Healthcare Inspection – Documentation of Patient Enrollment Concerns in Home Telehealth John D. Dingell VA Medical Center Detroit, Michigan

OIG conducted an inspection in response to allegations concerning the documentation of patient enrollment in home telehealth (HT) at the John D. Dingell VA Medical Center, (facility) Detroit, MI. We substantiated that from September 14, 2013, until October 1, 2013, HT program staff entered documentation of monthly HT monitoring for 836 patients. We found that that 828 of the 836 patients were not properly enrolled in HT. We substantiated that HT staff worked overtime from September 14, 2013, until October 1, 2013, for the purpose of initiating the enrollment process for new HT patients. The documentation included screening notes and monthly monitor notes that met the criteria for patient care encounters (workload) that contributed to the ability of the Associate Chief of Nursing Service for Specialty Services to meet one of two fiscal year 2013 performance measures for telehealth services. We substantiated that during the OT hours that HT staff worked on Sunday, September 29, 2013, and after regular working hours on Monday, September 30, 2013, they entered a total of 634 monthly monitor notes. However, we found that HT staff were not required to work OT for several weeks to produce documentation on the enrollment of patients in HT program. Rather, they voluntarily worked OT to complete patient enrollment and clean up missing notes. We found that without the use of OT during the last 2 days of FY 2013, the facility would not have reached or surpassed its performance goal of 11,724 HT encounters. We recommended that the Facility Director ensure HT staff are retrained and that HT documentation accurately reflects enrollment status, review the circumstances surrounding the entry of monthly monitor notes with the Office of Human Resources and the Office of General Counsel, and take appropriate action as necessary.