Community Based Outpatient Clinic Reviews: Farmington and Espanola, NM; Show Low and Buckeye, AZ; Maui and Kona, HI; Sonora and Modesto, CA

The VA Office of Inspector General reviewed eight Community Based Outpatient Clinics (CBOCs) the week of August 23–27, 2010. The CBOCs reviewed in Veterans Integrated Service Network (VISN) 18 were Farmington and Espanola, NM; and Show Low and Buckeye, AZ; and, in VISN 21, Maui and Kona, HI; and Sonora and Modesto, CA. The parent facilities of these CBOCs are New Mexico VA Health Care System (HCS), Phoenix VA HCS, VA Pacific Islands HCS, and VA Palo Alto HCS. 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, suicide safety plans, and CBOC contracts. We noted several opportunities for improvement and made the following recommendations to the VISN and facility management: New Mexico VA HCS • Ensure all designated CBOC staff at the Farmington and the Espanola CBOCs maintain current basic life support certification. • Locate all Espanola CBOC printers in secure areas to ensure personally identifiable information (PII) is protected. • Require the Espanola CBOC to collect, analyze, and report hand hygiene data as required by the Center for Disease Control and Prevention. • Develop safety plans at the Farmington CBOC for all patients identified as high risk for suicide. • Provide contract oversight in accordance with terms and conditions in the Espanola CBOC contract, to include enforcing penalties as necessary and requiring the contractor to reformat the invoice to comply with contract requirements. • Review the invoice validation process for all contract CBOCs to ensure there are adequate controls and proper validation before payment. • Have a process to provide improved oversight and coordination of contracted primary care. Phoenix VA HCS • Implement the recommendation to upgrade the panic alarm system at the Show Low CBOC. • Require that modifications to the entrance doors be made to improve access for disabled veterans at the Buckeye CBOC. • Conduct a review of the invoice validation process to improve efficiency and accuracy. Specifically, provide the list of billable patients to the contractor to eliminate the need to manually verify each patient. • Conduct a review of the procedures for identifying and invoicing traveling veterans. • Ensure the Primary Care Management Module Coordinator performs in accordance with Veterans Health Administration (VHA) Handbook 1101.02 to reduce the number of veterans assigned to more than one primary care provider. VA Pacific Islands HCS • Require that service chiefs comply with VHA Handbook 1100.19 and establish threshold/criteria for Ongoing Professional Practice Evaluations at both CBOCs. • Require that supplies and equipment are stored in the appropriate areas at the Kona CBOC. • Ensure all PII is secured and protected at the Maui CBOC. • Improve access for disabled veterans at the Kona CBOC. • Develop safety plans for patients at high risk for suicide at the Kona CBOC. VA Palo Alto HCS • Require that the Professional Standard Board grant privileges appropriate for the services provided at the Sonora and Modesto CBOCs. • Ensure all designated staff at the Sonora and Modesto CBOCs maintain current cardiopulmonary resuscitation training as required by VHA policy. • Conduct fire drills at the Modesto CBOC as required by National Fire Protection Association policy. • Conduct an environmental safety risk analysis to determine if there are safety hazards at the Modesto CBOC. • Monitor staff compliance to local policy and VHA suicide safety plan requirements at the Sonora and Modesto CBOCs.