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June 12, 2014 3:23 PM Who Should Head the VA?

By Phillip Longman

The White House no doubt thought it was making a shrewd move when it reached out to Delos M. Cosgrove in its search for a new head of the VA. Not only is Cosgrove the chief executive of the renowned Cleveland Clinic, he’s also a Vietnam Vet. But last Saturday, Cosgrove suddenly withdrew his name from consideration, stating that he still had work that needed doing at the Cleveland Clinic.

What might that work be? Just hours before Cosgrove made his announcement, the intrepid trade magazine Modern Healthcare published a little noticed article that revealed a long pattern of safety problems at the Cleveland Clinic—problems that were so serious that the federal government repeatedly threatened to shut off the $1 billion a year the clinic collects from Medicare. As recently as last July, inspectors from the Centers for Medicare and Medicaid Services were berating the clinic for covering up a case in which, for example, a surgeon left a suture needle in a patient after surgery.

This backstory points up an important lesson about how distorted prevailing views of the VA and health care in general have become. According to Modern Healthcare’s examination of CMS records, the Cleveland Clinic was on a “termination” track with Medicare between 2010 and 2013 following “more than a dozen inspections and follow up visits triggered by patient complaints.” Yet none of this made the news until the Cleveland Clinic’s CEO started being mentioned as a candidate to run the VA, and even now most people have no idea.

This is not to say the Cleveland Clinic isn’t a fine institution. So far as I can tell, it deserves its generally good reputation, even if it needs to work on patient safety. But it receives nowhere near the same media scrutiny as the VA. Nor does it have an inspector general looking over its shoulder, let alone two standing committees of Congress and well organized patient advocacy groups. All of which means that its mistakes generally go unreported, while those of the VA get blown up into national scandals. This distortion leaves even presumably sophisticated people in the White House believing that the Cleveland Clinic has something important to teach the VA, which is basically ludicrous.

So who should Obama pick? Well how about the man who transformed the VA in the 1990s? As chronicled in my book, Clinton’s under-secretary for health, Kenneth Kizer was the change agent most responsible for taking what was a long-broken institution and turning it into an exemplar of health care delivery system reform. After he left, the American Legion gave him a lifetime achievement award, while health care quality experts also lauded his performance. Since then he has remained active in health care issues vital to veterans, including work with the Institute of Medicine on Traumatic Brain Injury and Post Traumatic Stress Disorder. Today, he is a distinquished professor at the University of California Davis School of Medicine and the director of the Institute for Population Health Improvement at the UC Davis Health System. Someone at the White House should give him a call.

Phillip Longman is a senior editor at the Washington Monthly and a lecturer at Johns Hopkins University, where he teaches health care policy. He is also a senior fellow at the New America Foundation, where Atul Gawande is a board member.

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