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Managers at the Van Zandt VA Medical Center expect the hospital will climb back up the VA's internal "star" ratings system by one level when the national organization releases statistics for the last quarter of the just-completed fiscal year.
Van Zandt dropped from the top rating it held all of fiscal 2015 to four stars for the initial quarter of last year, then to three stars for the second quarter.
It remained three stars through the third quarter, but should return to four when the VA releases final data this month for the fiscal year, said spokeswoman Andrea Young and Acting Director Charles Becker, responding to a USA Today story published Wednesday on the ratings system, called Strategic Analytics for Improvement and Learning (SAIL).
The USA Today article focused on the "secrecy" of the system.
Statistics on 44 individual "benchmarks" are available on the VA's public website, but spiral charts that include the overall star levels are not.
The ratings system compares VA hospitals with one another, but not to outside hospitals, so the levels are strictly relative, Becker said.
Thus, it's possible for a hospital to maintain performance, yet move in the ratings due to movement by other hospitals, he said.
Still, "we did slip," Becker said. "Maybe we weren't paying as much attention to a couple of these things as we should have."
But provoking a response to improve is the purpose of SAIL, he said.
The issues that led to Van Zandt's drop from five to three stars include hospital stays that are longer than ideal, primary care that is less than ideal and inpatient numbers that are susceptible to radical percentage changes, according to Becker.
Van Zandt patients have stayed longer than they might have otherwise because the organization doesn't want to discharge them to a problematic home situation or when a nursing home slot isn't ready, he said.
In some cases, that means keeping a patient past the period paid for by insurance, Becker said.
The hospital has tried to remedy the problem by starting discharge preparations early -- often at the beginning of the patient's stay -- so everything is in place when it's time for discharge, he said. It's more a matter of efficiency than medical care, and it often involves social workers, he said.
The hospital has tried to improve primary care by identifying patients who may need to be seen sooner or more often than the norm, or who need to follow protocols that are more intensive than the norm, Becker said.
That can prevent the need for inpatient admission, which means more time at home, where patients are more comfortable, and where cost is less, he said.
Those patients are often the most complex cases, and many have problems like COPD, he said.
The primary care changes have required ensuring there is enough staff in the clinics to do the necessary analysis, he said.
There's not necessarily much to do about the low inpatient census, he said.
A low census -- the hospital averages about four inpatients at any one time -- means that a single death, for example, generates a big leap in the death rate, he said.
Unlike ratings systems such as the Pennsylvania Heathcare Cost Containment Council's, SAIL doesn't disregard findings when the statistical base is small, he said.
Mirror Staff Writer William Kibler is at 949-7038.