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Review of Alleged Delays in Care Caused by Patient-Centered Community Care (PC3) Issues

Report Information

Issue Date
Report Number
14-04116-408
VA Office
Veterans Health Administration (VHA)
Report Author
Office of Audits and Evaluations
Report Type
Audit
Recommendations
10
Questioned Costs
$0
Better Use of Funds
$0
Congressionally Mandated
No

Summary

Summary
OIG examined VHA’s use of Patient-Centered Community Care (PC3) contracted care to determine if it was causing patient care delays. We found that pervasive dissatisfaction with both PC3 contracts has caused all nine of the VA medical facilities we reviewed to stop using the PC3 program as intended. We projected PC3 contractors returned, or should have returned, almost 43,500 of 106,000 authorizations (41 percent) because of limited network providers and blind scheduling. PC3 contractors scheduled appointments without discussing the tentative appointment with the veteran, which VHA refers to as blind scheduling. We determined that delays in care occurred because of the limited availability of PC3 providers to deliver care. VHA also lacked controls to ensure VA medical facilities submit timely authorizations, and PC3 contractors schedule appointments and return authorizations in a timely manner. VHA needed to improve PC3 contractor compliance with timely notification of missed appointments, providing required medical documentation, and monitoring returned and completed authorizations. This was the second of a series of reports addressing PC3 service delivery issues. We are conducting additional reviews to evaluate the adequacy of the PC3 contract, provider networks, and the completeness of the medical documentation for PC3 payments. We will report these results separately. We recommended the Interim Under Secretary for Health ensure PC3 contractors submit timely authorizations, evaluate the PC3 contractors’ network, revise contract terms to eliminate blind scheduling, and implement controls to make sure PC3 contractors comply with contract requirements.

Open Recommendation Image, SquareOpenClosed and Implemented Recommendation Image, CheckmarkClosed-ImplementedNot Implemented Recommendation Image, X character'Closed-Not Implemented
No. 1
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
We recommended the Interim Under Secretary for Health establish timeliness criteria for submitting authorizations to the Patient-Centered Community Care contractors.
No. 2
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
We recommended the Interim Under Secretary for Health monitor timeliness of submitting authorizations to Patient-Centered Community Care contractors and take actions to improve timeliness when standards are not met.
No. 3
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
We recommended the Interim Under Secretary for Health evaluate the Patient-Centered Community Care contractor networks to ensure they are sufficient to meet contract performance requirements.
No. 4
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
We recommended the Interim Under Secretary for Health revise contract terms to eliminate the option of scheduling appointments before communicating with the veteran.
No. 5
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
We recommended the Interim Under Secretary for Health implement a control to ensure Patient-Centered Community Care contractors return authorizations if they cannot schedule an appointment within 5 business days of receipt of the authorization.
No. 6
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
We recommended the Interim Under Secretary for Health implement a control to ensure Patient-Centered Community Care contractors return authorizations when they cannot arrange for an appointment to take place within 30 days of the appointment creation date.
No. 7
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
We recommended the Interim Under Secretary for Health implement a control to ensure Patient-Centered Community Care contractors comply with requirements to notify Veterans Health Administration within 14 days of a missed appointment.
No. 8
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
We recommended the Interim Under Secretary for Health implement a control to ensure Patient-Centered Community Care contractors comply with requirements to return medical documentation within 14 days of the appointment's occurrence.
No. 9
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
We recommended the Interim Under Secretary for Health implement a mechanism to monitor all authorizations submitted to the Patient-Centered Community Care contractors.
No. 10
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
We recommended the Interim Under Secretary for Health revise the Patient-Centered Community Care dashboard to report completed authorizations and the percentage of total authorizations by the specific contractors performing these services.