Healthcare Inspection Community Based Outpatient Clinic Reviews Macon and Albany, GA Beaver Dam, WI and Rockford, IL Sioux City, IA and Aberdeen, SD Waterloo, IA and Galesburg, IL

The VA Office of Inspector General reviewed eight Community Based Outpatient Clinics (CBOCs) the week of September 14–18, 2009. The CBOCs reviewed in Veterans Integrated Service Network (VISN) 7 were Macon and Albany, GA; in VISN 12, Beaver Dam, WI and Rockford, IL; and, in VISN 23, Sioux City, IA and Aberdeen, SD; and Waterloo, IA and Galesburg, IL. The parent facilities of these CBOCs are Carl Vinson (Dublin) VA Medical Center (VAMC), William S. Middleton (Madison) Memorial Veterans Hospital, Sioux Falls VAMC, and Iowa City 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 VISNs and facility management: Require that contract requirements for physicians are met or aligned with VHA requirements. Ensure that contract providers are privileged according to policy. Review privileges that have been granted to clinical staff and grant privileges that are consistent with CBOC providers’ practices. When reprivileging, compare practitioner data to aggregated data of those privileged practitioners who hold the same or comparable privileges. Require that the Ongoing Professional Practice Evaluation (OPPE) plan, OPPE data, and the privileging process are managed in accordance with VHA requirements. Ensure the panic alarm system is functional. Conduct an information technology network security assessment and correct any vulnerability. Improve access for disabled veterans. Evaluate the effectiveness of the panic alarm system. Require that staff are able to safely access the sharps containers. Lock all computer stations when not in use. Maintain personally identifiable information in a secure manner. Develop a local policy for medical emergencies that reflects the current practice and capability of the CBOC. Provide contract oversight and enforcement in accordance with the terms and conditions as stated in the contract. Review key contractual provisions with the Contracting Officer’s Technical Representative (COTRs) and ensure the COTRs understand the terms of the contract and criteria. Monitor the COTR’s oversight by evaluating the evidence that the COTR’s review and approval of contractor invoices is in compliance with terms of the contract. Ensure that contractor performance measures are evaluated against the criteria established in the contract. Receive contractor invoices in electronic format in addition to paper documents to facilitate invoice analysis. Provide contractor with a current list of inactivated enrollees to prevent future overcharges on billings.