Administrative Summary - Primary Care Access, Scheduling, and Consult Management Concerns, Erie VA Medical Center, Erie, Pennsylvania

OIG conducted a healthcare inspection to evaluate primary care access, scheduling, and consult management concerns at the Erie VA Medical Center (facility), Erie, PA. We conducted a survey in advance of a December 2014 Combined Assessment Program review. Anonymous survey respondents alleged that (a) Primary care providers (PCP) were assigned too many patients, resulting in access issues, (b) Patient appointments were scheduled and later “cancelled by patient” without patients’ knowledge, and (c) Non-VA Care Coordination (NVCC) and inter-facility transfer consults were delayed. We substantiated that in March 2015, some PCPs were assigned more than the maximum number of patients specified under VHA procedures and local policy. Eleven of 22 providers (50 percent) had adjusted panel sizes outside the expected panel size range. Further, 12 of 22 providers (54.5 percent) had adjusted panel sizes outside the expected panel size range specified in facility policy. The facility attributed the panel sizes to challenges related to provider turnover, and recruiting and retaining qualified PCPs at least in part because of the competitiveness of salaries. Since our onsite visit, facility leaders implemented a number of strategies to enhance recruitment and retention leading to some improvement in PCP panel size. At the end of fiscal year (FY) 2016, 10 of 22 providers (45.5 percent) and 11 of 22 providers (50 percent) had adjusted panel sizes outside the expected ranges specified in VHA and facility policies, respectively. We did not substantiate that patients had limited access to primary care appointments. We found appointment wait times based on preferred date were relatively short, on average, both at the time of our onsite visit in March 2015 and at the end of FY 2016. We could not substantiate patient appointments were scheduled and subsequently “cancelled by patient,” without patients’ knowledge. Because the allegation was vague and lacked additional information such as specific patient appointments, staff involved, or time period, we were unable to fully address the anonymous survey respondent’s specific concern. We substantiated inter-facility transfer and NVCC consult delays occurred in FY 2015, due at least in part to another VA medical facility leader’s decision to decline certain transfer requests in an effort to address wait times concerns at the other facility. Facility leaders initiated multiple actions to address those delays which led to improved consult timeliness in FY 2016. Further, we did not identify patients who were clinically impacted by delays.