Healthcare Inspection – Summarization of Select Aspects of the VA Pacific Islands Health Care System, Honolulu, Hawaii

OIG conducted a review of the VA Pacific Islands Health Care System (VAPIHCS), Honolulu, HI to collect and summarize supplementary data in support of an August 2015 Combined Assessment Program review and to respond to Senator Mazie K. Hirono's concerns about access to care, travel benefits, cultural diversity, homeless services, and mental health care. We reviewed the Veterans Health Administration’s 6-point plan to address capacity and access to care within VAPIHCS primary care clinics. We found VAPIHCS has similar administrative and clinician availability issues found across the VA system for non-VA care compounded by a shortage of providers, the complexity of island logistics, and the diversity of the population served. VAPIHCS Beneficiary Travel Program’s expenditures are substantial due to providing care for patients across multiple islands. VAPIHCS acknowledged a delay in processing travel benefits claims, but expected to resolve the backlog by January 2016. As of August 2016, all but 21 of the unprocessed claims were resolved. We found that while there may be occasions when a provider’s management of a situation could potentially lack cultural sensitivity and competence, interviewees did not report this was a wide-spread problem. We also found VAPIHCS offers a comprehensive array of services for homeless veterans, a variety of general and specialty mental health services, and has improved staffing in the Suicide Prevention Program. In February 2014, VAPIHCS had one of the highest wait lists VA-wide for patients wanting primary care appointments. VAPIHCS implemented a 6-point plan to increase primary care panel sizes, extend clinic hours, increase primary care staffing at the community based outpatient clinics, contact and schedule appointments, and educate veterans on the importance of keeping appointments or calling to cancel. We found VAPIHCS had substantially improved access to care for new patients awaiting primary care appointments. We made one recommendation.