Federal Reports

Our audit covered 6,864 claims for which NW Hospice (located in Tigard, Oregon) received Medicare reimbursement of $31.5 million for hospice services provided from June 1, 2016, through May 31, 2018. We reviewed a random sample of 100 claims. We evaluated compliance with selected Medicare billing requirements and submitted these sampled claims and the associated medical records to an independent medical review contractor to determine whether the services met coverage, medical necessity, and coding requirements.

This Office of Inspector General (OIG) Comprehensive Healthcare Inspection Program report provides a focused evaluation of the quality of care delivered in the inpatient and outpatient settings of the John D. Dingell VA Medical Center in Detroit, which includes multiple outpatient clinics in Michigan. The inspection covers key clinical and administrative processes associated with promoting quality care. This inspection focused on Leadership and Organizational Risks; COVID-19 Pandemic Readiness and Response; Quality, Safety, and Value; Medical Staff Privileging; Medication Management: Long-Term Opioid Therapy for Pain; Mental Health: Suicide Prevention Program; Care Coordination: Life-Sustaining Treatment Decisions; Women’s Health: Comprehensive Care; and High-Risk Processes: Reusable Medical Equipment.The medical center’s executive leadership team appeared stable, with one of the five positions permanently filled for four months at the time of the OIG’s virtual review. Employee survey results revealed opportunities for the Associate Director for Patient Care Services to improve staff satisfaction and reduce moral distress. Patient experience surveys revealed opportunities for leaders to improve patient satisfaction. The OIG’s review of the medical center’s accreditation findings, sentinel events, and disclosures did not identify any significant concerns. Leaders were knowledgeable selected data used in Strategic Analytics for Improvement and Learning models and should continue to sustain and improve performance.The OIG issued five recommendations for improvement in three areas:(1) Medical Staff Privileging• Provider exit review process(2) Mental Health• Suicide prevention training completion(3) Women’s Health• Women veterans health committee membership• Women veterans program manager responsibilities• Designated maternity care coordinator

The VA Office of Inspector General (OIG) determined whether Veterans Health Administration (VHA) emergency department oversight ensured patients received emergency care services in a timely manner and whether facilities made any needed improvements to the patient flow process, which is how patients move through a facility from arrival to discharge or admission. Emergency departments measure timeliness using software that records this process. Some 2.3 million patients visit VHA’s 110 emergency departments each year.The data is necessary for VHA to determine how long patients waited to be seen, treated, and discharged. The OIG found data were inconsistently entered and contained inaccuracies. The OIG recognizes that emergency department staff may provide care first out of necessity before documenting it. However, data problems hindered identification of needed improvements in the patient flow process and the effectiveness of corrective action plans.The OIG found VHA’s data and evidence in patients’ electronic health records indicated that some patients with the most critical needs did not always receive emergency care within VHA timeliness thresholds. While the patients assessed in this audit were not found to have experienced clinically significant adverse outcomes due to their wait, VHA can improve its monitoring of the data for the patients most at risk.The OIG also identified possible data manipulation by the Baltimore VA Medical Center emergency department director that made it appear patient discharge or admission times were shorter than actual wait times. The director has since been replaced.The OIG made five recommendations to improve VHA’s emergency department oversight, including ensuring the Baltimore VA Medical Center reevaluates its corrective action plan, training staff on how to accurately record triage times, strengthening reliability reviews to improve data accuracy, establishing routine oversight for data reliability, and monitoring data of patients with the most severe needs receiving emergency care.