Exclusive: New VA chief on public scrutiny: Bring it

WASHINGTON — The Department of Veterans Affairs has a new message on public scrutiny: Bring it on.

President Trump’s pick to lead the agency, VA Secretary David Shulkin, is unveiling a new web site that reveals for the first time exactly how care at VA hospitals compares with nearby private-sector hospitals and national averages. The site has data for roughly 20 hospitals but more will be added soon, the VA says.

The site that went  live Wednesday, accesstocare.va.gov, also shows if veterans are satisfied with wait times at every hospital and clinic across the country and how long they are actually waiting on average.

Shulkin, the only holdover from the Obama administration in Trump’s Cabinet, told USA TODAY that he believes transparency is a critical step toward fixing the beleaguered VA, something he said he conveyed to Trump.

“He doesn’t understand why people are waiting this long, and he wants to fix it. My answer to him is, the way that you fix this is not by internally motivating people to fix it — you actually need the external environment, people looking, saying I don’t understand why it’s 45 days,” he said.

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“In my experience in health care — but it’s like every other industry — industries don’t change from within, they change from outside competition, and they change from outside forces, and that’s very much my philosophy.”

That’s a marked shift from his predecessor, former Procter & Gamble CEO Bob McDonald, who as secretary focused heavily on trying to spur internal cultural change, assailed critical media coverage and said that revealing internal quality ratings of VA hospitals would cause veterans “unwarranted distress” and possibly dissuade them from getting care.

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Shulkin himself had worried veterans might be scared away, but he says now that he’s in charge — he was previously undersecretary for health — he decided transparency is the best option. He provided a demonstration of the new web site to USA TODAY on Monday that showed wide variations in wait times.

In the greater Los Angeles area, for example, the average wait for new patients seeking mental health appointments ranged from eight days in Long Beach, Calif., to 87 days at a clinic in Santa Fe Springs, Calif.

In New York and New Jersey, average waits range from three days at a clinic on Staten Island to 58 days at a VA clinic in Morristown, N.J.

Shulkin said the information will empower the public to ask questions — including members of Congress and others outside the VA who can hold it accountable. And it helps veterans and their family members make more informed decisions about where to seek care.

“It starts giving people now some choice on essentially what they want to do,” Shulkin said.

At the Phoenix VA, which made headlines in 2014 after schedulers kept secret wait lists and veterans died waiting to be seen, the average wait is now 18 days for new primary care appointments and eight days for new mental health patients, according to the new site.

But on satisfaction, only 69% of veterans surveyed say they usually got an appointment when they needed one in Phoenix. The national average on that question is 85%, Shulkin said.

He noted that all of the roughly 150 VA hospitals now provide same-day services for veterans needing urgent or immediate appointments, a goal he had set when he started at the agency in 2015.

The site also shows how 19 VA hospitals compare to nearby private-sector facilities on more than a dozen quality measures, including complication rates after hip or knee surgery. It also displays national averages, allowing the public to see where VA care is lagging or better in average quality.

Shulkin is a practicing physician who still sees VA patients via videolink in his top-floor office at VA headquarters in Washington. He is quickly ramping up plans to deliver on Trump’s campaign promises, including setting up a White House hotline for VA complaints that Shulkin says should be up and running by June 1. He is also putting together a task force to investigate fraud and abuse at the agency.

His philosophy about transparency stems to his early career days in the 1990s, he said, when he was chief medical officer of the University of Pennsylvania Health System. The state of Pennsylvania released death rates for cardiac surgery programs and Penn’s was the highest.

“And everyone until then had thought, well Penn was the best. Now all of a sudden we have data, it’s the worst,” Shulkin said. “Well, I learned — not easily — I learned that was a gift to me to drive internal change, and I could never have stood up as a young kid and said, ‘guys we have a problem here.’ But when the reporters and the newspaper articles were saying you have an outcomes problem here, mortality’s three times as high as other hospitals in Pennsylvania, that allowed me to drive internal change.”

Shulkin hopes releasing the internal data on the sprawling VA system, which encompasses more than 1,200 medical clinics in addition to hospitals, will help him do the same.

“I really think that this is going to be, when we look back, this is going to be a turning point for VA because the leaders that aren’t focused on what they’re doing have no place now to hide and so they’re going to have to truly be accountable for their results,” he said.