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Healthcare Inspection Evaluation of Community Based Outpatient Clinics Fiscal Year 2011

Report Information

Issue Date
Report Number
11-01406-247
VISN
State
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Guam
Hawaii
Idaho
Indiana
Louisiana
Maryland
Massachusetts
Minnesota
Missouri
New Hampshire
New Jersey
New Mexico
New York
North Carolina
Ohio
Oregon
Pennsylvania
Puerto Rico
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
West Virginia
Wyoming
District
VA Office
Veterans Health Administration (VHA)
Report Author
Office of Healthcare Inspections
Report Type
Comprehensive Healthcare Inspection Program
Recommendations
13
Questioned Costs
$0
Better Use of Funds
$0
Congressionally Mandated
No

Summary

Summary
The purpose was to evaluate selected activities, assessing whether the community based outpatient clinics (CBOCs) are operated in a manner that provides veterans with consistent, safe, high-quality health care. CBOCs overall appear to be providing a quality of care that is not substantially different from parent VA medical centers. The CBOCs generally met Veterans Health Administration (VHA) directives and guidelines. We made recommendations affecting Women’s Health Liaisons, Computerized Patient Record System, Short-Term Fee Basis local policy, urban CBOCs’ outsourcing services, mental health emergencies plans, competency assessments, auditory privacy, security of patients’ personal information, security vulnerabilities in the allocated Information Technology network space, validation of invoices, contract provisions and acquisition planning, and contractors’ awareness of VA standards for coordination of care for mental health services. To improve operations, we made 13 recommendations to the Under Secretary for Health.

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 that the Under Secretary for Health, in conjunction with VISN and facility senior managers ensure that each CBOC has a Women’s Health Liaison who collaborates with the parent facility’s Women Veterans Program Manager on women’s health issues.
No. 2
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
We recommended that the Under Secretary for Health, in conjunction with VISN and facility senior managers ensure that all breast imaging and mammography results are linked to the appropriate radiology mammogram or breast study order.
No. 3
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
We recommended that the Under Secretary for Health, in conjunction with VISN and facility senior managers Ensure that each medical center has a local policy for STFB consults.
No. 4
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
We recommended that the Under Secretary for Health, in conjunction with VISN and facility senior managers Ensure that practitioners document a justification for the use of STFB care in the medical record, specifically at urban CBOCs.
No. 5
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
We recommended that the Under Secretary for Health, in conjunction with VISN and facility senior managers Ensure there is documentation in the medical record that the patient received written notification STFB consult approval, specifically at urban CBOCs.
No. 6
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
We recommended that the Under Secretary for Health, in conjunction with VISN and facility senior managers ensure that each CBOC has a plan that defines how MH emergencies that require a higher level of care are addressed.
No. 7
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
We recommended that the Under Secretary for Health, in conjunction with VISN and facility senior managers ensure patient care staff members at CBOCs have ongoing competency assessments validated for identified core competencies.
No. 8
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
We recommended that the Under Secretary for Health, in conjunction with VISN and facility senior managers ensure that auditory privacy is maintained during the check-in process.
No. 9
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
We recommended that the Under Secretary for Health, in conjunction with VISN and facility senior managers ensure that all PII is secured and protected.
No. 10
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
We recommended that the Under Secretary for Health, in conjunction with VISN and facility senior managers network space vulnerabilities in accordance with VA policy.
No. 11
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
We recommended that the Under Secretary for Health, in conjunction with the VISN and facility senior managers review the invoice validation process to consider creating a standardized billable roster report to improve oversight and accuracy of billable patient lists, thereby reducing man hours currently performing those duties and potential overpayments.
No. 12
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
We recommended that the Under Secretary for Health, in conjunction with the VISN and facility senior managers strengthen the oversight of the contract acquisition process to ensure that adequate planning occurs and that proper approvals are documented in the contract management system [eCMS] in accordance with VHA Directives.
No. 13
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
We recommended that the Under Secretary for Health, in conjunction with the VISN and facility senior managers ensure that MH services for contract CBOCs are addressed in a separate contract or within the primary care contract.