Healthcare Inspection Community Based Outpatient Clinic Reviews Cambridge and Fort Howard, MD Alexandria, VA and Greenbelt, MD Wilmington and Jacksonville, NC

The VA Office of Inspector General reviewed six Community Based Outpatient Clinics (CBOCs) the week of August 10–14, 2009. The CBOCs reviewed in Veterans Integrated Service Network (VISN) 5 were Cambridge and Fort Howard, MD; and Alexandria, VA and Greenbelt, MD; and, in VISN 6, Wilmington and Jacksonville, NC. The parent facilities of these CBOCs are VA Maryland Healthcare System, Washington DC VA Medical Center (VAMC), and Fayetteville 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 physician privileges are appropriate to the procedures performed. Utilize performance improvement data during the reprivileging process. Consistently monitor collaborative practice of physician assistants. Maintain patients’ auditory privacy during their check-in process. Apply appropriate protective screens to computer monitors. Determine the appropriateness of an internal panic alarm system. Install the approved panic alarm system. Properly identify the locations of all fire extinguishers. Revise standard operating procedures to reflect the current practices for medical emergencies and to include intervention for disruptive and violent behavior. Implement processes to secure and protect personally identifiable information. Examine the existing medication management processes to ensure quality and safety standards are met when dispensing the outpatient medications. Provide proper CBOC access to disabled patients. Provide contract oversight and enforcement in accordance with the contract terms and conditions. Take steps to recover overcharges on billings for enrollees who have not received services in the prior 12 months.