VA Health Care

In April 1990, the Joint Commission on Accreditation of Healthcare Organizations told the Department of Veterans Affairs (VA) that VA medical centers did significantly worse than non-VA hospitals in accreditation surveys done from 1987 to 1989. These surveys also showed that medical centers failed many key quality assurance elements more often than their non-VA counterparts. GAO found that VA medical centers surveyed in 1990 did substantially better than those surveyed in 1989. In addition, their overall compliance scores were close to those received by non-VA hospitals in 1990. Also, VA medical centers scored substantially higher on many key quality assurance elements that constitute the overall scores. This was a direct result of efforts by the VA central office, regional offices, and individual medical centers to ensure that medical centers were following Commission requirements and properly documenting their quality assurance activities.

GAO found that: (1) from July to December 1989, compliance scores varied widely among VA regions, primarily because some VA regions and medical centers did a better job of preparing for JCAHO surveys than others; (2) although VA maintained that the problems cited by JCAHO represented a lack of documentation and did not reflect the quality of care its medical centers were providing, without such documentation there was no evidence that appropriate procedures were being followed or that the facilities had the capability to provide quality care; (3) the way medical centers prepared for accreditation surveys was inconsistent among regional VA offices; (4) VA compliance with JCAHO standards improved from a score of 70 in 1989 to a score of 79 in 1990; (5) despite improvements in VA medical centers' compliance scores, they still scored significantly lower than non-VA hospitals in such areas as blood usage review, surgical case review, and surgical and anesthesia services; and (6) although VA has sufficient quality assurance mechanisms in place to ensure positive performance in JCAHO surveys, effective implementation of quality assurance systems requires the active, coordinated involvement of VA central office, regional offices, and medical centers.