Honolulu VA Medical Center Among Worst 30% -- again

by Steve Lipscomb

For the third year in a row, Honolulu’s Spark M. Matsunaga VA medical center is among the lowest-graded 30% of VA medical centers system-wide, and their overall statistics are in the bottom 10th percentile of the rating scale for ambulatory care-sensitive conditions, employee satisfaction, primary care new patient wait time, and mental health continuity of care, according to newly released data from the Department of Veterans Affairs (VA).

According to the VA’s Quality of Care website, “hospitalizations due to ambulatory care-sensitive conditions (ACSCs) such as hypertension and pneumonia are preventable if ambulatory care is provided in a timely and effective manner.  Studies show that effective primary care is associated with fewer ACSC-related hospitalizations.”

The Spark M. Matsunaga VA medical center is the only center in the VA Pacific Islands Health Care System (VAPIHCS), and together with the Geriatrics, Rehabilitation, and Extended Care Center, seven community based outpatient clinics, and other medical facilities in the Hawaiian Islands, Guam, Northern Mariana Islands, and American Samoa serves tens of thousands of veterans across the Pacific.

In an October 26, 2018 news release, VAPIHCS provided the following comments:

“Compared with data from the same period a year ago, the October 2018 release of VA’s Strategic Analytics for Improvement and Learning (SAIL) report showed VAPIHCS improved in overall quality in the third quarter. VAPIHCS showed improvement in several areas, including Mental Health experience of care, access to Primary Care and Specialty Care services, and employee satisfaction. VAPIHCS demonstrated a slight decline in the metric related to hospitalizations due to ambulatory care-sensitive conditions, and a multi-disciplinary workgroup is currently working to improve outcomes in this area.”

Referring to “positive strides” noted in the VAPIHCS news release, Jennifer Gutowski, medical center director says: “This is a step in the right direction to improving quality of services for our Veterans.”

Every year the VA provides two grades on 146 medical centers systemwide. A star rating compares each center to others across the nation. Then, each also receives a grade on its own internal improvement year-over-year.

The 2018 report showed Honolulu maintained its low two-star rating from 2016 and 2017, and similarly matched its 2017 individual rating of having achieved “small improvements” – down from attaining “large improvements” in 2016.

Both ratings are based on dozens of key performance areas such as death rates, readmissions, complications, and even employee and patient satisfaction. All the data is updated quarterly, with annual grades provided after September 30 of each year.

Because the star rating is generally based on a bell curve, three star ratings account for about 40% of the total centers, two and four stars are each about 20% of the total, and one and five star ratings are each about 10%. This means that even if all 146 centers improved one year, there would still be 1-star ratings. However, across-the-board improvement isn’t the case. In 2016, 82% of the centers attained internal improvement, that number fell to 64% in 2017 and stands at 66% for 2018.