Government and Regulations

VA Confronts Fallout of SAIL Facility Ratings

While some facilities tout their 5-star status, others emphasize that the measure does not provide a complete measure of the quality of care.


VA Secretary Robert McDonald minced few words in his reaction to the USA Today story that published VA’s 5-star ratings for VAMCs based on its Strategic Analytics for Improvement and Learning (SAIL) data. “What concerns all of us at VA is that USA Today has a consistent narrative of negativity in their news of VA,” McDonald charged. Specifically, use of the word secret in the headline was an “egregious hyperbole,” he insisted.

Still, within days, a number of VA facilities were using the story as an opportunity to tout their success. VA Central Western Massachusetts Healthcare System in Worcester, for example, used the opportunity to tell local media that it was “in the top 10% of the 152 VA medical centers in the nation for quality of care,” and 1 of 3 5-star facilities in Massachusetts.

Other facilities, however, were forced to explain the relative nature of the 5-star scale. Keith Sullivan, director of the Chillicothe VAMC in Ohio, which received a 3-star rating, responded to reporters by noting that, “Although SAIL is a tool that helps look at areas in need of improvements, we have many other ways to ensure quality care is in place,” he said.

Many VA officials point out that the comparison to other VA facilities may be unfair, especially in underserved locations. The VA Health Care Center at Harlingen in Texas recently improved from 1 to 2 stars. It received this score, in part, because of its difficulty filling open vacancies. “Compared to the nurse retention rates in our local communities we are doing very well, [but] not so much as compared to other VA health care systems in the nation,” a Harlingen customer service manager told a local newspaper .

To allay veterans’ fears, the VA Southern Oregon Rehabilitation Center and Clinics (VA SORCC) sent out a news release to explain the ratings and reassure the public that progress was being made even as it struggles with a shortage of providers. Insisting it had made “absolute performance improvements in wait times for both mental health and specialty care appointments” while acknowledging that the rating also shows “continued frustrations with difficulty in navigating the system and with coordination of care." These frustrations impact Veterans’ experience at the facility, leading to lower scores.” The release pledged that “VA SORCC is currently a 1-star facility but fully expects to move to a 2-star facility in the next quarter.”

The worry for many at the VA is that the veterans might avoid 1- and 2-star facilities. “My concern is that veterans are going to see that their hospital is a ‘one’ in our star system, assume that’s bad quality and veterans that need care are not going to get care,” VA Under Secretary of Health David J. Shulkin, MD, told USA Today . “And they’re going to stay away from hospitals and that’s going to hurt people.”

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