The following article originally appeared in the San Diego Union-Tribune on January 6, 2017. Read the full length piece here.

Two San Diego County congressmen are asking the San Diego VA for an explanation of why it was one of five VAs nationally that saw health care scores decline last year.

U.S. Reps. Darrell Issa and Duncan Hunter, both Republicans and military veterans, dispatched a joint letter to the U.S. Department of Veterans Affairs hospital in La Jolla on Friday.

“These results are unacceptable and signify that your branch of the VA has substantial room for improvement,” it said.

The letter asks the VA San Diego Healthcare System director to respond with a list of changes made in response to the decline in scores.

The list of year-over-year scores for all VA medical centers was published by the VA last month.

Of the 146 VA medical centers nationally, only four others — Tomah in Wisconsin, Hot Springs in South Dakota, Fargo, N.D., and El Paso, Texas — also showed “large declines” in performance in 2016.

The scores are based on a long list of measures of medical care and “access issues,” such as call center performance and wait times for appointments.

The director of San Diego’s VA medical system has said a change in the way access issues are included in the calculation is what prompted the San Diego network’s scores to fall -- including its overall ranking dropping from a four to a three about a year ago.

On the VA’s internal rating scale, five is the best; one is the worst.

A San Diego Union-Tribune analysis of data going back to late 2012 found the local system’s performance declined in several areas in 2014 and 2015 and has not fully rebounded.

Among the network’s medical procedures, its measures for in-hospital complications, readmission rates for heart-attack patients and ventilator-associated events such as pneumonia worsened. Starting this year, other inpatient performance measures also suffered.

Dr. Robert Smith, director of the VA San Diego Healthcare System, has said downgraded scores have already prompted change, including 14 additional people hired for the centralized call center in the past year.

Smith has also said there are issues with how the VA calculates its scores. He said technical matters, such as the criteria for categories changing over time, skewed some comparisons that showed declines on the medical side.

In response to the letter from Issa and Hunter, Smith released a statement to the Union-Tribune on Friday, saying: 

It is correct that the VA San Diego Health Care System fell from a four-star to a three-star ranking among all VA facilities in the fall of 2015. However, there has been no further decline in our overall ranking. The major reasons for that fall were our relative performance in measures of mental health and specialty care access, our call center performance, and our mental health experience of care. Over the last year, we have made significant improvement in these areas and are deeply committed to continuing that improvement while continuing our historically strong performance in measure of inpatient care such as overall hospital mortality and length of stay where our scores are among the best in the VA.

These are pivotal months for the national veterans agency.

The letter asks the VA San Diego Healthcare System director to respond with a list of changes made in response to the decline in scores.

The list of year-over-year scores for all VA medical centers was published by the VA last month.

Of the 146 VA medical centers nationally, only four others — Tomah in Wisconsin, Hot Springs in South Dakota, Fargo, N.D., and El Paso, Texas — also showed “large declines” in performance in 2016.

The scores are based on a long list of measures of medical care and “access issues,” such as call center performance and wait times for appointments.

The director of San Diego’s VA medical system has said a change in the way access issues are included in the calculation is what prompted the San Diego network’s scores to fall -- including its overall ranking dropping from a four to a three about a year ago.

On the VA’s internal rating scale, five is the best; one is the worst.

A San Diego Union-Tribune analysis of data going back to late 2012 found the local system’s performance declined in several areas in 2014 and 2015 and has not fully rebounded.

Among the network’s medical procedures, its measures for in-hospital complications, readmission rates for heart-attack patients and ventilator-associated events such as pneumonia worsened. Starting this year, other inpatient performance measures also suffered.

Dr. Robert Smith, director of the VA San Diego Healthcare System, has said downgraded scores have already prompted change, including 14 additional people hired for the centralized call center in the past year.

Smith has also said there are issues with how the VA calculates its scores. He said technical matters, such as the criteria for categories changing over time, skewed some comparisons that showed declines on the medical side.

In response to the letter from Issa and Hunter, Smith released a statement to the Union-Tribune on Friday, saying: 

It is correct that the VA San Diego Health Care System fell from a four-star to a three-star ranking among all VA facilities in the fall of 2015. However, there has been no further decline in our overall ranking. The major reasons for that fall were our relative performance in measures of mental health and specialty care access, our call center performance, and our mental health experience of care. Over the last year, we have made significant improvement in these areas and are deeply committed to continuing that improvement while continuing our historically strong performance in measure of inpatient care such as overall hospital mortality and length of stay where our scores are among the best in the VA.

These are pivotal months for the national veterans agency.

http://www.sandiegouniontribune.com/military/the-intel/sd-me-va-issahunter-20170106-story.html