Date: 1989-06-14
Speaker: JOHN GIBBONS (democrat)
Chamber: S

Director. Office of Technology Assessment. Washington. DC. DEAR CHARLES AND JACK: I am writing to request that both the Ocneral Accounting Office and the Office of Technology Assessment look into matters pertaining to the Veterans Administration (VA) FY 1986 Patient Treatment File Mortality Analysis. Enclosed is an October 11. 1988. Washington Post article. entitled "VA Researchers Ordered to Report Fewer Problem Hospitals". in which it is alleged that the VA altered the design of its mortality study so that more favorable results would be obtained. According to the article. the confidence limitsthe range within which there is a probability of concluding that there is a true or real difference between the observed and predictedwere expanded from 95 percent to 99 percent. It is my understanding that such a change might result in decreasing the number of VA medical centers erroneously identified as having a higher mortality rate than predicted. but would also have the potential for missing some centers with a higher than predicted mortality rate in need of further study. According to the article. over the objection of the VAs thenDirector of HealthCare Quality Assurance. the VAs Chief Medical Director (CMD) "ordered the researchers" to come up with a lower number of potential problem hospitals because the CMD reportedly was concerned that the "VA could not withstand the criticism that inevitably would result from comparison between its survey" and the survey of mortality in private hospitals released by the Health Care Financing Administration (HCFA) in December 1987. I believe that these allegations and the VAs methodology warrant a detailed study and investigation at this time. Thus. as Chairman of the Veterans Affairs Committee. I am requesting that the Office of Technology Assessment carry out a study designed to address the following ism .es: 1. Was the methodology ntilizeli by the VA when analyzing Its hospitals mortality rates a scientifically valid and reliable methodology? In responding. please specifically address the appropriateness of using either 95percent or 99percent confidence limits of changing the confidence limits after the data have been gathered. 2. Is the methodology utilized by the VA comparable to that utilized by HCFA? If not. in what ways do they differ and is one methodology preferable to time other? I am requesting that the General Accounting Office investigate the following matters: 1. At what point in the development and implementation of this study was the decision made to use higher confidence limits for measuring overall mortality rates between VA medical centers. why was that decision made. and who was responsible for making that decision? 2. Did the Chief Medical Director or any other VA official inappropriately attempt to give the appearance of fewer qualityassurance problems at VA medical centers that actually exist? Because of the serious nature of the allegations and the need to keep the public informed of the degree to which high quality health care is being provided within all VA medical centers. I am requesting that these studies be expeditiously undertaken. Thank you for your continuing assistance. I look forWard tO wotkingwith youin proceeding with these reviews. Should you have any questions. please have your staff contact Sandi Isaacson. Professional Staff Member (2249126). With warm regards. Cordially.