Healthcare Inspection - Improper Closure of Non-VA Care Consults, Carl Vinson VA Medical Center, Dublin, GA

OIG conducted an inspection in response to a complaint, followed by a request from Congressman Jack Kingston, regarding alleged consult mismanagement at the Carl Vinson VA Medical Center in Dublin, GA. We found that, in order to meet organizational goals, facility staff improperly “batch closed” more than 1,500 Non-VA Care Coordination (NVCC) consults on April 25, 2014. Batch closure should not have been used to close current requests for care. NVCC staff had generally been following established procedures to individually close older consults in the months preceding the batch closure. By batch closing 1,546 consults, the facility met the consult closure May 1 deadline. More than 600 patients whose consults were batch closed had not been seen by an NVCC provider at the time of consult closure. While we substantiated that NVCC staff were instructed to send NVCC consults back to the requesting providers for clinical review, and in some cases, providers had to re-enter consults, this action was appropriate and followed Consult Clean-Up guidance. As a result of the batch-closure, NVCC staff had to re-enter fee authorizations when care was still needed. The facility had difficulty scheduling timely non-VA care appointments. While they did not monitor timeliness of NVCC appointments, a Veterans Integrated Service Network (VISN) report showed that for the period October 1, 2013, though March 31, 2014, the facility failed to meet the Veterans Health Administration’s 90-day goal each month. Because some NVCC providers are overwhelmed with referrals, patients requiring certain types of specialty care can wait months for appointments. We recommended that the VISN Director review the circumstances surrounding the batch closures and confer with appropriate VA offices to determine the need to take administrative action, if any, and that the Facility Director track the timeliness of NVCC appointment scheduling and promptly respond to potential delays.