Healthcare Inspection—Clinical Activities, Staffing, and Administrative Practices, Eastern Oklahoma VA Health Care System, Muskogee, Oklahoma

OIG conducted a healthcare inspection in response to Senator James Inhofe’s request to evaluate a range of clinical, staffing, and administrative practices at the Eastern Oklahoma VA Health Care System (System), Muskogee OK. We evaluated nine areas and practices. Several of the System’s key leadership positions have been in flux in the past few years. The current System Director entered on duty June 12, 2016. We could not determine the impact of leadership vacancies and short-term coverage; however, we noted a decline in multiple quality measures from fiscal year (FY) 2015 to FY 2016. We found the System did not consistently provide the necessary monitoring and oversight to ensure that selected patient care processes were safe and effective. Deficient processes included provider-specific privileging, peer review, and institutional disclosure. The System had difficulty recruiting and retaining employees. The System used tele-medicine and contracted services to meet patient care needs when in-house specialty care was not readily available. The System largely met access metrics for primary care and mental health (MH); however, about 30 percent of new patient specialty care (SC) appointments were pending greater than 30 days as of Q2 FY 2016. The System did not meet call center performance targets as of Q1 FY 2016. The System has not consistently met Care in the Community (CIC) timeliness goals. We found that clinical providers consistently documented patients’ relevant histories and presenting problems, treatment plans, follow-up, and medication reconciliation; however, improved documentation of abnormal lab test notification and follow-up was needed. The System also needed to improve its ranking in the MH Domain (performance) measure. We found that the Emergency Department (ED) was generally meeting performance targets. We inspected patient care areas at the Muskogee main healthcare facility and three community based outpatient clinics. We identified compliance deficiencies related to oversight committee minutes and selected privacy, safety, security, and cleanliness requirements. We made 19 recommendations focusing on leadership stability and performance improvement activities; the meeting minutes of Quality, Safety, and Value subordinate committees, clinical privileging, severity assessment code scoring, peer review activities, institutional disclosure; recruitment and hiring; SC and MH access, and call center responsiveness; follow-up of CIC improvement actions; notification and follow-up of abnormal lab results, consult completion timeliness, and MH-related quality measure improvements; ED discharges; and environment of care-related compliance and improvements.