Last week, USA Today‘s Donovan Slack broke the story of the secret internal ranking system that the U.S. Department of Veterans Affairs (VA) has been using to monitor the performance of the hospitals and medical facilities that it operates across the United States.

WASHINGTON — The Department of Veterans Affairs has for years assigned star ratings for each of its medical centers based on the quality of care and service they provide, but the agency has repeatedly refused to make them public, saying they are meant for internal use only.

USA TODAY has obtained internal documents detailing the ratings, and they show the lowest-performing medical centers are clustered in Texas and Tennessee.

VA hospitals in Dallas, El Paso, Nashville, Memphis and Murfreesboro all received one star out of five for performance as of June 30, the most recent ratings period available.

The most disturbing part of the story, however, was a revelation about the VA hospitals most closely associated with its secret waitlist scandal. (Bear in mind that veterans seeking medical treatment at those facilities were placed on secret lists that hid how long they were waiting to receive treatment, while VA administrators and supervisors used the VA’s official waiting lists to claim bonuses for meeting the VA’s goals for providing speedy service.) Not only were those hospitals ranked lowly at the time the scandal became public, but their performance rankings have not improved despite the Obama administration’s highly public show that it was fixing the VA’s problems.

Some lower-ranking medical centers have remained poor performers despite high-profile crises and years of attention and resources from Washington.

For instance, the Phoenix VA was a one-star medical center in 2014 when news broke that veterans had died awaiting care there while schedulers kept secret wait lists masking how long veterans were waiting for appointments. The revelations triggered a national scandal, hearings on Capitol Hill and the replacement of the VA secretary.

Phoenix remained a one-star facility in the most recent ratings.

Needless to say, veterans groups were strongly disappointed in the Obama administration’s lack of tangible progress. Stars and Stripes‘ Tyler Hlavac reports:

Concerned Veterans for America, a veteran advocacy group that has been critical of the VA, released a statement condemning the findings. CVA Executive Director Mark Lucas said the ratings system underscores continuing problems in the organization and that the VA is not committed to transparency.

“By keeping this rating system secret, the VA was admitting that preserving the illusion of competency matters more to them than actually serving veterans — and the VA fails at both,” Lucas said. “The lengths to which the VA will go to hide its own bad performance should disturb veterans and American taxpayers alike.”

After more than two years of President Obama’s feckless and ineffective management of the veterans health care rationing scandal and his failure to see through needed reforms, the VA is in desperate need of real reform and a management turnaround, starting with major changes in the VA’s leadership throughout its bureaucracy.