A recent story in The New York Times outlined how the Veterans Affairs hospital in Roseburg apparently has attempted to lift its quality-of-care ratings by cherry-picking the patients it admitted.

The gambit worked, at least for the facility: On the five-star scale that the VA uses to rank its hospitals, the Roseburg facility went from one star to two stars in 2016. The director of the hospital collected an $8,120 bonus, the Times reported.

It might not have worked out so well for the patients who were refused admission to the hospital. For example, the Times story begins by telling the story of Walter Savage, an 81-year-old veteran who was malnourished and dehydrated and suffering from broken ribs incurred during a fall at home. A doctor recommended Savage be admitted.

However, the Times reported, a nurse in charge of enforcing admission rules determined that Savage was not sick enough to be admitted.

Savage apparently wasn't the only one: An investigation by the Times showed that the hospital started in 2016 to be overly selective about the patients it admitted. The idea, said doctors who worked at the hospital, was to admit only low-risk patients because those patients were more likely to get better, thus improving the hospital's rating.

In fact, when Savage finally was admitted (against the wishes of the administration) a day after first appearing at the hospital, he was moved to a nursing home in less than 24 hours. That's so Savage's case couldn't count against the facility's rating.

To be fair, the director of the Roseburg hospital, Doug Paxton, told the Times that even though being more selective about patients had improved the hospital's rating, it had not turned away patients just for the sake of ratings. Rather, he said, the Roseburg hospital — a facility in a generally rural area — doesn't have the resources to deal with acute patients, so they must be moved to other facilities.

This all would be troubling enough if the problems seemed to be isolated to the Roseburg hospital. But the Times noted that recent government reports have cast doubt on the accuracy of the metrics the Department of Veterans Affairs uses to keep tabs on all its facilities.

The problem there, of course, is that the Veterans Affairs medical system is so vast that it needs to use some kind of measuring tool. David Shulkin, the rare member of the Obama administration who was invited to continue on with the Trump administration, told the Times that without the metrics, "we're like an airport with no air traffic control."

That's undoubtedly true. But Shulkin and his colleagues need to be sure that the metrics they're using are accurate and difficult to manipulate. 

Here's the bottom line: When today's veterans joined the armed forces, part of the promise we made to these men and women was that we would take care of their health care needs. We have failed in that promise. Considering the mess he inherited, Shulkin isn't doing a bad job, but the Times report starts to suggest how much work remains. (mm)

Driving downtown

Albany drivers will have to put up with at least a few more weeks of construction work jamming up the downtown area. 

The original idea in the city's Downtown Streetscape Improvements Project was to have work finished by the end of 2017. However, as you might have noticed, the construction crews and equipment downtown did not vanish over the New Year's holiday.

The good news is that work to complete curbs and ramps should be finished this week. Sidewalks should be done early next month. The final work in the project, redoing asphalt where necessary, may not be finished for a couple of months after that.

In the meantime, downtown drivers need to remember that construction crews (not to mention other drivers and pedestrians) deserve extra consideration during the final few weeks of the project. (mm)