Audit of Community Care Consults during COVID-19

During COVID-19, VHA’s Office of Community Care (OCC) took steps to ensure veterans continued to have expanded access to health care in the community, as required by the VA MISSION Act of 2018. OCC issued policies to VA facilities to postpone nonurgent appointments and offer alternatives to in-person care, such as telehealth. The VA Office of Inspector General (OIG) conducted this audit to determine whether VHA effectively managed community care consults for routine appointments during the pandemic. The OIG found that routine community care consults were unscheduled for an average of 42 days, not meeting VHA’s timeliness goal of 30 days. Community care staff faced significant challenges beyond their control that contributed to the scheduling delays, such as the lack of availability of appointments in the community. The OIG also found some patients were hesitant to schedule appointments during the pandemic, failed to return phone calls, or declined care once it was offered. While these challenges prevented the OIG from evaluating whether timeliness could be improved, they underscore the need to strengthen VHA’s governance over community care. The OIG found community care providers and staff did not consistently comply with requirements to manage routine consults, and leaders lacked tools to sufficiently monitor program operations that could have identified the problems. Deficiencies emerged in documenting when patients were contacted about scheduling appointments, designating patients eligible for alternative care, and ensuring staff were trained in ways that would address those weaknesses. The OIG recommended that the under secretary for health develop guidelines requiring supervisors to monitor documentation of communication between staff and patients, establish a tool to monitor whether community care staff both document the suitability of alternatives to face-to-face care and offer them to eligible patients, and reassess the frequency and approach to its training for scheduling community care consults.