Healthcare Inspection – Alleged Program Inefficiencies and Delayed Care, Veterans Health Administration’s National Transplant Program

OIG assessed the merit of allegations regarding how liver transplantation referrals were processed by the Houston VA Transplant Center (VATC) and timeliness of care for patients referred for liver transplant evaluations at all VATCs. The allegations included policy concerns. In absence of specific allegations of wrongdoing or patient harm, we determined these concerns pertained to decisions that must be made by the Veterans Health Administration (VHA) in conjunction with congressional oversight bodies and were outside the scope of this review. We substantiated that three stable patients referred to the Houston VATC for liver transplant evaluations were referred more than once because information was missing or additional information was needed. Those patients represent about 2 percent of patients referred January 1, 2013, through December 31, 2014. We did not find that the Houston VATC’s requiring referring facilities to resubmit referrals for a small number of patients represented a noteworthy program inefficiency. We substantiated that some patients referred for liver transplant evaluations at all VATCs experienced delays. We estimated that 6.9 percent of emergency referrals were not responded to in VHA’s electronic transplant referral system within 48 hours, as required. Among stable patient referrals, we estimated that 9.6 percent of referrals were not responded to in VHA’s electronic transplant referral system within 5 business days, as required. About half of stable patients who were deemed eligible for further evaluation did not receive an initial patient evaluation within 30 days, as required. We made three recommendations.