Healthcare Inspection Veterans Choice Program Dermatology Delays, Captain James A. Lovell Federal Health Care Center, North Chicago, Illinois

OIG conducted a healthcare inspection of alleged inefficiencies in processing Veterans Choice Program (Choice) dermatology consults that resulted in delays and duplicative procedures at the Captain James A. Lovell Federal Health Care Center (FHCC), North Chicago, IL. The specific allegations were: A patient was referred to Choice and underwent a “redundant and unnecessary biopsy; A patient was referred to Choice and experienced a delay in obtaining a procedure; A patient was inappropriately referred for Choice care; Patients who were referred for Choice dermatology care, including those with skin cancers, experienced delays. We substantiated that a patient underwent a duplicate biopsy. The FHCC dermatologist biopsied the patient’s lesion and ordered a non-VA care consult for Mohs surgery. We found that fee department staff provided pathology results from the original biopsy to the Choice third-party administrator. However, the Choice dermatologist did not receive the patient’s VA EHR information, including the patient’s pathology results, from the Choice third-party administrator. The Choice dermatologist repeated the biopsy to confirm the cancer diagnosis before completing Mohs surgery. We substantiated that a patient experienced a delay in obtaining Mohs surgery because the Choice dermatologist did not initially receive a readable copy of the patient’s pathology results. We found that although fee department staff provided a readable pathology results copy to the Choice third-party administrator, the faxed versions sent to the Choice dermatologist were faint and difficult to read. Although we substantiated that fee department staff initially offered a patient care through Choice, which was appropriate, we found that the patient ultimately received care through traditional non-VA care. We substantiated apparent delays among Choice dermatology consults. For consults ordered from March 1, 2015 through February 29, 2016, we found 569 of 613 patients (92.8 percent) with Choice dermatology consults appeared to have experienced delays. Several factors contributed to apparent delays, including fee department staff not taking timely action. We did not find patients who were clinically impacted by delays. We also noted that the apparent delays persisted through at least September 30, 2016. We recommended that the FHCC Director ensure that fee department staff take timely action (1) when providers order non-VA care and Choice dermatology consults and (2) to complete, cancel, or discontinue non-VA care and Choice dermatology consults.