‘New’ RAND Study On VA Health Care A Bait And Switch Sham
The newest RAND study supporting VA health care quality is merely a regurgitation of pre-2010 research data that does not answer questions about present VA quality of care.
At best, this study was a waste of taxpayer dollars and should not have been undertaken since none of the research data and studies analyzed reflect the present quality of VA health care.
At worst, it was a political public relations stunt perpetrated to advance opponents of the Veterans Choice Program.
READ IT: Comparing VA And Non-VA Quality Of Care: A Systemic Review
The purpose of the study was to gauge whether quality of care at VA has changed in the past 6 years since the previous study on the same subject:
“This review indicated that in most studies, the care provided in the VA compares favorably to non-VA systems. However, quality may have changed in the last 6 years since this review, and concerns about quality of care have continued to mount. To assess the quality of care provided by the VA, we performed a systematic review of published comparisons of the quality of care in VA facilities to other settings.”
COMPARE IT: Comparison Of Quality Of Care In VA And Non-VA Settings
Here is the real deal. The document RAND is currently holding out to the public as a “new” study is little more than a literature review of studies published from 2005 to 2013. There is nothing “new” about it.
The non-reading public may walk away believing what RAND is asserting, that VA care is as good if not better than non-VA care. But those individuals are likely unaware of how published research works. It takes years to publish and for that reason the data is somewhat older.
Those old studies relied on even older data sets created between 1985 to 2009.
Do you remember what you were doing in 1985? That the year Jim McMahon rocked the Chicago Bears into the Super Bowl, three decades ago.
WATCH: Bears Super Bowl Shuffle
PROBLEMS WITH THE STUDY
The study also primarily compares VA care to the care provided by patients through Medicare, which is not the same as non-VA care because it excludes private insurance users who may receive very expensive care types when compared to Medicare recipients.
The RAND study plays at three bait and switch logical fallacies – ie shams to deceive casual readers.
The first sham based on the study headline was that the study examined non-VA care, which would include private insurance, compared to VA care while actually comparing Medicare recipient care to VA patient care.
The second sham is that the research examined was new and addressed the period from 2011 to 2016 because that is the period in question, right? It did not address new research data since 2009 other than the results of a small minority of studies but no new research data.
The third sham is that VA quality of care is equal to or better than that received by Medicare patients. It is not – at least not when it comes to surgery and major procedures. Assertions that it is of that kind of quality gives veterans and the public a false sense of security.
As I will talk about below, surgical care at VA is frightening. VA is great at running up its numbers through numerous screening tests. When it comes to fixing the problems through surgery or chemo, VA is horrific.
A closer look at the new study shows it only evaluated earlier studies that used data from 2009 or older. Some dated back to the 1990’s and one included data from 1985.
While a couple of those studies were published as recently as 2013, the vast majority predated the previous 2010 analysis of VA health care quality. And they all used research data from last decade.
Now answer me this question: How can you study the current status of anything by studying data that largely was created before the invention of the iPhone? Why did taxpayers even bother paying for this study?
Ironically, even the RAND study could not totally escape from certain truths. For example, it included research showing VA surgical care for veterans was “not consistently bad” and that some veterans had 21% lower odds of dying from more timely non-VA care.
The findings were part of a larger apparent whitewash of VA health care where 69 studies published in the past 10 years found that VA did as well or better in 22 of 34 studies. Nine of those showed VA was worse and three were a mixed review.
RAND STUDY A BAIT AND SWITCH
It is noteworthy that the study chose to evaluate studies published between January 1, 2005, to January 1, 2015, rather than from January 1, 2010, to January 1, 2016.
It then wrapped in all the studies, published from 1999 to 2013, and concluded VA is as good or better than non-VA health care as of the present time. This is clearly a bait and switch, especially given that more than half the studies reviewed were published prior to 2010 and ALL THE STUDIES USED PATIENT DATA PREDATING 2010.
So how could RAND reach any conclusion about the present state of VA health care by evaluating old, previously evaluated studied?
They could not. The present study is a deception to grab headlines supporting VA during an election year when VA problems stand to weigh heavily in the minds of voters.
The present study is a deception to grab headlines supporting VA during an election year when VA problems stand to weigh heavily in the minds of voters.
And what about those other studies where VA was worse? They were in areas of timeliness, surgical quality, and other lifesaving areas of health care that seem important.
In those areas where people die, VA still apparently sucks enough to warrant a bait and switch puff publication from RAND. Shame on them.
RAND STUDY CONCLUSION
RAND ultimately concluded the following using vague descriptors like “often” or “better than or similarly” rather than clearly delineating and declaring the winner:
“The VA often (but not always) performs better than or similarly to other systems of care with regard to the safety and effectiveness of care. Additional studies of quality of care in the VA are needed on all aspects of quality, but particularly with regard to timeliness, equity, efficiency, and patient-centeredness.”
RAND STUDY IN THE PRESS
After completing its literature review study, RAND Corporation quickly fomented that summary of its review about VA quality that led to various headlines like, “Study: VA performs as well or better than other health systems”, just in time for the election.
The RAND researchers basically concluded, to borrow from UPI, “the VA system is comparable in safety and efficacy to care otherwise available, despite often dealing with patients who are more sick or have a wider range of conditions.”
However, not clearly noted within the study was the appendix of the study explaining various factors not well articulated within the press coverage.
[BE SURE TO LOOK AT THE APPENDIX AT THE BOTTOM OF THE STUDY]
UPI also summarized holes within the report as follows:
“There were some areas without enough previous research to make a comparison, such as in timeliness, efficiency and patient-centeredness.
“There also were some areas, such as surgical complications and availability of services, where results were less favorable, though the researchers say these reports were not consistently bad.”
Wait, “not consistently bad”? What does that even mean?
So what is the background with this kind of spin? Why did RAND regurgitate the evaluations and publish it in the Journal of General Internal Medicine right now?
HAPPY HEADLINES
Well, the headline sure sounds snappy and Hillary Clinton will be able to announce Secretary Bob McDonald basically fixed VA health care under his MyVA initiative. My guess is the study was timed to be released just prior to going into the final election cycle.
Is a ‘congratulations’ in order for Mister Bobby? You might want to hold your applause.
I started my review of the RAND’s puff piece by looking at the parts they left out of the online publication page – the appendix.
In the appendix of the report, you can find more information about the areas within the report cited as not having enough research to really know the outcome.
VA TIMELINESS
For example, on timeliness, only one study evaluated the timeliness of VA care compared to non-VA care. That study found a significantly shorter wait time, but the appendix curiously fails to note the wait time difference.
Hip fracture was the condition studied, where veterans waited a “significantly” longer amount of time within VA. VA care was deemed worse by the study but nothing really dug into the difference.
The footnotes contain the answer in a journal article titled, “Fee-based care is important for access to prompt treatment of hip fractures among veterans.” (2013)
Now here is some scary data for veterans.
The research found veterans who received fee-based care received surgical care within 1 day.
Veterans stuck at VA had to wait three days.
Additionally, fee-based veterans enjoyed 21% lower risk of death within one year than their VA treated counterparts who had to wait three days.
How about that for those with broken hips? Why aren’t there more studies about this topic in light of the wait list scandal?
These were not the only examples. Veterans who underwent coronary bypass surgeries had significantly higher odds of dying. Still, others were at higher risk of the surgeon leaving items inside the patient.
RAND CORPORATION PUFF PIECE BREAKDOWN
RAND started with 461 articles and excluded all but 69. Eight of those excluded were omitted due to RAND giving them a low grade of C. I could not figure out exactly how RAND reached that grade, nor could I find the article omitted, but I sure would like to see them.
RAND broke down its puff piece, which was nothing more than a summary of some of the research it evaluated, in the following order:
- Safety
- Mortality
- Morbidity
- Complications
- Other Safety Measures
- Effectiveness
- Outpatient Care
- Non-Ambulatory Care
- Medication Management
- Availability of Services
- End-of-Life Care
- Timeliness, Equity, Efficiency, and Patient-Centeredness
VA did score better in some areas that non-VA facilities, according to RAND. But I would not toot the victory horn yet if I were McDonald, especially in light of the bait and switch.
OTHER VA SURGICAL COMPLICATIONS
VA still struggles to avoid complications after the procedures are over. Of note within the literature review were cataract surgeries and all kidney transplants. Veterans receiving kidney transplants had a higher graft failure risk than non-veterans.
What gives with the kidney problem, and why are these the only areas RAND looked at under complications? Not sure.
The study paid little duty to the third element of the review, timeliness, equity, efficiency and patient-centeredness.
EFFECTIVE DEATH CARE
But about effectiveness, VA apparently supplied “similar or superior quality to non-VA facilities with respect to preventive, recommended, and end-of-life care, as well as managing medications. Non-ambulatory care studies indicated similar care quality between VA and non-VA settings.”
I guess that means veterans needing end-of-life care should go to VA for a swift death. Do not pass Go. Do not collect $200. Go straight to VA. Die quickly and feel good doing it?
If you take a look at the appendix, there is mention that VA withholds chemo from veterans nearing death, and the study concludes this is good since chemo makes people feel bad as they near death.
Okay, I guess. So do not try to save me because it might make me feel worse?
Still want to rely on VA for all your health care needs?
VA appears to do a good job screening veterans with all its resources. The basic things it seems to do well. When it comes to surgeries, you better run like hell.
Source: https://link.springer.com/article/10.1007/s11606-016-3775-2
Thanks very much for covering this Ben and digging into it so thoroughly. I thought the same as you…how convenient the timing on some drivel being published like this in the face of ZERO evidence that it’s true.
If you look at the research authors, they all look like students or recent graduates of Harvard in the medical administration or policy field. None look like they had any experience actually administering a health care system.
As I said in my previous comment, it looks as if someone in the VA had a certain conclusion they wanted some outside body to give credibility to. The government has done that with RAND for years. It would be interesting to see the contract that paid for this to see how much was paid for such a pathetic “study”.
It reminds me of the study RAND did years ago for the Pentagon on Gulf War Illnesses and exposure to DU. I believe the RAND study was released prior to the DODs own Case Narrative on DU, which now seems as if the DOD wanted to just point to the RAND study finding their was no evidence of health problems from exposure to DU.
I went to the Pentagon for release of that study, along with representatives of several other VSOs.
Bernard Rostker, Undersecretary of Health for Gulf War Illnesses went overboard claiming DU could be eaten like a candy bar, and no harm would result because the veteran would expel most of it from exhaling or through urinating.
The RAND study was BS as any could see from quickly thumbing through it, and I asked if the researchers looked at any studies looking for the presence of U236. The researcher said they had not, so then I passed around copies of a report on the cleanup at Jefferson Proving Ground. In the report, they had tested deer for the presence of U236 because they knew it was a man made isotope. I asked why the DOD considered deer more important for this testing than veterans. I thought Rustler was going to have a stroke.
I then passed around another copy of a document I had showing the DOD knew of the hazards of DU since 1958, the date on the page.
The RAND researcher mumbled something about looking at more research, but for the next couple days, the DOD pushed the “safe as eating a candy bar” crap.
It was the first time I ever heard another “veteran” tell me I should just shut up about it because the research supposedly was taking money from other veterans health care. That guy was from the DAV.
The RAND study wasn’t cited much since it was so easily discredited, like this current study.
And that Undersecretary for Health Bernard Rostker? He graduated from some college in 1964. His biography showed he bounced back and forth between RAND and the DOD from 1964 to the late 1990’s depending on who was in the White House. For years he was the head of the Selective Service System.
RAND is nothing more than a jobs program for out of work government flunkies.
It took an internet search about 0.3 seconds to return a synopsis of another, or perhaps even the same, study by RAND for VHA. Read it carefully and you will see that RAND is quick to point out they used the performance metrics specified by VHA, but beyond that, I judge these RAND reports based on the conclusion paragraph written by RAND who of course is paid directly by VHA. This was just over a decade ago straight from their report to VHA and America;
“If other health care providers followed the VA’s lead, it would be a major step toward improving the quality of care across the U.S. health care system.”
Direct copy paste from RAND from over a decade ago. What do you believe now?
Send that quote to a non VA clinic and the laughter echos off the hillside. Maybe a few vets rolled over in their graves?
The RAND institution is supposed to report on facts, not drivel, but they’ve done the same thing in CA worker compensation even with witness testimony that the WC system was f—-d UP on the treatment of injured workers and everything is of course, far worse than ever before..
This is just about the VA just getting more money for it’s secret malicious attempts to do worse while parading around that it is working for the best, for vets. Better results would result in less money every year but making less money is not the idea, it is about making even more money for making the vet machine which is just making the VA more dangerous every year for our vets. That’s the machine of the VA getting bigger and bigger every year for itself, certainly not for the betterment of our vets and RAND lost its way with providing false facts coming from the DOD & VA.
The same applies to the worker compensation systems where it is those who are in the mechanics of it all, WHO are the only ones who are getting any benefits such as a full time job with lifetime benefits, all on the backs of injured workers whose only benefits are maiming, pain, illness, poverty and then death. To which the last 4 days one will get PLENTY of care, that is hospice & palliative care with of plenty of morphine, no food and no water. Nothing like being starved to death, totally dehydrated to death but all the morphine the body can handle till it expires. That’s the award for those who do get hurt or sick after providing their all.
It happens to private patients too. All we are is a way for the two legged incompetent parasites to live well. Health care is not medical care anymore. it is really just a evil system pushing us all into our demise as soon as possible and kaiser was the one who leads the way.
This study is nothing but ‘the emperor’s new clothes’ so the VA can look all spiffy for the last ca$h grabs before new fiscal year, as it’s about time for another sacrifice to the VA’s Black Hole. It’s hungry and it’s legion want their performance bonuses.
Hey namnibor, just like VA employees weren’t supposed to receive bonuses last year. That was a federal mandated law, signed by Obamy!
Of course we all know VA runs by their own set of laws! Screw Congress, the taxpayers and veterans. They just make it up as they go along. McDuck, Gibson, Shulkin and the rest of the ingrate asswipes need to be in stripped cloths. Making little rocks out of big rocks!
Another study the Big Vet Organizations will hang their hat on to tell people the VA is really bigger, better and faster than the outside world. We, here, know that is just plain bull.
Only when the public realizes the true motto of the VA is, “Dead Men tell no Tales”, will they understand how ludicrous these studies and statistics are.
As a side note, I was at the VA the other day and the eligibility clerk was sitting in for the travel clerk. I am listening to her talk to someone about an Afghan Vet who was attempting to get care. She is telling the person on the other end, he isn’t eligible for enrollment because he served there 7 years ago. I said excuse me, does he have a Purple Heart? She said, “Oh, we didn’t ask.” I bet you don’t need two guesses what the vet’s answer was.
I bring this up, because in reality the VA only treats about 35% of all veterans. Add to that the vet population is dwindling and within a couple of years all the WWII and Korean vets will be gone and half the population of vets will be over 50. So, what is wrong with the VA transitioning to private care instead of building new monuments of stupidity at ridiculous costs?
I’m stuck! I guess I’m waiting for Trump. I gave up yesterday. I’ll just wait. If Trump doesn’t produce I guess I’ll have to figure what to do with my 15 years of anger built up. I have some serious ideas though.
I read that study plus the comments that were contractually allowed by the people at Rand when it was published. The were extremely precise in explaining that the study guidlelines, protocol, data sets, and access to records was tightly controlled by VHA and NOT by the researchers doing the study. Rand was careful to emphasize that any existing problems (findings) detected by the team that might otherwise detract from thheir findings but were not precisely defined by VHA as part of the data sets were not to be included by contractual arrangement.
Moreover, they are contractually obligated to refrain from any furher comment on the study.
I read this stuff and I remember things like this because the VHA became a hobby the moment my Congressmans office informed me that I had threatened to murder a clinic staff. This was news to me at the time and indeed inspired a surge on study activity on my part that continues to this day.
I guess being falsley accused of planning multiple homicides by a Federal Cabinet level agency as relayed through my Congressional Representative sparked keen interest in this disabled American vet.
Give up this fight and someday the goons with guns might be knocking on a lot more doors than just a crippled veterans home. I wont do that.
Hey redturtle984
The VA is already trying their best to “…strip veterans of their weapons…”! Yet, they were not all together successful -YET!
The VHA tried going through the back door on this issue. By asking veterans about “gun locks”! They have been somewhat stopped so far! Remember the few articles, which came about in the past few years, over VA (security police) going to veterans homes, to collect their weapons?
Myself and Seymore put a few articles, one in California and another in Idaho, on Ben’s blogs about this! There’s more. You just have to look!
Now, the Social Security Administration is using the same ideology, and tactics, as VHA to “…strip the elderly…” of their “2nd Amendment rights”! Which many are veterans!
We veterans get a bunch of our Constitutional rights taken away over this issue.
Rep. Trey Gowdy (R-SC), and a few others, has tried to show us, (on Utube), just how dangerous our government has begun on taking away our rights!
Check it out. You’ll be amazed at what’s really taking place on this issue!
So just as I thought. A conclusion in search of some authors to “prove” it through “research”.
Any idea when this study was first started or requested?
Looks like RAND is willing to whore themselves out regardless to keep that door open for future government gravy.
Well, this is another eye opener. Rand was always in cahoots with DOD and now with the VA as far as I know. Nothing at the VA is going to change. Veterans are second class citizens to be poked and prodded on and used for experiments, mostly. Whenever I go to my PCP now, I try and talk him out of running any tests on me. I’m scared of VA health care.
Unless i am on deaths door i stay away. I get refills and choleterol filled via email.
When they stop doing that i will pay out of pocket
The last 2 times I went by ambulance to the VA, with heart attacks, the emergency room tossed me out. I checked into a psych ward, thought I’d rather die there. My last heart attack was A big one, so I went to a real hospital, and underwent surgery immediately. Where RAND is getting it’s information beats me. I am positive that I would be dead, if VA is all I had. And Ben, even years ago the VA has always been pitiful.
I didn’t notice what Ben did in his post…that RAND, rather than studying just the last 5 or 10 years, they looked at crap published years ago.
I believe they did this because a shorter time period would likely show much worse results, so they had to include years prior to try average those bad results down.
Yes, I want to rely on the VA for my health care. But not the present one. The one that existed before President Reagan’s pen and ink changes and the continuing deterioration since.
Good to hear sm common sense on here instead smtimes u get these right wing dick holders
Like Seymore asked yesterday. If VA doesn’t have monies for healthcare, why the hell are they ordering a report?
I wonder how much VA paid for this garbage?
Like I learned about reports years ago – “garbage in – garbage out!”
Statistics can, at every turn, be used to fool the unsuspecting! We, veterans and taxpayers, are being played for fools! This report is a pack of lies.
I wonder if Hit-LIAR-y was involved in this?
I mention the RAND DU study in another comment. I recall them blatantly ignoring other publicly known information on DU with the excuse that it was not a part of their study parameters.
As for this study that Ben mentions, why not have the IOM or other quasi-governmental health agency conduct it rather than RAND?
Figures don’t lie
But
Sometimes those who figure do
I am always lloking over my shoulder when I am treated at the VA. IT SUCKS
RAND Corp.=
R–eadily
A–vailable
N–efarious
D–eterminations…………at a good price by whatever desired outcome. The vending machine of studies.
RAND is very good at writing BS research conclusions that give a scrap of red meat to one side, while also giving all of the conclusions wanted by the government agency paying their tab.
Then the agency can tout those conclusions while ignoring the scrap.
let me show you something firectly from RAND in the introduction to a study commission by (guess who) an interested party that predicts Hillary Clinton will be our next President. I will quote, then explain;
(with all due reapect to network news outlets, the following text is available as a picture file with sounds designed for immediate digestion)
RAND, 2016, intro to a complex study;
“….there is a family of mathematical techniques called multi-dimensional scaling (MDS). These techniques can be used to place people on a two-dimensional “map,” such that people who are similar to each other are close together on the map, and people who are dissimilar from each other are far apart on the map.”
Now, as a Marine and educated solely in Public School wil translate into Marineese for my fellow Marines, Southern dialect; “…shhhheeeeiiitttt man! They just changed the fu$@ing numbers man! That’s (farmhand scatological explicitive here)!”
yep, the word “scaling” means they changed the numbers until it fits the mold, thusly the number are “scaled”. This is commonly done in research in a scientific field known as S.W.A.G.
Scientific Wild Ass Guesses, and brother it would make you sick to see how much of our fate is decided by SWAG coming from RAND.