paxton will be reassigned to a VA hospital in West Virginia.
At another of the VA's one-star facilities, veterans and their families say change can't come soon enough. A number of veterans who received psychiatric care at the VA hospital in Murfreesboro, Tennessee, relapsed within days or weeks of discharge and died by suicide, according to an article from the Tennessean.
The trend raises concern that the VA is not effectively treating veterans with severe mental illness, including post-traumatic stress disorder, or severe addiction, according to the article. The hospital in Murfreesboro has treated almost 6,000 patients in its Residential Recovery Treatment Program, and officials said that most reviews are positive.
However, Daniel Stott, who was treated in the program, said he spent 19 days feeling like a prisoner. "When I came, I was hopeless. I was lost," Stott said. "When I left, I was homicidal and suicidal."
The families of the veterans who committed suicide told the newspaper that the patients were discharged with mountains of medication, or before they should have left treatment, according to the article.