Cruz Cornyn Pen Letter Urging VA Medical Centers to Improve Quality of Care

Letter follows recent study done on the quality of care at VA medical centers Texas Insider Report: WASHINGTON D.C. U.S. Sens. Ted Cruz (R-Texas) and John Cornyn (R-Texas) sent a letter to United States Secretary of Veterans Affairs David Shulkin making the case for the critical need for improvement in Texas VA medical centers. The letter followed the recent study done by The Department of Veterans Affairs Strategic Analytics for Learning and Improvement (SAIL) which found that three Texas VA medical centers had the lowest possible rating. The three medical centers with one star ratings included West Texas VA Health Care System (Big Springs) the El Paso VA Health Care System and the VA Health Care Center at Harlingen. Since approximately one in twelve U.S. veterans lives in the state of Texas amounting to nearly 1.5 million veterans in total and these medical centers provide care to a large number of those veterans we view these findings demonstrate a systemic failure to care for our veterans" the Senators wrote. It is critical that the VA makes every effort to improve the quality of care at these medical centers immediately." You can read the letter here and full text is below: November 9 2017 Secretary Shulkin U.S. Department of Veterans Affairs 810 Vermont Avenue NW Washington DC 20420 Dear Secretary Shulkin We are writing to express our deep concern about the quality of care at our Texas Veterans Affairs medical centers. The recently published Department of Veterans Affairs Strategic Analytics for Improvement and Learning (SAIL) Report rated three Texas VA medical centers with the lowest possible score on the annual quality rating review. Since approximately one in twelve U.S. veterans lives in the state of Texas amounting to nearly 1.5 million veterans in total and these medical centers provide care to a large number of those veterans we view these findings demonstrate a systemic failure to care for our veterans. It is critical that the VA makes every effort to improve the quality of care at these medical centers immediately. According to the reports findings three VA medical centers in Texas received a one-star rating out of a possible five-star rating. Two of these hospitals the West Texas VA Health Care System (Big Spring) and the El Paso VA Health Care System received the lowest possible score for a second consecutive year. The VA Health Care Center at Harlingen dropped from a two-star the second lowest rating last year to a one-star the lowest rating this year. This is particularly alarming for Texas veterans considering the report shows net improvements in 64 of medical centers nationally. Below are some findings from the VAs latest SAIL report for the Big Spring El Paso and Harlingen. We found the following items to be particularly troubling:

• Big Spring received scores below the 10^thpercentile with a total of 16 of 24 graded areas falling below the 50^th percentile. Areas below the 10^th percentile included Mental Health and Patient Experience as well as Mental Health Population Coverage and Ratings of Primary Care Providers.
• El Paso received nine graded areas below the 10^thpercentile with a total of 19 of 24 graded areas falling below the 50^th percentile. Areas below the 10^th percentile included Mental Health Care Transitions as well as registered nurse turn over and efficiency.
• Harlingen did slightly better receiving only four points below the 10^thpercentile with a total of 13 of 24 falling below the 50^th percentile. Even with slightly better overall scores Harlingen scored below the 10^th percentile in Care Transitions Patient Experience and Ambulatory Care-Sensitive Condition (ACSC) Hospitalization.
• All three centers showed low scores in overall rating of primary care and specialty providers Patient-Centered Medical Home (PCMH) timely appointment care and information and efficiency.

As the United States enters its 16th year of conflict and our service members and their families continue to bear the burden of high operational tempo and continued deployments we must ensure that they have access to high-quality care when then they return. The VAs SAIL report for the West Texas region clearly demonstrates that Texas veterans are not receiving that care. In light of these findings we respectfully request answers to the following questions:

1. Considering the West Texas VA Health Care System (Big Spring) and the El Paso VA Health Care System received the lowest possible score for a second consecutive year what changes were made to improve the quality of care at those medical centers since the previous years report?  How do you judge the effectiveness of those changes?
2. Has the VA conducted a root cause analysis to determine the reasons for the low quality of care at Big Spring El Paso and Harlingen?  If so please explain the findings and actions.
3. What is the VAs strategy for turning around the lowest-performing medical centers in this report?  Please provide specific plans for the three Texas medical centers
4. What immediate steps have you taken to improve the quality of primary and specialty care PCMH timely appointment care and information and efficiency in the West Texas region?
5. How do areas graded in the lower 10^thpercentile at each of the three identified VA medical centers compare with their commercial equivalent in the surrounding communities?
6. What if any current policies or laws inhibit the VAs ability to expeditiously improve quality of care and overall rankings of these medical centers?

At the beginning of your tenure you committed to making the VA the most transparent organization in government." We commend you for this effort and understand the SAIL report demonstrates your commitment to that pledge. However we must turn that transparency and these findings into meaningful institutional changes in order to provide veterans with the quality care they deserve. Thank you in advance for looking into these matters and your continued commitment to caring for our nations veterans. We look forward to your prompt response. Sincerely /s/