Community Based Outpatient Clinic Reviews: Georgetown, DE and Ventnor, NJ; Guayama and Ponce, PR; Goshen, IN; Belton and Nevada, MO; Capitola and French (Stockton), CA

The VA Office of Inspector General reviewed nine Community Based Outpatient Clinics (CBOCs) during the week of February 7, 2011. CBOCs were reviewed in Veterans Integrated Service Network (VISN) 4 at Georgetown, DE and Ventnor, NJ; in VISN 8 at Guayama and Ponce, PR; in VISN 11 at Goshen, IN; in VISN 15 at Belton and Nevada, MO; and, in VISN 21 at Capitola and French Camp (Stockton), CA. The parent facilities of these CBOCs are Wilmington VA Medical Center (VAMC), VA Caribbean Health Care System (HCS), VA Northern Indiana HCS, Kansas City VAMC, and VA Palo Alto HCS, 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, management of laboratory results, and CBOC contracts. We noted opportunities for improvement and made the following recommendations to VISN and facility managers: Wilmington VAMC • Require that the Professional Standards Board (PSB) grant privileges appropriate for the services provided at the Georgetown and Ventnor CBOCs. • Improve processes to communicate normal test results to patients and monitor compliance at the Georgetown CBOC. VA Caribbean HCS • Ensure that providers use the template required by local policy to document communication of critical laboratory results at the Guayama and Ponce CBOCs. • Require that normal test results be communicated to patients within the specified timeframe at the Guayama CBOC. • Define in the local policy how medical emergencies, including the use of equipment and medications, are to be managed at the Ponce CBOC, and educate staff accordingly. VA Northern Indiana HCS • Require that employees receive Basic Life Support training within the timeframe specified in facility policy at the Goshen CBOC. • Require that auditory privacy be maintained during the check-in process at the Goshen CBOC. • Require that the Contracting Officer’s Technical Representative develop a process to validate the prorated capitated rate calculation submitted by the contractor on the monthly invoice. • Require that the VA Northern Indiana HCS Director determine the total amount of overpayments to the contractor during the contract period as a result of ineligible enrollees and, with the assistance of the Regional Counsel, assess the collectability of the overpayment. • Require that the VA Northern Indiana HCS Director comply with the contract terms that specify VA maintain the authority to end enrollment of patients. Kansas City VAMC • Require that the service chief complete the Ongoing Professional Practice Evaluation assessments, according to facility policy, for providers at both the Belton and Nevada CBOCs. • Ensure the PSB submit appointment recommendations to the Executive Committee of the Medical Staff (ECMS). • Include in the ECMS meeting minutes the documents reviewed and the rationale for the recommendation decision. • Require that normal test results be consistently communicated to patients within the specified timeframe at the Belton CBOC. • Collect, analyze, and report hand hygiene data at the Belton and Nevada CBOCs. • Require the Chief of Office of Information and Technology evaluates identified Information Technology (IT) security vulnerabilities and implements appropriate IT security measures at the Belton and Nevada CBOCs. • Complete annual safety and fire inspections at the Nevada CBOC. • Improve access for disabled veterans at the Belton CBOC. • Require that exit routes remain free and unobstructed at the Belton CBOC. • Require that all personally identifiable information be secured and protected at the Belton CBOC. • Complete automated external defibrillator preventive maintenance every 6 months as required by facility policy at the Belton and Nevada CBOCs. VA Palo Alto HCS • Require ordering providers to document patient notification and treatment actions in response to critical test results at the Capitola CBOC. • Ensure clinicians communicate normal test results to patients within the specified timeframe at the Stockton CBOC. • Consistently collect, measure, and analyze hand hygiene data at the Capitola CBOC.