Healthcare Inspection Inadequate Coordination of Care Orlando VA Medical Center Orlando, Florida

The VA Office of Inspector General (OIG) Office of Healthcare Inspections (OHI) conducted an inspection in response to allegations of inadequate coordination of care with Fee Basis Service (FB), Interfacility Consults (IFC), and Project Health Effectiveness through Resource Optimization (HERO) at the Orlando VA Medical Center (OVAMC), in Orlando, Florida. The purpose of this inspection was to determine whether the allegations had merit. We confirmed that Veterans experienced delay of medical care due to poor coordination and communication in the care management system. We did not substantiate that any patients were harmed as a result of these delays. We confirmed that the FB authorization letter and communication between FB staff and Veterans needed improvement. We found breakdowns in the communication between FB staff and primary care providers (PCP) on the status of fee basis consults. We confirmed that OVAMC had not established a system to ensure timeliness of care for veterans requiring IFCs, however a care management team established in December 2009 improved timeliness of care. We confirmed that Project HERO was not meeting its contractual performance benchmarks of 100% compliance for timely referrals and communication with FB providers; however performance benchmarks regarding access to care and return of medical records averaged 90%. We recommended that FB and IFC consults be completed within the time frames established by VHA policy and tracked through completion in VistA and that patients’ electronic medical records be updated accurately and timely. The VISN and medical center Directors concurred with our report and have developed action plans in response to our recommendations.