Federal Reports

The VA Office of Inspector General (OIG) evaluated the quality of care delivered at the VA Northern Indiana Health Care System. This included reviews of key clinical and administrative processes that affect patient care outcomes—Quality, Safety, and Value; Environment of Care; Medication Management; Coordination of Care; Diagnostic Care; Moderate Sedation; Community Nursing Home Oversight; and Management of Disruptive/Violent Behavior. OIG provided crime awareness briefings to 53 employees.OIG identified certain system weaknesses in utilization management; environmental cleanliness; anticoagulation processes and competency assessment; transfer data collection and documentation; re-evaluations prior to moderate sedation procedures; community nursing home clinical visits; disruptive behavior program implementation, processes, and training; and credentialing and privileging. As a result of the findings, OIG could not gain reasonable assurance that: (1) Physician advisors provide input for utilization management decisions.(2) The facility maintains clean bed frames.(3) The facility has a comprehensive anticoagulation therapy management program.(4) The facility has effective processes for the safe transfer of patients.(5) Clinicians re-evaluate patients prior to moderate sedation procedures.(6) The facility monitors and assures the safe care of patients in the community nursing home program by conducting clinical visits.(7) The facility effectively manages disruptive/violent behavior incidents, and employees receive training to reduce and prevent disruptive behaviors.(8) The facility has an effective process for approving another facility’s physicians for teledermatology services and obtaining professional practice evaluation data for telemedicine providers.OIG made recommendations for improvement in the following seven review areas: (1) Quality, Safety, and Value; (2) Environment of Care; (3) Medication Management; (4) Coordination of Care; (5) Moderate Sedation; (6) Community Nursing Home Oversight; and (7) Management of Disruptive/Violent Behavior. OIG made repeat recommendations from the previous Combined Assessment Program review in Quality Management.

The Federal Managers’ Financial Integrity Act (FMFIA), P.L. 97-255, as well as the Office of Management and Budget’s (OMB) Circular A-123, Management Accountability and Control, establish specific requirements for management controls. Each agency head must establish controls to reasonably ensure that: (1) obligations and costs are in compliance with applicable laws; (2) funds, property and other assets are safeguarded against waste, loss, unauthorized use, or misappropriation; and (3) revenues and expenditures applicable to agency operations are properly recorded and accounted for in order to permit the preparation of reliable financial and statistical reports, as well as to maintain accountability over the assets. FMFIA further requires each executive agency head, on the basis of an evaluation conducted in accordance with applicable guidelines, to prepare and submit a signed statement to the President disclosing that the agency’s system of internal accounting and administrative control fully comply with requirements established in FMFIA.

OIG conducted a healthcare inspection to follow up on concerns regarding access to care in the urology service at the Phoenix VA Health Care System (system) in Phoenix, Arizona. We limited our inspection to determining whether a delay in care was associated with adverse patient impact.During OIG’s 2014 review of system scheduling practices and wait times, we reported that large numbers of patients referred for urological evaluation and/or treatment experienced significant delays. The delays involved obtaining an appointment, scheduling follow-up, and/or receiving authorizations for non-VA urology care (see: Review of Alleged Patient Deaths, Patient Wait Times, and Scheduling Practices at the Phoenix VA Health Care System, Phoenix, Arizona; [Report No. 14-02603-267, August 26, 2014]). OIG’s Office of Healthcare Inspections opened an expanded review focusing on access to urology care at the system. An interim report Review of Phoenix VA Health Care System’s Urology Department Phoenix, Arizona; (Report No. 14-00875-112, January 28, 2015), detailed our findings regarding incomplete documentation for 759 urology patients and the potential impact on care. In Review of Access to Urology Service at the Phoenix VA Health Care System, Phoenix, Arizona; (Report No. 14-00875-03, October 15, 2015), we found a significant urology staffing shortage, inconsistent non-VA urology provider documentation of patient care, and untimely care to patients needing urological services. We committed to reviewing the records and management of the 759 patients once the Veterans Health Administration provided us with the necessary documentation. This report details these findings. We determined that 148 (20 percent) of the 759 patients experienced delays in getting new evaluations or follow-up appointments. When a delay was identified, we assessed the impact of that delay on the patient’s care. From a clinical standpoint, we found that none of the patients were adversely impacted by a delay in care.