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The VA Nebraska-Western Iowa Health Care System fared well after a surprise inspection last fall.

The VA Nebraska-Western Iowa Health Care System fared well after a surprise inspection last fall, according to a Department of Veterans Affairs inspector general report.

The recently released audit showed that the Omaha-based health care system achieved the VA’s top five-star rating in mid-2017. The rating is based on 25 statistical measures of quality, ranking it among the top 10 percent of the 128 regional health care systems that make up the VA. That’s up from a three-star rating in 2015.

It was among the 10 best in two categories: speedy access to specialty care and low rate of readmission to the hospital for the same problem within 30 days.

The VA Nebraska-Western Iowa lagged in two categories: one measuring the rate of turnover among registered nurses, and another measuring mental health coverage in rural areas.

André Kok, a VA spokesman, said in a statement that the VA already has reduced the nurse turnover rate greatly through increased pay, schedule flexibility, more promotions and other incentives. He also said that rural states like Nebraska tend to fare worse than urban health care systems in the rural mental health coverage metric, but the VA has taken steps to improve. He cited increasing referrals and increased use of psychotherapy in addition to using medicines to treat mental health conditions.

A separate survey showed that 87 percent of inpatient and 83 percent of outpatient veterans agreed with the statement “I felt like a valued customer.” Sixty-nine percent said they would “definitely” recommend the VA to family or friends.

The auditors found no major deficiencies at the VA hospital in Omaha or the eight outpatient clinics across a region stretching from Holdrege, Nebraska, to Shenandoah, Iowa. They inspected facilities, reviewed clinical records and performance data, and interviewed employees, managers and senior leaders. Wait times for medical appointments were better than the national average in Omaha and at all clinics except Norfolk, which was short of physicians during the first half of 2017. The wait times generally averaged less than five days for new patients, and less than three days for returning patients.

The inspector general team made its unannounced visit in November, focusing on nine areas including women’s health, mental health care, high-risk medical processes, and medication management. Such audits typically are conducted about once every three years. The audit did not cover unauthorized waitlists for psychotherapy treatments at the Omaha VA hospital, or for certain eye exams, which were discovered by VA Nebraska-Western Iowa officials last year and revealed in The World-Herald last fall.

The inspectors made seven recommendations for improvements, primarily dealing with administrative procedures. None were labeled as “critical.” They included:

» Requiring medical providers to notify patients of the results of mammograms, after finding that only 76 percent of patients audited had been informed of results.

» Ensuring that registered nurses supervise the geriatric evaluations of elderly patients in long-term care.

» Verifying drug inventories in the pharmacy at least every 72 hours so that any diversion or theft of drugs is detected quickly.

Administrators agreed to adopt all of the recommendations by early 2019.

“We strive to provide the very best care in the nation,” Kok said.

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