Care in the Community Inspection of VA Sierra Pacific Network (VISN 21) and Selected VA Medical Centers

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Title Full

Date Issued

Wednesday, January 22, 2025

Submitting OIG

Department of Veterans Affairs OIG

Agencies Reviewed/Investigated

Department of Veterans Affairs

Report Number

24-00566-16

Report Description

This Office of Inspector General (OIG) Care in the Community healthcare inspection program report describes the results of a focused evaluation of community care processes at seven VA Sierra Pacific Veterans Integrated Service Network (VISN) 21 medical facilities with a community care program. This evaluation focused on five domains:
•    Leadership and Administration of Community Care
•    Community Care Diagnostic Imaging Results
•    Administratively Closed Community Care Consults
•    Community Care Provider Requests for Additional Services
•    Care Coordination: Scheduling and Communication with Patients Referred for Community Care
The OIG issued 13 recommendations for improvement in the five domains:
•    Leadership and Administration of Community Care
o    Community oversight councils functioning according to charters
o    Entering patient safety events in the Joint Patient Safety Reporting system
o    Briefing patient safety trends, lessons learned, and corrective actions
o    Scanning community care documents into the electronic health record
•    Community Care Diagnostic Imaging Results
o    Using the significant findings alert for abnormal diagnostic imaging results
•    Administratively Closed Community Care Consults
o    Confirming patients attended appointments obtaining medical documents
o    Making two attempts to obtain medical documents after administratively closing consults
•    Community Care Provider Requests for Additional Services
o    Processing requests
o    Sending approval and denial letters to community providers and patients
•    Care Coordination: Scheduling and Communication with Patients Referred for Community Care
o    Timely scheduling of patients
o    Confirming patients attended appointments
o    Using the Community Care–Care Coordination Plan note to document care coordination activities

Report Type

Inspection / Evaluation

Agency Wide

Yes

Number of Recommendations

Questioned Costs

Funds for Better Use

Report updated under NDAA 5274

Open Recommendations

This report has 13 open recommendations.

Recommendation Number	Significant Recommendation	Recommended Questioned Costs	Recommended Funds for Better Use
01	Yes	$0	$0
The Veterans Integrated Service Network Director, in conjunction with facility directors, ensures community care oversight councils function according to their charters and meet the required number of times per fiscal year.
02	Yes	$0	$0
The Veterans Integrated Service Network Director, in conjunction with facility directors, ensures facility community care staff enter community care patient safety events into the Joint Patient Safety Reporting system.
03	Yes	$0	$0
The Veterans Integrated Service Network Director, in conjunction with facility directors, ensures patient safety managers or designees brief community care patient safety event trends, lessons learned, and corrective actions at community care oversight council meetings.
04	Yes	$0	$0
The Veteran Integrated Service Network Director, in conjunction with facility directors, ensures facility staff scan all community care documents into the patient’s electronic health record within five business days of receipt.
05	Yes	$0	$0
The Veterans Integrated Service Network Director, in conjunction with facility directors, requires facility community care staff to use the significant findings alert to notify the ordering provider of abnormal diagnostic imaging results.
06	Yes	$0	$0
The Veterans Integrated Service Network Director, in conjunction with facility directors, ensures facility community care staff confirm patients attended their appointments and attempt to obtain medical documentation prior to administratively closing consults.
07	Yes	$0	$0
The Veterans Integrated Service Network Director, in conjunction with facility directors, ensures facility community care staff make two additional attempts to obtain community providers’ medical documentation within 90 days of the appointment following administrative closure of consults that are not low risk.
08	Yes	$0	$0
The Veterans Integrated Service Network Director, in conjunction with facility directors, ensures facility community care staff process community care providers’ requests for additional services within three business days of receipt.
09	Yes	$0	$0
The Veterans Integrated Service Network Director, in conjunction with facility directors, ensures facility community care staff send approval or denial letters to community providers for requests for additional services.
10	No	$0	$0
The Veterans Integrated Service Network Director, in conjunction with facility directors, ensures facility community care staff send approval or denial letters to patients for requests for additional services.
11	Yes	$0	$0
The Veterans Integrated Service Network Director, in conjunction with facility directors, ensures facility community care staff schedule patients for community care appointments within seven days of consult entry or receipt in the department.
12	Yes	$0	$0
The Veterans Integrated Service Network Director, in conjunction with facility directors, ensures facility community care staff confirm patients attended scheduled community care appointments and received care.
13	Yes	$0	$0
The Veterans Integrated Service Network Director, in conjunction with facility directors, ensures facility community care staff use the Community Care–Care Coordination Plan note to document all care coordination activities for consults with an assigned level of care other than basic.