When Navy veteran Todd Harris Jr. recently sought care at the Memphis Veterans Affairs Medical Center, he anticipated tough discussions about his post-traumatic stress disorder.
What he wasn’t prepared for, he said, was the way VA staff treated him. Employees at the front desk were rude, he said. They told him they would call him back but didn’t. “They're not professional, the people there,” Harris said.
His impression was not unique. According to surveys of inpatient experience, the Memphis VA Medical Center rated worse, on average, than other hospitals in Tennessee and nationwide on every measure.
The Memphis medical center was the only VA facility in the country to receive one out of five stars for patient experience, according to ratings recently published for the first time for VA hospitals. A federal website, Care Compare, now allows veterans to compare patient perceptions of care at VA and non-VA hospitals based on industry-standard star ratings.
For many, the results are encouraging. As of Friday, half of VA hospitals with ratings on the site – 60 out of 121 – earned at least four out of five stars, a USA TODAY review found. VA facilities with too few patients or data, and those that don’t provide inpatient care, were not included.
Nationally, roughly 40% of the nation's 3,462 hospitals that were rated achieved that distinction in 2019, according to Centers for Medicare & Medicaid Services data. Only 3% – 90 hospitals – got one out of five stars.
The new patient experience ratings represent a marked shift at the Department of Veterans Affairs, which in the past relied on its own star ratings that didn't include non-VA facilities. The agency scrapped those amid criticism in 2019.
VA officials say they are working to include more measures on Care Compare. They say they're on track to ensure the site will feature overall star ratings for VA facilities by 2023. Patient experience is one component in the overall ratings, which also include quality measures such as death and infection rates.
“VA is working hard to align our performance measurement and public reporting systems with those across U.S. health care,” the VA said in a statement.
Care Compare allows consumers to compare medical providers on a host of criteria and includes information from thousands of Medicare-certified hospitals across the country. It features two types of star ratings, one for patient experience and one overall. Consumers can click further to see how hospitals performed on categories within each compared to regional and national averages.
The patient experience ratings are based on questionnaires sent to recently discharged patients that include questions about whether the hospitals were clean and quiet, if staff was responsive and if they would recommend the facilities to others.
In Memphis, out of 364 patients surveyed, only about half said staff helped them in a timely manner, their rooms were clean, and they would recommend the hospital to others.
That compares to at least 70% of patients, on average, at hospitals across the nation.
Veteran disappointed in treatment by Memphis VA staff
Harris said he has not been an inpatient at the Memphis VA, which serves more than 68,000 patients annually from Tennessee and nearby parts of Arkansas and Mississippi. But he said his interactions with staff at the facility were disappointing nonetheless.
He said he did some research after moving to the Memphis area in 2017 and decided against using the VA hospital for much of his medical care. The hospital for years received low quality marks in VA’s internal rankings, which have now been scrapped. A VA review in 2017 found problems in surgery, research, nursing, engineering and human resources. The VA inspector general issued a report last fall finding a veteran died by suicide after receiving inadequate care there.
But Harris said he has repeatedly called the Memphis VA seeking mental health care and couldn’t get an appointment. Harris said staff claimed they sent him letters, but he never received them. He went to the VA to be examined for a disability claim, which was later denied. He said when he asked for directions, front desk staff were “obnoxious.”
Harris, who spent 20 years in the Navy before retiring in 2014, said before moving to Memphis, he went to the VA medical center in Mountain Home, Tennessee. His experience could not have been more different. He said he saw a dermatologist, got a check-up and had prescriptions changed, all without incident and with polite staff.
That facility garnered five out of five stars for patient experience.
“It's working good in other places, but it's not working across the board. I just think there needs to be one standard,” Harris said. “I shouldn't have to go to the VA in Mountain Home for good care. I should have it here.”
VA officials said agency specialists in “veterans perception and improving experiences” have intervened to provide guidance to employees and managers in Memphis and 11 VA hospitals that received two out of five stars.
Memphis VA officials did not comment on Harris's experience but said in a statement that recent surveys show patient perception has improved. Associate director Michael Nichols said more than 80% of patients reported positive interactions with staff.
"We continue to work in good faith to improve the quality of care and operational efficiency within our medical center," he said.
A rocky rollout after history of problems
The Department of Veterans Affairs made national headlines in 2014 after veterans died waiting for appointments at the VA hospital in Phoenix while staff kept secret wait lists. President Barack Obama installed new leadership at the agency, and Congress passed legislation allowing veterans to see outside doctors paid by the VA if they couldn’t get VA appointments within a month.
The law required the VA to publish quality data and wait times at its health care facilities, and to submit data to the Department of Health and Human Services so it could be included on the Care Compare website.
That didn't go smoothly. The agency developed a website in 2017 that showed wait times and quality compared to non-VA facilities, but it featured limited data, the Government Accountability Office concluded.
The agency at the time also published a dizzying array of spreadsheets comparing VA medical centers to other facilities on a host of measures, but it did not boil them down to star ratings.
The GAO said the VA couldn't ensure its website helped veterans make informed choices about their care until the agency could “provide information on a broader range of health care measures and services and present this information in a way that is easily accessible and understandable."
A USA TODAY analysis of the data in 2019 found many VA hospitals reported lower death rates and post-surgical complications than non-VA facilities on average. At the same time, dozens had higher rates of preventable infections and severe bed sores – a sign of potential neglect. And nearly every VA medical center performed worse than other medical providers on most patient satisfaction measures.
Harris said the new patient experience ratings are a welcome step so veterans and their families can make informed decisions about health care.
“I'm a firm believer in complete transparency in any government-operated entity," he said. "And I just think that taxpayers need to know what's happening with this program.”