Now that we have discussed what potentially caused it. How would we fix it?
NBC News: How to Fix VA
CNN: Will that Fix VA
Think Progress: 4 Ways to Fix VA
Modern Healthcare: Fixing Waiting List
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15 comments:
To fix wait lists, first you have to know why there are wait lists.
--Hiram
Inefficiency. Low motivation. Bureaucratic nightmare. Strong unions. Other?
"For perspective, 60% of cardiologists reported seeing between 50 and 124 patients per week, according to a 2013 survey of medical professionals’ compensation conducted by Medscape. On the low end, the average single private practice cardiologist who participated in the study saw more patients in a week than the Albuquerque VA’s entire eight-person cardiology department."
So why do some doctors see more patients than other doctors?
--Huram
I like to think of myself as innumerate because I never know if numbers are too high or too low. Is seeing 50 patients a week, too high or too low? Is seeing 124 patients a week, too low or too high? I simply don't know the answer to either question. Just to go a bit further, I don't even have a clear idea on what bases such questions can or should be answered.
--Hiram
I love numbers. You can learn so much from them, even if you only have relative numbers, not absolutes. In this case, if one doctor sees 50 patients in a week in private practice, and EIGHT doctors see 50 patients a week at the VA, We have to say the VA is only 12.5% as efficient at delivering care and that ASSUMES similar outcomes, a fact not in evidence. Looked at another way, the average private cardiologist sees roughly one patient per hour, while the average VA doctor sees roughly one per DAY. The simple "fix" for the VA is to send all of the VA's patients to private doctors and hospitals. Assuming equal payment per service (not known), we could cut VA costs by almost 90%. Or better yet, we could buy enough CARE so that people wouldn't die waiting.
. In this case, if one doctor sees 50 patients in a week in private practice, and EIGHT doctors see 50 patients a week at the VA, We have to say the VA is only 12.5% as efficient at delivering care and that ASSUMES similar outcomes, a fact not in evidence.
Lots of arguments work a lot better if one assumes the existence of facts not in evidence. Sadly, the facts not in evidence are often the ones that matter.
--Hiram
In this case, however, it is incumbent upon the VA to make the case that the standard of care they deliver is 8 times better than that in private practice, justifying the added time and cost. Since people are dying left and right under their care, it is hard to imagine they could make that case.
'In this case, however, it is incumbent upon the VA to make the case that the standard of care they deliver is 8 times better than that in private practice, justifying the added time and cost."
What is incumbent on the VA is to provide medical care, not become a constituent part in Washington's scandal machine. Every moment a doctor is testifying before a Congressional committee is a moment he is not providing care to our veterans. Some things that's an even trade, others of us, do not.
--Hiram
Are you trying to tell me that every employee of the VA organization is a practicing physician with a full load of patients and cannot be spared for even a day? Sorry, but that defies all credulity. We've already spoken about how the VA doctors see only one patient per day, surely they could put the guy on a waiting list for one more day while testifying or, more likely, we could get some of the thousands of VA bureaucrats who contribute NOTHING to patient care, and ask them the questions we already know the answers to.
Like so many government programs, the simple "fix" is just to eliminate the whole mess and let private contractors do it.
"Are you trying to tell me that every employee of the VA organization is a practicing physician with a full load of patients and cannot be spared for even a day?"
I think every employee is contributing to the care of veterans and not a single one was hired to be a participant in Washington's scandal machine. Scandal is a big business in Washington, and if they want others to participate in it, DC scandal entrepreneurs should be willing to give a piece of the action.
--Hiram
The problem is, very few employees were hired to give effective care to veterans. I assume they get paid the same whether patients live or die, suffer or recover. It's the typical perverse incentives inevitable with a government program. Somebody should do the same thing we do when we "reconstitute" a school. That is, we fire everybody, bring in a hard-headed, results-oriented manager, and let him/her re-hire those who thinks can work effectively in the new system.
The problem is, very few employees were hired to give effective care to veterans.
Then we should reorganize. The problem with health care in America generally, is that too many people involved don't give care to patients. This problem is hardly limited to veterans.
--Hiram
Ah, but if having the government run the system is the best way to do it, then why isn't it the most efficient system NOW? Wouldn't any necessary "reorganization" have been done long ago?
Ah, but if having the government run the system is the best way to do it, then why isn't it the most efficient system NOW?
I am sure it is, or at least more efficient than the private sector. We just don't understand the private sector because it's private.
--Hiram
Sorry, but that's just wrong. As seen from previous posting, private care is 8 TIMES more efficient than the VA.
Whenever we have a question like this, I always find it helpful to look at "what are the incentives?" In this case, the incentives were to not have long waiting lists, despite the fact that there were thousands of people waiting to be seen, so, let's have TWO lists; the one we report and get our bonuses for, and the one we actually use to schedule patients. Rather than incentivize getting adequate care to those in need, the incentives drove the OPPOSITE.
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