Federal Reports

The VA Office of Inspector General (OIG) conducted a focused evaluation of the quality of care delivered in the inpatient and outpatient settings of the VA Pittsburgh Healthcare System. The review covered key clinical and administrative processes associated with promoting quality care—Leadership and Organizational Risks; Quality, Safety, and Value; Credentialing and Privileging; Environment of Care; Medication Management: Controlled Substances Inspection Program; Mental Health: Posttraumatic Stress Disorder Care; Long-term Care: Geriatric Evaluations; Women’s Health: Mammography Results and Follow-up; and High-risk Processes: Central Line-associated Bloodstream Infections. The Facility leaders, permanently appointed staff who have been working as a team since January 2016, supported patient safety, quality care, and other positive outcomes. However, the presence of organizational risk factors, as evidenced by Patient Safety Indicator data and root cause analyses, may contribute to future issues of noncompliance and/or lapses in patient safety unless corrective processes are implemented and continuously monitored. The leadership team was knowledgeable about selected SAIL metrics and should continue to take actions to maintain and improve care and performance of selected Quality of Care and Efficiency metrics that are likely contributing to the current “4-Star” rating. The OIG noted findings in two of the eight clinical areas reviewed and issued four recommendations that are attributable to the Deputy Director and Chief of Staff. The identified areas with deficiencies are: (1) Credentialing and Privileging • Focused and Ongoing Professional Practice Evaluation processes (2) Environment of Care • Facility and CBOC environmental cleanliness and maintenance • Inpatient mental health safety

The VA Office of Inspector General (OIG) conducted a focused evaluation of the quality of care delivered in the inpatient and outpatient settings of the Salem VA Medical Center. The review covered key clinical and administrative processes associated with promoting quality care—Leadership and Organizational Risks; Quality, Safety, and Value; Credentialing and Privileging; Environment of Care; Medication Management: Controlled Substances Inspection Program; Mental Health: Posttraumatic Stress Disorder Care; Long-term Care: Geriatric Evaluations; Women’s Health: Mammography Results and Follow-up; and High-risk Processes: Central Line-associated Bloodstream Infections. The OIG noted that Facility leaders appear to be actively engaged with employees and were working to improve inpatient satisfaction scores. Organizational leaders support efforts related to patient safety, quality care, and other positive outcomes (such as initiating processes and plans to maintain positive perceptions of the Facility through active stakeholder engagement). The OIG did not identify any substantial organizational risk factors. The Facility leaders, with the exception of the newly-assigned Acting Associate Director for Patient Care Services, were generally knowledgeable of selected Strategic Analytics for Improvement and Learning metrics and should continue to support care and performance of Quality of Care and Efficiency metrics that contributed to the improvement from the previous “4-Star” to the current “5-Star” rating. The OIG noted a finding in one clinical area reviewed and issued a recommendation that is attributable to the Chief of Staff. The identified area with a deficiency is High-risk Processes: Central Line-associated Bloodstream Infections. A comprehensive Facility policy should be developed and implemented on the use and care of central lines.

Louisiana did not comply with Federal and State requirements prohibiting Medicaid payments for inpatient hospital services related to treating certain provider-preventable conditions (PPCs) because it did not have controls to identify claims with PPCs that would have required a reduction in claim payment. We identified inpatient hospital claims totaling $55.4 million ($34.9 million Federal share) that contained a diagnosis code identified as a PPC and certain present-on-admission (POA) codes, or the claims were missing POA codes.

We completed an inspection of the Bureau of Land Management’s (BLM’s) small miner (those with 10 or fewer claims) mining claims. We focused on whether the BLM monitors these claims to ensure that they are legitimate, that maintenance fees are paid, and, if these fees are waived, that the required assessment work is conducted and complies with all applicable laws and regulations.We found that the BLM does ensure that small miner claims are legitimate and that maintenance fees are paid. The BLM does not physically validate the assessment work reported by small miner claimants seeking waivers to the maintenance fee, however. In Colorado and California, the two BLM State offices we inspected, we found that the BLM verifies that small miners requesting a waiver qualify for that waiver. We also found that the BLM verifies that documentation of work performed on mining claims, which is required of those who receive the waiver, is received annually by September 1. Identifying that work has been performed for waived claims, however, is essentially an honor system. We found that many affidavits included a description of assessment work apparently not in compliance with what was listed in regulations as qualifying work. The remoteness of claim locations also make BLM in-person validation of an owner’s onsite maintenance work unlikely.We make two recommendations: one to the BLM that proposes a cost-benefit analysis of the administrative cost and the burden of managing the maintenance fee waiver for small miners, and the second to the Secretary of the Interior that suggests using the BLM’s cost-benefit analysis to determine the future of the program.