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Report File
Date Issued
Submitting OIG
Department of Veterans Affairs OIG
Other Participating OIGs
Department of Veterans Affairs OIG
Agencies Reviewed/Investigated
Department of Veterans Affairs
Report Number
23-01602-147
Report Description

The VA Office of Inspector General (OIG) conducted a healthcare inspection to review the high usage of community care services for primary care by the VA Loma Linda Healthcare System (system), the impact of that use, and system leaders’ oversight of VA outpatient clinics (clinics).The OIG found that a new company responsible for managing the system’s five non-VHA-operated clinics experienced challenges staffing the clinics, which increased the number of patients assigned to the panels of patient aligned care team providers. As a result, system leaders paused enrollment of new patients at all five non-VHA-operated clinics. The OIG learned that VHA-operated clinics’ inability to absorb the volume of additional patients, and insufficient staffing at the non-VHA-operated clinics contributed to an increase in the system’s use of community care for primary care.Despite adequate staffing levels in the community care department, the system did not meet VHA expectations for the timely processing of consults and scheduling of appointments for care in the community. While there was an increase in patients receiving primary care in the community and delays in processing and scheduling community care consults, the OIG did not identify patients who experienced poor outcomes.The lack of a formal oversight structure of the non-VHA-operated clinics, coupled with staff turnover in leadership positions at the system and the new company, created a vulnerability in the management of primary care services provided at the system’s clinics.The OIG made three recommendations to the System Director related to monitoring primary care staffing and panel sizes, timeliness of community care consult processing, and oversight of all the system’s clinics.

Report Type
Inspection / Evaluation
Location

Loma Linda, CA
United States

Number of Recommendations
3
Questioned Costs
$0
Funds for Better Use
$0

Open Recommendations

This report has 1 open recommendations.
Recommendation Number Significant Recommendation Recommended Questioned Costs Recommended Funds for Better Use Additional Details
01 No $0 $0

The VA Loma Linda Healthcare System Director confirms that a mechanism is in place to monitor primary care patient aligned care team staffing and panel sizes at the non-VHA-operated clinics to ensure staff are available to care for enrolled patients.

Department of Veterans Affairs OIG

United States