Healthcare Inspection – Scheduling, Staffing, and Quality of Care Concerns at the Alaska VA Healthcare System, Anchorage, AK

OIG conducted an inspection at the request of Senator Lisa Murkowski to assess the merit of allegations regarding (1) provider availability, workload, access, quality of care, and security at the Mat-Su VA Community Based Outpatient Clinic (CBOC), Wasilla, AK, and (2) scheduling practices at the Alaska VA Healthcare System, Anchorage, AK. We substantiated the allegation that provider workload and staffing negatively impacted access to care at the Mat-Su VA CBOC for the patients reviewed. We further substantiated that the Mat-Su VA CBOC lacked a permanent provider from May to October 2014. We substantiated that decreased and delayed access resulted in quality of care issues. Patient care was compromised by a lack of communication, care coordination, and follow-up, in addition to outright delays in the provision of care. We did not substantiate the allegation that since its opening, the Mat-Su VA CBOC has been plagued by security issues. We substantiated the allegation that the facility did not comply with Veterans Health Administration scheduling directives in 2008. However, we did not find evidence of current scheduling irregularities. We substantiated the allegation that adequate urology services were not available to patients following the departure of the system’s only urologist in 2008. In addition, we found organizational structure and processes lacking, particularly in areas under the domain of clinical leadership. Insufficient processes in peer review, provider evaluation, and committee activity and reporting, as well as issues of culture and employee morale, have the potential to compromise patient safety. We made nine recommendations. The Veterans Integrated Service Network and Facility Directors concurred with our recommendations and provided acceptable action plans.