As Assistant Deputy Under Secretary of Health Quality, Safety and Value, Shereef Elnahal, MD led VA efforts to improve the quality of care and to find, develop, and expand successful local programs through the Diffusion of Excellence initiative. More recently, he helped to develop new performance metrics for VA facilities and to increase transparency to veterans about wait times and quality. Federal Practitioner recently asked Dr. Elnahal to discuss these initiatives.
Improving the Veteran Experience
Federal Practitioner. Last year, VA launched accesstocare.va.gov to provide the public access to performance, wait time, and other data. What was the rationale for creating the website?
Shereef Elnahal, MD. The rationale, which directly aligns with the top priorities outlined by VA Secretary David J. Shulkin, MD, was simple: If we provide veterans with an easy-to-use tool that lets them see data on wait times and quality, they’ll be able to make informed decisions about where and when they receive their health care.
Secretary Shulkin has underscored the importance of improving the timeliness of VA health care services while simultaneously empowering veterans through transparency of information. This website provides a vital tool for realizing his vision.
Federal Practitioner. What types of data and tools are currently included on the site and what would you like to include in the future?
Dr. Elnahal. Right now, veterans can find information about wait times, quality of care, as well as other veterans’ experiences at local VA facilities. They also can compare quality of care provided by VA medical centers with that of local private hospitals. In addition, we recently added a feature whereby veterans can see if a local VA facility is better, worse, or the same as the regional average wait time of private sector clinics.
For example, if you’re a veteran and want to find out how quickly you can get an appointment with a primary care provider in your area, you simply visit www.accesstocare.va.gov and click the box “How Quickly Can My VA Facility See Me?” You’ll then be directed to a page that asks whether you want to find out about wait times at individual facilities or learn about facilities with same-day access. By clicking the former, you’ll be taken to a screen that includes a map and a few drop-down menus. From there, you can query the system in several ways, including “How soon can I get an appointment at the facility closest to me?” in which case the site will display a list of facilities in your area, with the closest facility listed first, along with wait times. Or you can ask “How soon can I get an appointment at a nearby facility?” in which case, the system will list facilities in your area displayed according to wait time, with the shortest wait time listed first. No other health care system that we know of provides this level of transparency.
Finally, last October, we also added a new feature, “Our Providers,” which provides information on more than 40,000 full-time and part-time VA health care providers. By visiting www.accesstocare.va.gov/ourproviders, veterans and their families can search practitioners by state, VA facility name, occupation, gender, and the service line to which the practitioner is assigned.
Federal Practitioner. What feedback have you received on accesstocare.va.gov from veterans and veterans groups?
Dr. Elnahal. The response has been overwhelmingly positive, both in terms of what veterans and Veterans Service Organizations (VSOs) have told us, and what we’ve seen in the news. For example, I read a story quoting an Arizona Veterans of Foreign Wars senior vice commander who said “That’s the thing about transparency. You can talk about it and promise it, but putting yourself out there online and making it available for everyone to use is a whole other story. That’s being pretty transparent.” 1
I should note, though, that our desire for feedback didn’t end with the site’s launch. We want veterans and VSOs to continue advising us on ways to improve the site. On the website itself, you can find a section that allows you to give feedback, and we encourage veterans and their family members to do so.
Quality of Care
Federal Practitioner . What metrics are you using internally to measure and improve the quality of VA performance and health care?
Dr. Elnahal. We mainly use metrics that are already reported by private sector hospitals and clinics, such as Medicare core metrics, patient experience surveys, and those that are administered by the National Committee for Quality Assurance (NCQA).
Federal Practitioner. How are central office, VISN, or facility leadership using these metrics?