After a reported access crisis in the VHA involving long wait times, the 2014 Veterans Access, Choice, and Accountability Act (VACCA) was passed. It established the Veterans Choice Program or "Choice" to expand Veterans' access to community providers when VHA medical facilities have long wait times or when geographic accessibility is excessively burdensome. Choice provider network inadequacy is one challenge that stemmed from implementing a complex program under an aggressive timeline. Accordingly, the VHA is planning to replace and expand existing community care networks.
Quality, efficiency, and costs of surgeries still vary greatly among community providers. The Institute of Medicine (IOM) defines quality of care as "the degree to which health services for individuals increase the likelihood of desired health outcomes and are consistent with current professional knowledge." Performance measurement is the regular collection of data on health care processes, experiences, and/or patient outcomes for use in characterizing variation in quality and efficiency across providers and facilities. The Office of Community Care is considering adopting performance measures to identify eligible community orthopedic and cardiac surgery providers that meet certain minimum requirements.
A significant barrier to the Office of Community Care in selecting performance measures for determining community provider eligibility is that there are a large number of measures meant as indirect indicators of health outcomes (eg, readmissions, process measures, etc) but uncertainty about their actual association with health outcomes (eg, mortality, quality of life, or function). The purpose of our review was to determine whether such performance measures are associated with health outcomes and compare their measurement burden and unintended consequences.