Delays in Processing Community-Based Patient Care at the Orlando VA Medical Center, Florida

At Congressman Bill Posey’s request, the VA Office of Inspector General (OIG) conducted a healthcare inspection at the Orlando VA Medical Center, Florida, following allegations that a patient died while experiencing a delay in obtaining approval for surgery outside VA. It was additionally alleged that the facility failed to timely approve, process, and coordinate non-VA care coordination (NVCC) consults, and these delays were causing adverse clinical outcomes The patient died prior to receiving scheduled heart surgery for asymptomatic severe aortic stenosis (narrowing of a heart valve); however, the OIG did not substantiate that the death occurred because of a long delay in approval for NVCC services. Facility staff complied with consult processing and scheduling guidelines when coordinating an evaluation with an NVCC provider, except for the 46 days that elapsed between the time the NVCC provider submitted a request for additional services (RAS) and acknowledgement of the request by the facility The OIG substantiated delays in the processing of other thoracic surgery NVCC consults entered during a 10-month period in 2017 related to an increase in the number of consults and limited staff available to process consults. The OIG did not identify adverse clinical outcomes associated with the delays. Problems were identified with providers’ assigning of clinically indicated dates (CID) and staff adhering to the assigned CIDs. The facility lacked a mechanism to track RASs. The OIG concluded the absence of a fully implemented tool to assist with care coordination increased the possibility of disruptions in the care coordination for the NVCC patients. Six recommendations were made related to a practitioner’s care who evaluated the patient six months prior to death, implementation of a tool to track the NVCC process, evaluation of providers’ assignments of CIDs, tracking of RASs, and ensuring NVCC appointments are scheduled within 30 days of CID.