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VA Hospital 'Star' Ratings Measure Improvement, Not Overall Quality

Peter Biello

Since the Boston Globe's report on unsanitary and dangerous conditions at the VA Medical Center in Manchester appeared over the weekend, attention has turned in part to the hospital's "four-star" rating.

Four out of five stars is usually a good thing, so how did the Manchester VA earn those stars?
"It's a misnomer to think that this is a four-star quality VA medical center," says Howie Howe, a veterans advocate. "That's not true. It means in the previous year that they did so much improvement, they rated four stars."

He says Manchester fixed enough problems to earn four stars, but that doesn't mean other problems don't exist.

The rating system's official name is kind of a mouthful: Strategic Analytics for Improvement and Learning, or SAIL. Each year, VA hospitals look at access, quality, employee perception, nursing turnover, efficiency, and other metrics. The ratings that result are based on improvement.

It's different from the way star systems typically work. Dave Kenney is chairman of the State Veterans Advisory Committee.

"I understand that they gotta come up with some kind of rating system, but this three, four, five star thing? It's not like you're trying to rate a hotel," he says.

In theory, under this system, a high-performing VA hospital could get a rating of one-star, and a hospital with problems like the ones in Manchester could end up getting four. It's a relative rating system. Five stars isn't like getting an 'A' in school.

Al Montoya, who is now charged with leading the Manchester VA, says that's part of the problem with these SAIL ratings. I spoke with him at a town hall meeting in Colebrook last year.

"For one organization to go up, another one has to go down in the VA. So that's the unfortunate part about that metric," Montoya says.

Montoya is coming to Manchester from the VA in White River Junction, Vt., which received three stars last year—which, if you don't know any better, may make White River seem worse than Manchester.

Investigators arrived at the Manchester VA Medical Center Monday to look into the recently revealed issues there.

Peter Biello is the host of All Things Considered and Writers on a New England Stage at New Hampshire Public Radio. He has served as a producer/announcer/host of Weekend Edition Saturday at Vermont Public Radio and as a reporter/host of Morning Edition at WHQR in Wilmington, North Carolina.
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