In a U.S. Veterans Affairs system that ranks hospitals from best – a score of 5 – to worst – a score of 1 – the VA Portland hospital is near the bottom of the barrel, with a score of 2. But in the weeks after Secretary of Veterans Affairs David J. Shulkin announced his efforts to bring transparency to VA improvement efforts, leaders of the Portland hospital say they are not shying away from their imperfections.
Instead, Michael W. Fisher, director of the VA Portland Health Care System since July 2016, says he invites scrutiny as his hospital works to identify its weaknesses and continue improvements that began several years ago during public outcry over long wait times to see a doctor.
The national scandal over appointment wait times has faded, and with good reason. Today, 88 percent of qualified veterans seeking an appointment from the Portland VA can schedule time with a medical provider within the next 30 days. And even if appointment is not immediately available when they call, the VA can often find fit people in as cancellations emerge, meaning that 94 percent of veterans actually do see a provider within 30 days. The Choice program, which allows patients to get VA-funded care from medical providers who are not part of the system, has also boosted access.
But even with those gains, Fisher outlined a number of areas where the Portland VA is hoping to improve its results.
Specifically, Fisher highlighted these areas where the local system ranked lower than the rest of the U.S.
- Wait times for endoscopy, urology and opthlamology. The aging of the VA’s patient population has pushed up demand for colonoscopies, yet the Portland hospital has recently lost several doctors and nurses, forcing greater reliance on community providers to maintain access to endoscopies – and similar challenges are driving up wait times to see other specialists.
- Ambulatory care for sensitive conditions. “People with congestive heart failure, diabetes – we try to keept hem out of the hospital and manage them on an outpatient basis,” Fisher said. “Comparing us ot the rest of the country, we are admitting more of those patients. We need to do a better job.”
- Job satisfaction and turnover. Portland ranks among the worst in the U.S. for registered nurse turnover, and internal surveys have shown low job satisfaction among local VA employees. The system has been forced to reduce inpatient bed counts because of staffing storages. Nursing salaries were recently boosted 10 percent, after determining the VA was paying below-market rates, a move Fisher said he hopes reduces turnover.
- Patient satisfaction. In surveys conducted after they receive care, Portland patients are less satisfied than VA patients in the rest of the U.S.
- Suicide rates: Oregon veterans have the eighth highest suicide rate in the U.S. – mirroring a broader trend of high suicide rates among civilians in the Pacific Northwest as well.
On suicide, Fisher and his support staff described a number of community outreach efforts. He noted that many veterans do not receive healthcare through the VA system, yet the agency has been charged with finding even these people to address their psychiatric needs. To identify people who are not currently VA patients, Fisher and his staff have reached out to county health departments, agencies across the state that work with veterans, and others. But the challenge continues.
“I’m looking for any ideas from anyone” that will help identify people at risk of suicide, and reduce suicide risk once those people are identified, Fisher said. “Inside the agency, outside the agency – is there an idea?”
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Reach Courtney Sherwood at [email protected].
