Review of Community Care Utilization, Delivery of Timely Care, and Provider Qualifications at the VA Boston Healthcare System in Massachusetts, Fiscal Year 2024

The VA Office of Inspector General (OIG) reviewed aspects of community care utilization at the VA Boston Healthcare System for fiscal year 2024. The system, part of Veterans Integrated Service Network 1, includes three VA medical centers and several outpatient clinics. VA direct care (provided at VA facilities) and VA community care (delivered by providers in the community paid by VA) were compared.

The patient population consists of 58,324 patients who received medical care at the system or through community care paid for by the system. Nearly all received primary and mental health care through VA direct care. About 97 percent of patients received specialty care services exclusively through VA direct care. Inpatient community care accounted for 12 percent of acute care bed-days. Most community care referrals were requested due to drive times.

The OIG assessed referral processes, appointment timeliness, and use of disqualified providers for community care services. About 83 percent of direct and 84 percent of community care referrals were activated within two days. Appointment setting met timeliness standards in 55 percent of direct and 53 percent of community care referrals. Over 90 percent of referrals were completed within 90 days of the requested date. However, some referrals lacked documentation of scheduled appointments.

The OIG found no community care referrals for primary care and less than 3 percent for mental health care. About 66 percent of mental health and 61 percent of specialty care community appointments met timeliness standards. No disqualified providers were found. 

In response to three recommendations, the System Director concurred with two recommendations and described enhancing reports of metrics for scheduling, completed appointments, wait times, and facility access and identifying opportunities to improve and refine practices. The System Director concurred in principle with one recommendation and committed to educating staff on consult documentation practices.