Healthcare Inspection Community Based Outpatient Clinic Reviews Kosciusko and Meridian, MS Tulsa, OK Konawa and Lawton, OK Texarkana, AR and Longview, TX

The VA Office of Inspector General reviewed seven Community Based Outpatient Clinics (CBOCs) the week of December 7–11, 2009. The CBOCs reviewed in Veterans Integrated Service Network (VISN) 16 were Kosciusko and Meridian, MS; Tulsa, OK; Konawa and Lawton, OK; and Texarkana, AR and Longview, TX. The parent facilities of these CBOCs are G.V. (Sonny) Montgomery (Jackson) VA Medical Center (VAMC), Jack C. Montgomery (Muskogee) VAMC, Oklahoma City VAMC, and Overton Brooks (Shreveport) VAMC, 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, patient satisfaction, and CBOC contracts. We noted several opportunities for improvement and made the following recommendations to the VISN and facility management: Review privileges that have been granted to clinical staff and grant privileges that are consistent with CBOC providers’ practices. When reprivileging, compare practitioner data to aggregated data of those privileged practitioners who hold the same or comparable privileges. Require the CBOC contractor to collect and review quality data on a regular basis for radiologists providing services under a sub-contract agreement. Accomplish providers’ background checks according to VHA policy. Ensure staff are trained and evaluated, and that their competencies are documented. Require the CBOC contractor to inspect CBOCs on a regular basis for cleanliness and needed repairs. Develop and implement a secure method of transporting medications and patient care information to the parent facility. Comply with VHA policy to maintain personally identifiable information in a more secure manner. Ensure all potentially harmful items are secured during the mental health (MH) intake process. Maintain an emergency management plan that includes emergency response to all medical and MH emergencies and reflects current practices. Evaluate the adequacy of access to MH services. Provide contract oversight and enforcement in accordance with the contract terms and conditions. Provide the contractor with a current list of inactivated enrollees to prevent future overcharges on billings. Take steps to collect the overpayment for laboratory collection, shipping, and transportation expenses. Recover overcharges associated with the contractor’s billings for MH professionals who were VA employees. Correct administrative deficiencies that led to overcharges on capitated payments. Recover lab overcharges and prepare an addendum to the contract for payment of additional lab services.