Community Based Outpatient Clinic Reviews Payson and Sun City, AZ Sidney, NE and Fort Collins, CO Eureka and Ukiah, CA

The VA Office of Inspector General reviewed six Community Based Outpatient Clinics (CBOCs) the week of February 16–19, 2010. The CBOCs reviewed in Veterans Integrated Service Network (VISN) 18 were Payson and Sun City, AZ; in VISN 19, Sidney, NE and Fort Collins, CO; and, in VISN 21, Eureka and Ukiah, CA. The parent facilities of these CBOCs are Phoenix VA Health Care System (HCS), Cheyenne VA Medical Center (VAMC), and San Francisco VAMC, respectively. The purpose of the review was to assess whether CBOCs are operated in a manner that provides veterans with consistent, safe, high-quality health care. The review covered five areas: quality of care measures, credentialing and privileging, environment of care and emergency management, patient satisfaction, and CBOC contracts. We noted several opportunities for improvement and made the following recommendations to the VISN and facility management: Ensure contract providers are privileged to meet the terms of the contract. Review privileges that have been granted to clinical staff and grant privileges that are consistent with CBOC providers’ practices. Ensure staff are trained and evaluated, and that their competencies are documented. When reprivileging, compare practitioner data to aggregated data of those privileged practitioners who hold the same or comparable privileges. Ensure that the contract provisions for treatment and management of MH patients are followed. Require the CBOC contractor to collect and review quality data on a regular basis for any radiologist providing services under a subcontract. Enforce the contract requirement and have a panic alarm system installed. Ensure clean and dirty items are stored according to VHA policy. Ensure fire drills are conducted. Require safety and fire inspections. Meet safety criteria in all patient rooms. Maintain auditory privacy during the check-in process. Store and maintain medical supplies and equipment according to VHA policy. Provide contract oversight and enforcement in accordance with the terms and conditions as stated in the contract. Review the subcontract to ensure consistency with the statements of work. Monitor the patient billing lists monthly and remove those enrollees from the contractor’s invoices who have transferred to other facilities or have not received any services in the prior 12 months.