Healthcare Inspection Evaluation of Community Based Outpatient Clinics Fiscal Year 2009

This evaluation was conducted to determine whether (1) the community based outpatient clinics’ (CBOCs) quality of care measures are comparable to the parent VA medical center (VAMC) clinics, (2) CBOCs maintain the same standard of care as their parent facility to address the mental health needs of the Operation Enduring Freedom/Operation Iraqi Freedom era veterans, (3) CBOC providers are appropriately credentialed and privileged in accordance with Veterans Health Administration (VHA) Handbook 1100.19, (4) CBOCs are in compliance with standards of operations according to VHA Handbook 1006.1 in the areas of environmental safety and emergency management, and (5) the CBOC contracts were administrated in accordance with contract terms and conditions. The CBOCs generally met VHA directives and guidelines. CBOCs overall appear to be providing a quality of care that is not substantially different from parent VAMCs. We found no statistically significant differences VA-staffed and contract CBOC estimates overall. However, we noted several opportunities to improve the parent facilities’ oversight of CBOCs. To improve CBOC operations, we recommended that the Under Secretary for Health, in conjunction with Veterans Integrated Service Network (VISN) and facility senior managers: (1) grants privileges that are consistent with providers’ practices at the CBOCs; (2) collects and appropriately uses performance improvement data in the medical staff reprivileging process; (3) ensures that all CBOCs are handicap accessible; (4) ensures that a vulnerability assessment is conducted at all CBOCs to determine if a panic alarm system is required and ensures a system is implemented if one is deemed necessary; (5) ensures that all CBOCs maintain auditory privacy during the check-in process; (6) reviews the oversight of the invoice approval process and implements steps to strengthen the oversight process and identify additional administrative support when needed; and (7) reviews the contract process for primary care to improve oversight, simplifies the invoice process to rely on VHA data, and standardizes essential provisions such as billable enrollee.