VA Reports Some Health Care Quality Measures on Hospital Compare and a Broader Range of Measures on Its Website

		On Hospital Compare, VA Reports 35 of the 79 Health Care Quality Measures That Non-VA Hospitals Report

In implementing a requirement under the Choice Act, VA reports some of  the 79 possible health care quality measures reported by non-VA  hospitals on HHS’s Hospital Compare website. VA Reports 110 Health Care Quality Measures on Its Website, Including Some Categories of Measures Not Available on Hospital Compare

As of June 2017, VA reported on its own website 110 health care quality  measures for its VAMCs. For example, the additional measures include measures of how  long veterans must wait to obtain care at VAMCs and measures of the  quality of care related to ambulatory care, such as colorectal cancer  screening rates. This is the same  February 2015 notice VA provided on the Hospital Compare website. VA Reports Health Care Quality Measures on Two Separate Webpages, and Its Primary Webpage Is Accessible and Understandable but Lacks Certain Relevant Information

		VA Reports Health Care Quality Measures on Two Separate Webpages of Its Website, Considering One of Them as VA’s Primary Source of Information on Care Quality for Veterans

VA publicly reports 110 health care quality measures on two separate  webpages on its website—the “Access and Quality” webpage, launched  in April 2017, and the “Quality of Care” webpage, which VA has used  since 2008. However, until VA’s website  provides information on a broader range of health care services,  highlights key differences in clinical quality of care, and reports this  information in a manner that is easily accessible and understandable, VA  is missing an opportunity to provide veterans with relevant quality  information that it has already collected to help veterans make informed  decisions about their care. VA Central Office Has Not Systematically Assessed the Completeness and Accuracy of the Clinical Information Used to Calculate Health Care Quality Measures

Studies and other evidence we reviewed indicate potential problems with  the completeness and accuracy of the clinical information in patient  records that is used to calculate VA’s publicly reported health care quality  measures on Hospital Compare and its own website. However, according to an independent assessment of VA’s clinical  documentation procedures conducted by McKinsey & Company in 2015,  VA as a whole is below industry standards. However, the assessment found that only 62  of 134 VAMCs examined had a CDI program as of 2014. VA Central Office Has Not Systematically Assessed the Completeness and Accuracy of Clinical Information in Patient Records and How this Affects Accuracy of Health Care Quality Measures

Within VA, VA Central Office is responsible for calculating and reporting  the health care quality measures that VA publicly reports for each of its  VAMCs and ensuring that these measures provide accurate information  on the quality of care at these facilities. However, while studies and other  evidence we reviewed indicate potential problems with the clinical  information recorded at some VAMCs, VA Central Office has not  determined the extent to which these problems exist across VAMCs and  adversely affect the accuracy of the quality measures VA publicly reports  on Hospital Compare and its own website. When asked why they have not  conducted such an assessment, VA Central Office officials told us that  they have focused instead on improving the accuracy of medical coding  and on specific clinical quality issues identified at individual VAMCs. VA Central Office’s lack of a systematic assessment of the completeness  and accuracy of clinical information recorded in patient medical records  and the extent to which this affects the accuracy of its quality measures is  inconsistent with federal standards for internal controls related to  information and monitoring. Without a systematic assessment of the  completeness and accuracy of the clinical information recorded in VAMC  patient medical records and their potential effects on the health care  quality measures VA reports, VA Central Office does not have reasonable  assurance that differences in VAMCs’ performance on VA’s quality  measures reflect true differences in the quality of care and not differences  in the accuracy and completeness of the underlying clinical information. Until VA can provide  information on a broader range of health care measures and services,  highlight key differences in the quality of clinical care at VAMCs, and  present this information in a way that is easily accessible and  understandable, VA cannot ensure that its website is functioning as  intended in helping veterans make informed choices about their care. Therefore, VA  lacks reasonable assurance that the quality measures reported on  Hospital Compare and its own website provide accurate information to  veterans so they can make informed choices about their care. Recommendations for Executive Action

We are making two recommendations to the Department of Veterans  Affairs.
Why GAO Did This Study

To help veterans make informed choices about their care, the Veterans Access, Choice, and Accountability Act of 2014 (Choice Act) directs VA to publicly report applicable health care quality measures for its medical facilities on HHS's Hospital Compare website and on VA's own website.
The Choice Act also contains provisions for GAO to review the health care quality measures VA publicly reports. In this report, GAO 1) describes the quality measures VA reports on Hospital Compare and its own website; 2) evaluates VA's reporting of quality measures on its website; and 3) examines the extent to which VA has assessed the accuracy of the quality measures it publicly reports. GAO reviewed the quality measures VA publicly reports, reviewed studies and interviewed VA officials about the accuracy and completeness of the clinical information used to calculate the measures, and assessed the presentation and relevance of VA's information on quality of care using criteria identified in previous GAO work to evaluate health care websites.

What GAO Found

As of June 2017, the Department of Veterans Affairs (VA) publicly reported 35 health care quality measures on the Hospital Compare website, which is maintained by the Department of Health and Human Services. Veterans can use information on this website to compare the performance of VA medical centers (VAMC) and non-VA hospitals on a common set of quality measures. Those measures include patient reports of their experience of care, such as how well doctors and nurses communicated with them, and actual outcomes of care, such as readmissions to the hospital. On its own website, VA reported 110 quality measures, including some of the same measures reported on Hospital Compare . VA also reports quality measures not found on Hospital Compare , such as measures of how long veterans must wait to access care at VAMCs.
VA reports health care quality measures on two separate webpages of its website. VA launched the Access and Quality webpage in April 2017, which according to VA officials is the primary source of information for veterans on the quality of care at VAMCs. GAO found that this information is generally presented in a way that is accessible and easy to understand. However, GAO also found that the primary webpage provides information from a small subset—15—of the 110 measures VA reports on its website as of June 2017. Most of the other measures are available on a second, older webpage that resides elsewhere on VA's website and is generally not easily accessible and understandable. Until VA can provide information on a broader range of health care measures and services and present this information in a way that is easily accessible and understandable, VA cannot ensure that its website is functioning as intended in helping veterans make informed choices about their care.
Within VA, VA Central Office is responsible for calculating the health care quality measures that VA publicly reports for each of its VAMCs and ensuring that these measures provide accurate information on the VAMCs' quality of care. However, GAO found that VA Central Office has not systematically assessed the completeness and accuracy of the underlying clinical information that is used to calculate these measures. This clinical information is recorded in veterans' medical records and includes diagnoses given and treatments provided. Several studies have found potential problems with the accuracy and completeness of this clinical information at some VAMCs. For example, a 2015 independent assessment conducted by McKinsey & Company found that VA's clinical documentation procedures are below industry standards and that many VAMCs do not have programs in place to improve clinical documentation practices. VA Central Office officials told GAO that they have not systematically assessed the completeness and accuracy of the clinical information across VAMCs and the extent to which this affects the accuracy of its quality measures because they have focused on other priorities. However, the lack of such an assessment is inconsistent with federal standards for internal controls related to information and monitoring. As a result, VA does not have assurance that the quality measures it publicly reports on Hospital Compare and its own website accurately reflect the performance of its VAMCs and provide veterans with the information they need to make informed choices about their care.

What GAO Recommends

GAO recommends that VA 1) report a broader range of health care quality measures in an accessible and understandable way on its website and 2) conduct a systematic assessment of the patient clinical information across VAMCs to ensure its accuracy and completeness. VA concurred with GAO's first recommendation and concurred in principle with the second recommendation, and described steps to implement the recommendations.