VA to limit surgeries at some hospitals

(MILITARY TIMES)   In a move that could force some veterans to travel farther for surgery or have their operations at nonveterans hospitals, VA officials are imposing a new grading system on its 112 in-patient treatment facilities that will rank their abilities to do complex, intermediate or standard procedures.

Beginning May 11, no elective surgery will be done at a VA medical center that exceeds the rating, said Dr. William Gunner, the VA’s director of surgery.

Emergency surgery still could be done if required, he said.

The facilities immediately affected will be the medical centers in Alexandria, La.; Beckley, W.Va.; Fayetteville, N.C.; Illiana, Ill.; and Spokane, Wash., all of which received the lowest ranking and have been performing surgeries now judged to be beyond their capabilities.

Gunner began briefing lawmakers about what he called the “surgery complexity initiative” on Thursday, but said in an interview that the grading system has been in use since March, when agreement was reached on how to judge the complexity of a procedure against the surgical capabilities of each medical center.

Grading for medical centers takes into consideration medical staffing, both for the operating room staff and surgical consultants who are available, plus equipment and diagnostic capabilities.

Of VA’s 112 in-patient surgical facilities, 66 have been approved for complex procedures and 33 for intermediate procedures.

Thirteen facilities are limited to standard procedures, Gunner said. A review of what procedures have been done in recent years at those facilities found that five of the 13 had done operations of greater complexity, he said.

The VA does about 357,000 surgical procedures a year, and only about 364 are above the complexity grade of the facility under the new scale, which means the impact on patients should be small.

VA officials promise to help with transportation of veterans who might have to travel farther for surgery.

Complex procedures are cardiac, brain and pancreas surgeries, according to VA officials. Intermediate procedures include colon resections, joint replacement and repairs of abdominal aortic aneurysms. Standard procedures include things like hernia repair, surgeries to the ear, nose and throat, and urologic operations.

Those needing elective surgery that is above the complexity approved for the facility will have the option of being transferred to the next closest VA location that is approved for the surgery or be sent to a nearby civilian facility at VA’s expense.

VA officials said medical center transportation officials will try to help a veteran who has been referred elsewhere.

The initiative is VA’s response to criticism of problems with surgical care at the medical center in Marion, Ill. The issues at that hospital, since resolved, involved physician credentialing, standards of care, peer review and quality management. A review ordered in September 2007 found problems at other VA medical centers as well.

VA officials stress they are not cutting services, but are instead trying to improve care by ensuring that a surgical program at a particular facility is qualified to do a procedure.

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