Healthcare Inspection – Eye Care Concerns, Eastern Kansas Health Care System, Topeka and Leavenworth, Kansas

OIG conducted an inspection to assess the validity of allegations concerning eye care at the Topeka, KS, and Leavenworth, KS, divisions of the Eastern Kansas Health Care System. We substantiated the allegation that staff used an unapproved wait list for patients awaiting cataract surgery and determined that system leadership did not ensure the staff were adequately trained to use the required surgical scheduling software package. We did not substantiate that the unapproved wait list was created to falsify cataract surgery wait times. However, at the time of our onsite review, system leadership had instructed staff to reduce the cataract surgery wait time to no more than 90 days and, to achieve this, had been authorizing Non-VA Care more frequently. We substantiated that providers did not consistently enter eye care requests for new Leavenworth VAMC and Topeka VAMC Eye Clinic patients using the consult referral process as required. However, we could not substantiate that providers did not follow the required consult process in an attempt to falsify wait times. We did not substantiate that cataract surgeries were completed unnecessarily for two identified patients nor that patients were harmed while awaiting surgery. We substantiated that ophthalmologists’ productivity was below expected thresholds. We determined that improved productivity may reduce cataract surgery wait times. We found intra-departmental discord and poor communication at the Topeka VAMC and Leavenworth VAMC Eye Clinics and learned that both Eye Clinics had not had a chief for 6 years. We recommended that the System Director ensure Eye Clinic Leavenworth VAMC staff use only an approved cataract surgery wait list, that providers use the Computerized Patient Records System for eye care consults, and that system leadership explore and implement measures to improve communication and operations.