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U.S. Representatives Debbie Dingell (MI-12) and Tim Walberg (MI-07) today sent a letter to U.S. Department of Veterans Affairs (VA) Secretary Robert McDonald seeking answers about steps that are being taken to improve performance and quality of care at the Detroit VA. The letter follows press reports that the Detroit VA Medical Center has become a one-star facility based on an internal rating system used by the VA, called the Strategic Analytics for Improvement and Learning (SAIL) database.

“We are deeply disturbed to learn that the Detroit VA, which serves many of our constituents, has fallen to a one-star facility,” the Representatives wrote. “The slip to a one-star facility is extremely troubling and we must ensure that veterans receiving healthcare at the facility not be harmed in any way. We must get at the root causes of the problems at the Detroit VA in an expeditious manner.”

The Detroit VA saw performance deteriorations in three critical SAIL categories: their Healthcare Effectiveness Data and Information Set (HEDIS) score, wait time for specialty care appointments and readmission rates for cardiovascular and medical patient cohorts. The Representatives are requesting information about how VA Headquarters intends to ensure the Detroit VA improves on each target area, the timeline for doing so, and what Congress needs to do to ensure progress is being made and patients are safe. The Representatives also questioned the lack of transparency surrounding the SAIL database.

“As you know, this information is not released to the public,” they wrote. “Veterans, just like every other patient, deserve to know how their hospitals are performing and what services need to be improved. Having a secret rating system only serves to increase distrust of the VA and may give the appearance that the Department has something to hide. To address these concerns, we introduced legislation earlier this year that would improve transparency at the VA by requiring each VA medical facility to issue a quarterly report on the rate of surgical infections and cancelled or transferred surgeries at VA hospitals. Increasing transparency is critical to understanding the type of care veterans are receiving and how to fix any problems we are facing.”

Dingell and Walberg will meet with Mr. Robert McDivitt, Director for VISN 10, and Dr. Pamela Reeves, Director of the Detroit VA Medical Center, this week and will continue working with the VA to address the problems and ensure veterans are receiving the best possible care.

The full letter can be read here and below.

December 12, 2016

The Honorable Robert McDonald
Secretary
U.S. Department of Veteran’s Affairs
810 Vermont Avenue, NW
Washington, DC 20420

Dear Secretary McDonald:
            
            This letter is regarding the poor rating of the Detroit VA Medical Center which we learned of last Friday following the public release of an internal rating system used by the U.S. Department of Veterans Affairs to assess the performance of VA hospitals.  We are deeply disturbed to learn that the Detroit VA, which serves many of our constituents, has fallen to a one-star facility.   The slip to a one-star facility is extremely troubling and we must ensure that veterans receiving healthcare at the facility not be harmed in any way.  We must get at the root causes of the problems at the Detroit VA in an expeditious manner. 

            Part of the issue is the lack of transparency surrounding the quality rating system used by the VA, called the Strategic Analytics for Improvement and Learning (SAIL) database.  As you know, this information is not released to the public.  Veterans, just like every other patient, deserve to know how their hospitals are performing and what services need to be improved.  Having a secret rating system only serves to increase distrust of the VA and may give the appearance that the Department has something to hide.  To address these concerns, we introduced legislation earlier this year that would improve transparency at the VA by requiring each VA medical facility to issue a quarterly report on the rate of surgical infections and cancelled or transferred surgeries at VA hospitals. Increasing transparency is critical to understanding the type of care veterans are receiving and how to fix any problems we are facing.

            In regards to the current situation, we are committed to working with you and the leadership at the Detroit VA to address these problems so veterans know they are receiving the best possible care. We request answers to the following questions:
            
1.    Please provide us with a complete and un-redacted copy of the latest SAIL star rankings, as well as a list of all rankings going back 5 years.   As you are aware, our only knowledge of the star rankings is coming from press reports. 

2.    The Detroit VA saw performance deteriorations in three critical SAIL categories: their HEDIS score, wait time for specialty care appointments and readmission rates for cardiovascular and medical patient cohorts.  How does VA Headquarters intend to ensure that the Detroit VA improves on each of these important targets?   What is the timeline for these improvements?  How will we be kept informed of their progress?

3.    Does the Detroit VA have to submit a formal plan to VA Headquarters for how they intend to improve their performance and quality of care?  

4.    What assistance and resources is VA Headquarters offering the Detroit VA, or any other one-star facility, to ensure all necessary and appropriate measures to improve care at the facility are occurring?

5.    In general, are there any penalties or punishment in place for one-star hospitals in the VA system?  If so, please provide a detailed explanation of the penalties.  If not, please explain why the VA thinks it is unnecessary to have increased accountability for struggling hospitals.   

6.    How is the public informed if a hospital in their area only has one star? What type of accountability systems are in place for a hospital which stayed at one-star status for over a year to ensure performance is immediately improved?  How many hospitals nationwide have been one-star hospitals for over a year?

7.    How are the metrics used in the SAIL system determined?  How often are these metrics reviewed and updated? 

8.    Will both VA Headquarters and the Detroit VA commit to providing our offices with regular briefing and updates on your progress in improving the star rating of the Detroit VA?

9.    How do we ensure that veterans that are currently receiving treatment at the Detroit VA are being properly cared for and are not in danger? 

We are deeply disturbed to read this report in last Friday’s newspaper. Providing for our veterans is a critical responsibility for you and us.  It is absolutely essential that we ensure veterans at the Detroit VA are receiving the good, quality healthcare which they were promised and that it not be impaired in any way.  We are meeting with Mr. Robert McDivitt, Director for VISN 10, and Dr. Pamela Reeves, Director of the Detroit VA Medical Center, this week and must be kept informed of how this will be fixed moving forward.  We all must come together to address the problems at the Detroit VA so our veterans can have confidence that they are receiving the best possible care which they were promised.   Providing prompt answers to our questions and working to improve transparency at the VA will help us achieve these critical goals.  We look forward to receiving your response. 

Sincerely,

            Debbie Dingell                                                            Tim Walberg
            Member of Congress                                                   Member of Congress