Report Summary

Title: Evaluation of VHA Community Based Outpatient Clinics Fiscal Year 2012
Report Number: 13-00090-346
Issue Date: 9/30/2013
City/State:
VA Office: Veterans Health Administration (VHA)
Report Author: Office of Healthcare Inspections
Report Type: CBOC Reports
Release Type: Unrestricted
Summary: The purpose was of our evaluation was to assess if community based outpatient clinics (CBOCs) provide veterans with consistent, safe, and high-quality health care. OIG performed this review with inspections of 92 VHA CBOCs during FY 2012. These inspected CBOCs are a statistical sample of all VHA CBOCs with more than 500 patients aligned under selected parent VA facilities. Our review focused on four components: (1) FY 2012 CBOC-specific information gathering and review, (2) EHR reviews of care performed in FY 2011 for determining compliance with VHA policies, (3) on-site EOC and EM inspections during FY 2012, and (4) CBOC contract reviews of quarter 3 of FY 2011. OIG recommended that (1) CBOC clinicians document foot care education provided to diabetic patients in the electronic health record (EHR), (2) perform risk assessments and document risk levels for diabetic patients in the EHR, and (3) document referrals for preventative foot care, including foot wear, as clinically indicated, for patients with diabetes in the EHR; (4) CBOC managers establish a process to consistently link breast imaging and mammography results to the appropriate radiology mammogram or breast study order for all fee basis and contract patients, and (5) establish a process to notify patients of normal mammogram results within the allotted timeframe and that notification is documented in the electronic health record; (6) service chiefs’ documentation in VetPro reflects documents reviewed and the rationale for privileging or re-privileging CBOC providers; and (7) facility Directors grant privileges consistent with the services provided at the CBOCs. We also recommended that (8) adequate resources and controls are in place to address deficiencies in the invoice validation process and to reduce the risk of overpayments; (9) the oversight of the contract acquisition process is compliant with VA Directives, including a thorough pre-award review and interim contract authority prior to contract approval; and (10) all new CBOCs undergo the required contract approval processes prior to initiating operations.