Delays in Community Care Consult Processing and Scheduling at the Martinsburg VA Medical Center in West Virginia

The OIG received a hotline complaint about delays by staff at the Martinsburg VA Medical Center in processing and scheduling veterans’ community care consults. These consults are referrals to non-VA providers for clinical services. The OIG substantiated that as of February 28, 2023, there were over 5,000 active consults (meaning staff were working to process them), that staff took more than 100 days to make the first contact attempt with the veteran, and that staff took longer than 45 days on average to schedule veterans for care in the community (well in excess of the seven-day requirement). While evaluating the merits of the specific complaints, the OIG learned that, in an effort to make staff aware of the repercussions of untimely scheduling, the chief of community care had sent her whole team a list of veterans who had passed away with unscheduled consults. The list contained personally identifiable information. The OIG determined that community care scheduling delays occurred because of (1) ineffective processes used to manage community care consults, (2) shortages of specialty care providers, such as in otolaryngology, gastroenterology, radiology, orthopedics, and cardiology, and (3) a lack of controls to ensure manager accountability for consult timeliness. The OIG recommended ensuring that personal information of veterans is only shared on a need-to-know basis, evaluating alternative workflows to improve consult processing and scheduling, exploring ways to increase the availability of specialty care providers, and adding to the community care chief’s performance plan standards related to the metrics for community care.