Community Based Outpatient Clinic Reviews: Fredericksburg, Danville, and Lynchburg, VA; Greenville and Rock Hill, SC; Elgin and Oak Lawn, IL; Wisconsin Rapids and Loyal, WI

The VA Office of Inspector General reviewed nine Community Based Outpatient Clinics (CBOCs) the week of July 19–23, 2010. The CBOCs reviewed in Veterans Integrated Service Network (VISN) 6 were Fredericksburg, Danville, and Lynchburg, VA; in VISN 7, Greenville and Rock Hill, SC; and, in VISN 12, Elgin and Oak Lawn, IL; and Wisconsin Rapids and Loyal, WI. The parent facilities of these CBOCs are Richmond VA Medical Center (VAMC), Salem VAMC, Columbia VAMC, Hines VAMC, and Tomah VAMC. 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 six areas: quality of care measures, credentialing and privileging, environment of care and emergency management, reusable medical equipment, suicide safety plans, and CBOC contracts. We noted several opportunities for improvement and made the following recommendations to the VISN and facility management: Richmond VAMC: Require appropriate documentation in the service chief’s comments in VetPro and Medical Professional Standards Board minutes in accordance with VHA Handbook 1100.19. Ensure threshold/criteria for Ongoing Professional Practice Evaluations are established and communicated to the providers at the Fredericksburg CBOC. Ensure the Fredericksburg CBOC adheres to Americans with Disabilities Act guidelines. Ensure the check-in area meets safety criteria at the Fredericksburg CBOC. Monitor and collect measurable hand hygiene data at the Fredericksburg CBOC. Salem VAMC: Monitor and collect measurable data for hand hygiene at the Lynchburg CBOC. Provide contract oversight in accordance with terms and conditions in the Danville CBOC contract. Specifically, we recommend that a review be performed on the invoice validation process to ensure that future overpayments do not occur and are adequately supported. Determine, with the assistance of the Regional Counsel, the extent and collectability of the overpayments on the contract. Columbia VAMC. Require that all device-specific standard operating procedures for reusable medical equipment are consistent with manufacturers’ instructions (MI) at the Greenville CBOC. Require that staff competencies are consistent with MI at the Greenville CBOC. Review mental health cost control strategies, including differentiating between the cost for patient care encounters for group therapy and individual therapy sessions when assessing the best model for future contracts. Hines VAMC: Ensure that discussions and actions associated to the delineation of clinical privileges for providers at the Oak Lawn CBOC be documented and approved by the Medical Center Director. Tomah VAMC: Require that safety plans are developed for patients at high risk for suicide at the Wisconsin Rapids CBOC.