Improvements Are Needed in the Community Care Consult Process at VISN 8 Facilities

The OIG conducted this audit to determine whether facilities in Veterans Integrated Service Network (VISN) 8 were appropriately staffed and structured to manage the community care needs of veterans. VISN 8 serves more than 1.6 million patients across Florida, south Georgia, Puerto Rico, and the Caribbean. The audit team found that between during fiscal year 2018, patients experienced community care appointment delays in VISN 8 due to the facilities’ insufficient staffing and consult-processing structure at community care departments. These departments review, authorize, and schedule community care consults, or requests from a VA facility service for a patient to receive care from a non-VA provider. The team noted that the departments were not sufficiently staffed for administrative functions, such as contacting patients and coordinating appointments. The team also noted that merging the consult authorization and scheduling tasks within community care departments would allow scheduling to begin promptly. The OIG made five recommendations to the VISN 8 director to improve the timeliness of community care consults and to address staffing deficiencies. The recommendations included implementing a mechanism for VA facility services and community care departments to identify and routinely exchange wait time data. This exchange would ensure that patients understand potential wait times and would help staff routinely monitor the timeliness of each community care processing stage. The OIG also recommended that VISN 8 routinely monitor the VA Office of Community Care (OCC) staffing tool, ensure community care administrative staff are effectively cross trained to carry out applicable administrative consult processing duties, and monitor whether community care departments are processing consults in accordance with OCC’s guidance and recommendations. In addition, VISN 8 should implement specific facility plans to address the backlog of open consults and the growing number of new consults.