Care in the Community Summary Report for Fiscal Year 2022

Report Information

Issue Date
Report Number
22-03772-28
VA Office
Veterans Health Administration (VHA)
Report Author
Office of Healthcare Inspections
Report Type
Care in the Community Healthcare Inspection
Report Topic
Appointment Scheduling and Wait Times
Care Coordination
Community Care
Mental Health
Major Management Challenges
Healthcare Services
Recommendations
7
Questioned Costs
$0
Better Use of Funds
$0
Congressionally Mandated
No

Summary

Summary

The purpose of the Office of Inspector General (OIG) Care in the Community (CITC) healthcare inspection program is to evaluate various aspects of care delivered in Veterans Health Administration (VHA) community-based outpatient clinics (CBOCs) and through non-VA healthcare providers. In fiscal year 2022, the OIG reviewed eight Veterans Integrated Service Networks (VISNs), VISNs 1, 2, 5, 6, 8, 12, 19, and 20, which are responsible for oversight of care provided by their associated medical facilities, CBOCs, and non-VA providers.

To examine VISN oversight and the care provided in CBOCs and by non-VA providers, the OIG reviewed VHA requirements and Joint Commission standards and evaluated core processes in the following six areas of administrative and clinical operations:
1.    Leadership: oversight and management of care in the community
2.    Environment of care: emergency management of CBOCs
3.    Care coordination: congestive heart failure management
4.    Primary and mental health care: diagnostic evaluations for depression and alcohol use disorder
5.    Quality of care: home dialysis care
6.    Women’s health: mammography services by community providers

Women’s health was a congressionally mandated review, and the OIG will report the results of the evaluation of mammography services by community providers in a separate publication to provide stakeholders with a more comprehensive picture of regional VHA challenges and ongoing efforts in this area of women’s healthcare services.

The OIG issued seven recommendations for improvement in two areas:
1.    Care coordination
•    Care coordination needs documented in the Community Care Coordination Plan note
•    Consults acted on no later than two business days after receipt
•    Appointments scheduled in a timely manner
•    Three attempts made to retrieve medical documentation from non-VA providers
2.    Quality of care
•    Initial and annual dialysis program home visits
•    Processes to monitor delivery of non-VA home dialysis
•    VISN dialysis council

Open Recommendation Image, SquareOpenClosed and Implemented Recommendation Image, CheckmarkClosed-ImplementedNot Implemented Recommendation Image, X character'Closed-Not Implemented
No. 1
Open Recommendation Image, Square
to Veterans Health Administration (VHA)

The Under Secretary for Health, in conjunction with Veterans Integrated Service Network directors, ensures staff document veterans’ care coordination needs within the Community Care Coordination Plan note for consults assigned a level of care coordination above basic.

No. 2
Open Recommendation Image, Square
to Veterans Health Administration (VHA)

The Under Secretary for Health, in conjunction with Veterans Integrated Service Network directors, ensures staff act on consults no later than two business days after receipt and document accordingly.

No. 3
Open Recommendation Image, Square
to Veterans Health Administration (VHA)

The Under Secretary for Health, in conjunction with Veterans Integrated Service Network directors, ensures staff schedule community care appointments in a timely manner.

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

The Under Secretary for Health, in conjunction with Veterans Integrated Service Network directors, ensures staff make three attempts to retrieve medical documentation from non-VA providers.

No. 5
Open Recommendation Image, Square
to Veterans Health Administration (VHA)

The Under Secretary for Health, in conjunction with Veterans Integrated Service Network directors, ensures patients in the home dialysis program receive initial and annual home visits.

No. 6
Open Recommendation Image, Square
to Veterans Health Administration (VHA)

The Under Secretary for Health, in conjunction with Veterans Integrated Service Network directors, ensures staff implement and sustain processes to monitor the delivery of non-VA home dialysis.

No. 7
Open Recommendation Image, Square
to Veterans Health Administration (VHA)

The Under Secretary for Health, in conjunction with Veterans Integrated Service Network directors, ensures each Veterans Integrated Service Network establishes a dialysis council.