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Report File
Date Issued
Submitting OIG
Department of Veterans Affairs OIG
Agencies Reviewed/Investigated
Department of Veterans Affairs
Components
Veterans Health Administration
Report Number
24-02154-154
Report Description

VA can authorize veterans to receive care in the community in specific circumstances. After the care occurs, the community provider must return associated medical records to VHA and community care staff close the consult. If records are not received, staff must administratively close consults (that is, update the status from “open” to “complete”) to indicate the veteran received care and make three requests for the records within 90 days of the appointment. The VA OIG reviewed whether VHA staff took appropriate action to retrieve and document medical records from community providers and import the records into veterans’ electronic health records.

The OIG found that, as of December 16, 2024, VHA closed nearly 3 million community care consults for appointments scheduled to occur between October 1, 2023, and April 1, 2024. Among these, over 2.4 million (82 percent) had medical records attached, and nearly 1 million were administratively closed (34 percent). In addition, for the same period, VHA had 71,447 open consults, virtually all of which were more than 90 days beyond the scheduled appointment date.

According to the OIG’s analysis, 62 facilities imported 90 percent or more of medical records for completed community care consults into veterans’ electronic health records. However, 11 facilities imported the records less than 60 percent of the time.

Staff said competing priorities reduced the amount of time available to request and process incoming records. Once records were received, community care staff did not always use the Consult Toolbox to document the receipt, and related policy was both unclear and inconsistently used. Furthermore, VHA facilities varied in meeting timeliness metrics.

VHA concurred with the OIG’s 10 recommendations (including concurrence in principle to recommendation 2) to direct the Office of Integrated Veteran Care to correct identified deficiencies related to processes, internal controls, timeliness, and oversight.

Report Type
Review
Agency Wide
Yes
Number of Recommendations
10
Questioned Costs
$0
Funds for Better Use
$0
Report updated under NDAA 5274
No

Open Recommendations

This report has 10 open recommendations.
Recommendation Number Significant Recommendation Recommended Questioned Costs Recommended Funds for Better Use Additional Details
01 No $0 $0

Evaluate which staff should have access to and should update the Consult Toolbox when records are requested or received and update the “Consult Business Rules and Uses of the Consult Package Standard Operating Procedure” to reflect necessary changes.

02 No $0 $0

Include controls within the Consult Toolbox to prevent errors and improve data quality, including controls on administrative closure of low-risk consults and documenting the records-retrieval method.

03 No $0 $0

Update consult closure policies and procedures to clarify requirements for administrative closure and determine whether metrics for the percentage of records received should be a requirement and included in policy.

04 No $0 $0

Determine whether Veterans Health Administration facilities’ community care offices should continue to be required to use the administrative closure report for oversight of administratively closed consults, and if not, determine what reports should be required.

05 No $0 $0

Evaluate the workload of community care staff to determine the most efficient way to structure and execute their duties.

06 No $0 $0

Determine if there are mechanisms to identify standardization opportunities and increase efficiency for improving records return processes.

07 No $0 $0

Ensure community care staff follow procedures to reduce duplicate records received.

08 No $0 $0

Evaluate ways to increase use of provider electronic records portals to reduce reliance on electronic fax when retrieving medical records.

09 No $0 $0

Consider increased implementation of technologies to improve records processing once received to reduce the manual renaming of electronic files and uploading of records into the electronic health record.

10 No $0 $0

Ensure records from the Joint Longitudinal Viewer are uploaded into the electronic health record.

Department of Veterans Affairs OIG

United States