Care in the Community Inspection of VA MidSouth Healthcare Network (VISN 9) and Selected VA Medical Centers

Report Information

Issue Date
Report Number
23-01737-205
VISN
9
State
Arkansas
Georgia
Indiana
Kentucky
Mississippi
Tennessee
Virginia
District
VA Office
Veterans Health Administration (VHA)
Report Author
Office of Healthcare Inspections
Report Type
Care in the Community Healthcare Inspection
Report Topic
Care Coordination
Community Care
Major Management Challenges
Healthcare Services
Recommendations
14
Questioned Costs
$0
Better Use of Funds
$0
Congressionally Mandated
No

Summary

Summary

The Office of Inspector General (OIG) Care in the Community program evaluates selected performance elements of the Veterans Health Administration (VHA) Veterans Community Care Program. The resulting report describes selected care coordination activities required to initiate and process referrals for non-VA care (community care). The OIG reviewed community care processes in five VISN 9 medical facilities with a community care program from June 12 through July 13, 2023. The OIG evaluated the facilities’ processes for community care referral and care coordination in the following domains:
1.    Leadership and Administration of Community Care
2.    Community Care Diagnostic Imaging Results
3.    Administratively Closed Community Care Consults
4.    Community Care Provider Requests for Additional Services
5.    Care Coordination: Scheduling and Communication with Veterans Referred for Community Care

The OIG issued 14 recommendations for improvement across all five domains as follows:
1.    Leadership and Administration of Community Care
•    Operating model staffing tool reassessment
•    Patient safety event reporting
•    Briefing the oversight council
•    Document scanning
2.    Community Care Diagnostic Imaging Results
•    Diagnostic imaging result attachment to required note
•    Significant findings alert use for abnormal results
3.    Administratively Closed Community Care Consults
•    Obtaining medical documentation
•    Significant findings alert use when closing consults without documentation
4.    Community Care Provider Requests for Additional Services
•    Requests for services processing
5.    Care Coordination: Scheduling and Communication with Veterans Referred for Community Care
•    Level of care assignments
•    Care coordination documentation
•    Timely update of consult status to active
•    Timely appointment scheduling
•    Appointment attendance confirmation

Open Recommendation Image, SquareOpenClosed and Implemented Recommendation Image, CheckmarkClosed-ImplementedNot Implemented Recommendation Image, X character'Closed-Not Implemented
No. 1
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
Closure Date: 12/30/2024

The Veterans Integrated Service Network Director, in conjunction with facility directors, ensures employees complete the operating model staffing tool reassessment every 90 days.

No. 2
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
Closure Date: 3/31/2025

The Veterans Integrated Service Network Director, in conjunction with facility directors, ensures facility community care staff report community care patient safety events in the Joint Patient Safety Reporting system.

No. 3
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
Closure Date: 3/31/2025

The Veterans Integrated Service Network Director, in conjunction with facility directors, ensures patient safety managers or designees brief community care patient safety event trends, lessons learned, and corrective actions at community care oversight council meetings.

No. 4
Open Recommendation Image, Square
to Veterans Health Administration (VHA)

The Veterans Integrated Service Network Director, in conjunction with facility directors, ensures VHA staff scan all community care documents into the patient’s electronic health record within five business days of receipt.

No. 5
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
Closure Date: 6/26/2025

The Veterans Integrated Service Network Director, in conjunction with facility directors, ensures facility staff attach community diagnostic imaging results to the designated Community Care Consult Result note.

No. 6
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
Closure Date: 3/31/2025

The Veterans Integrated Service Network Director, in conjunction with facility directors, requires facility community care staff to use the significant findings alert to notify the ordering provider of abnormal diagnostic imaging results.

No. 7
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
Closure Date: 6/26/2025

The Veterans Integrated Service Network Director, in conjunction with facility directors, ensures facility community care staff make required attempts to obtain medical documentation within 90 days of the appointment after administratively closing consults without medical documentation.

No. 8
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
Closure Date: 3/31/2025

The Veterans Integrated Service Network Director, in conjunction with facility directors, requires facility community care staff to use the significant findings alert when they administratively close community care consults without medical documentation.

No. 9
Open Recommendation Image, Square
to Veterans Health Administration (VHA)

The Veterans Integrated Service Network Director, in conjunction with facility directors, ensures facility community care staff process community care providers’ requests for services within three business days of receipt.

No. 10
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
Closure Date: 3/31/2025

The Veterans Integrated Service Network Director, in conjunction with facility directors, ensures facility community care staff assign a level of care coordination to all community care consults as required.

No. 11
Open Recommendation Image, Square
to Veterans Health Administration (VHA)

The Veterans Integrated Service Network Director, in conjunction with facility directors, ensures facility community care staff create and use the Community Care–Care Coordination Plan note for documenting all care coordination activities for consults with an assigned level of care other than basic.

No. 12
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
Closure Date: 3/31/2025

The Veterans Integrated Service Network Director, in conjunction with facility directors, ensures facility community care staff change the status of community care consults to active within two business days of the consult’s initial entry or date forwarded to community care staff.

No. 13
Open Recommendation Image, Square
to Veterans Health Administration (VHA)

The Veterans Integrated Service Network Director, in conjunction with facility directors, ensures facility community care staff schedule patients for community care appointments within the required time frames.

No. 14
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
Closure Date: 3/31/2025

The Veterans Integrated Service Network Director, in conjunction with facility directors, ensures facility community care staff confirm patients attended scheduled community care appointments and received care.