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Ranking the VA Hospitals
Looking at one region — New England — how do VA hospitals stack up against competitors?
All ranking systems are flawed — some moreso than others. The day before yesterday (and a couple weeks back) we uncovered how the US News & World Report rankings are close to worthless when it comes to “best schools for veterans” — almost entirely arbitrary. And as everyone in the military knows, when in the course of performing spot checks you find a deficiency, you dig deeper and usually find more.
College is expensive in terms of money and of time; one of the greatest investments that a person will make in their life. It’s far too important a choice to leave to others (in the form of pressure to attend a high-ranking college). Even so, it isn’t halfway as crucial as selecting a hospital, where a procedure can mean the difference between life and death. And yet, as we learned yesterday, the ranking systems for hospitals have blind spots in them; they trust the opinion of experts in whose interest it is to rank certain hospitals and departments (such as their own) higher than others.
Veterans who use the VA system for health care have a slight advantage, here; there is an excellent ranking system developed at Yale that does a pretty good job of creating an apples-to-apples comparison between individual Veterans Affairs Medical Centers (VAMCs), and between VAMCs and other hospitals. The only caveat is that the system only includes hospitals that take accept Medicare and Medicaid, so is not comprehensive. Nevertheless, given sufficient data, the VA’s “Care Compare” system is able to offer people options in their area, is fairly comprehensive, and — perhaps most crucially — has very little bias in it.
THE BIG STORY
Ranking the VA Hospitals
Looking at one region — New England — how do VA hospitals stack up against competitors?
In an effort to create a true “apples to apples” comparison of use to the general public, the VA commissioned the Yale New Haven Health Services’s Center for Research Outcomes & Evaluation (CORE) to (drawing on public data) rank as many hospitals as possible. CORE determined that the most effective way to do so was to assign hospitals that had generated enough data two sets of 1-5 stars; one for outcomes (hospital quality) and one for reputation (patient satisfaction, determined through surveys).
The result proved a core claim of the VA’s — that their hospitals generally outperformed all but the most well-funded hospitals, and competed favorably with those well-funded private hospitals. The VA is always hard-pressed to justify the cost of its care, and often meets with competition from groups that hope to dismantle it, and turn its hospitals and healthcare assets into private businesses.
For this piece, I looked at all the hospitals that were fully rated in the New England region, VA and non-VA. A total of 128 hospitals providing acute care coverage across six states — Connecticut, Rhode Island, Massachusetts, Vermont, New Hampshire, and Maine — received full ratings. Five of those hospitals were VA hospitals; Togus VA Medical Center in Maine, White River Junction in Vermont, VA Boston Medical Center in Massachusetts, Providence VA Medical Center in Rhode Island, and the West Haven VA Medical Center in Connecticut.
Why New England? First and most importantly, because I live here, and have the most experience with its hospital and medical landscape; I feel fairly competent and confident discussing this region, both as someone who uses Connecticut’s West Haven VA for health care, and as someone who’s encountered health care at other facilities. Second, because New England has a good reputation for old and established medical schools, and medical schools usually mean better quality hospitals and VAs. Third, it didn’t provide an overwhelming number of hospitals to analyze, and I have a limited amount of time for analysis.
Why focus on acute care hospitals, rather than critical care hospitals? All states had acute care hospitals, but critical care hospitals were located in just 2 states, and my feeling in reading about what they provided to a community versus what acute care facilities provided was sufficiently different to dilute this small project.

VA Medical Centers across the country are competitive with their privatized peers, both in terms of quality of care, and patient satisfaction. Photo via DIVDS, by Timothy Westmorland.
128 hospitals were rated, each of which received between 1-5 stars for quality of outcomes, and 1-5 stars for patient satisfaction. No hospital scored lower than a 4. 23 of the 128, or about 18%, received a combined score of 9 or better (at least one “5-star” rating, and another rating of minimum 4 stars).
Looking at outliers — one acute care hospital received a pure “10” rating, the New England Baptist Hospital in Massachusetts. Two hospitals received “1-star” rankings in either of the categories — both for quality of outcomes. Very few hospitals had variances of more than 1 star between their two rankings — in other words, a hospital that received a 5-star ranking in one area was unlikely to receive less than a 4-star ranking in the other. To put it another way, a hospital that received a 2-star ranking in one area was unlikely to receive more than a 3-star ranking in the other.
Low rankings were less likely than higher rankings (relatively speaking), though this is likely due to a combination of (1) underperforming hospitals may have been reluctant to share data or (2) didn’t qualify to generate it in the first place, and (3) there is a bias toward hospitals that perform well year after year continuing to do so; the system selects for success, in other words.
22 acute care hospitals achieved “5-star” rankings in quality of care, but only 4 achieved “5-star” rankings in terms of patient satisfaction; it was far more difficult to impart patients with feelings of satisfaction after their care, than to provide them with what the medical community sees as top-quality care.
The most important thing to stress, here, is that CORE’s system and methodology are transparent, and seem reasonable to me; it is a good faith effort to rank hospitals in a way that fairly compares them to each other, and is in my mind unquestionably superior to the system of US News & World Report.
In Connecticut, of the 26 hospitals that provided acute care, 3 (or, 12% of the acute care hospitals) achieved ratings of 9: Sharon Hospital, Midstate Medical Center, and the West Haven VA Medical Center. Both Sharon and Midstate got 5 stars for the quality of their care. West Haven got 5 stars for patient satisfaction. This is my medical provider — and they really are quite good.
Next door in Rhode Island, 2 of the 11 (18%) acute care hospitals achieved ratings of 9; South County Hospital and The Miriam Hospital. The Providence VA Medical Center received a 5; it was one of the two acute care hospitals in New England to receive a 1-star rating, for quality of service. It was also the only hospital to have a variance of 3 stars between quality of service and patient satisfaction, where it received a 4-star rating. In Rhode Island, if the rating is to be believed, patients are happy to receive some of the worst medical care in New England. That, or something’s wrong with how it’s being evaluated, I can’t say.
8 of Massachusetts’s 52 ranked acute care hospitals (15%) received 9 stars or better; the Boston VA Medical Center received 7 stars total, so was not among them. I know that the Boston VA benefits from excellent medical students and faculty in the Boston area, so it’s difficult to understand why it isn’t among the best places for veteran health care. But it is not.
If you live in Vermont, 3 of the 7 ranked acute care hospitals received 9 stars, for an insane 43%; it’s good to have Bernie Sanders as your senator, is what I’m taking away from those numbers, whether that’s the real reason or not. The White Junction VA is one of them; it is also, like the West Haven VA Medical Center, among the 4 acute care hospitals to get 5 stars for patient satisfaction.
New Hampshire had 14 acute care hospitals, and only 2 of them received 9 stars (14%). No VA hospitals were rated.
Finally, Maine had 5 of its 18 hospitals receive 9 star ratings. Togus VA Medical Center was among them — and, like West Haven and White Junction, did so with 4 stars for quality of care, and 5 for patient satisfaction. Also among them? Maine Medical Center, where my father received care for his injury earlier this year. MMC has average reviews on google, and doesn’t rank nationally with US News & World Report. But CORE’s system gives them 5 stars for patient outcomes, and 4 stars for patient satisfaction.
What are the takeaways? VA medical centers do a good job of giving patients a feeling of satisfaction, even when (as seems to be the case with Rhode Island) it isn’t necessarily deserved. Patient satisfaction is harder to achieve than the outcome of care — though I wonder how dissatisfaction factors into a patient’s health, long term (personally I would prefer a 5 star experience from a satisfaction point of view, and a 4 star experience from a quality of care point of view). And VA Medical Centers in New England are among the best places to receive health care, even when compared to the other nearby private hospitals.
Finally, if you think you had a good experience at a hospital and are impressed with it, but learn that Google and US News and World Report don’t rate it highly, you actually might be right, and Google and US News and World Report might be wrong!
TOP READS IN MONEY & FINANCE
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TOP READS IN THE MILITARY
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TOP READS FOR VETERANS
Progress on the Camp Lejeune contaminated water class action lawsuit.
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TOP READS AROUND THE WORLD
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HUMOR
Sometimes I don’t think The Onion is as funny as it is accurate. Like I didn’t really laugh reading that piece.