National Review of Hospice and Palliative Care at the Veterans Health Administration

The VA Office of Inspector General (OIG) conducted a healthcare inspection to review the utilization of hospice and palliative care (HPC) services at the Veterans Health Administration (VHA). The OIG reviewed relevant directives, policies, handbooks and conducted interviews with VHA and non-VHA HPC subject matter experts. After reviewing relevant documentation and conducting interviews, the OIG examined the electronic health records of patients who were newly diagnosed with a malignant cancer in fiscal year 2017 to determine how many patients received a formal HPC consult or had an informal HPC-related discussion with a provider. The OIG determined that 10.3 percent of the reviewed patients had a formal HPC consult or an HPC-related interaction/conversation without a designated HPC consult or stop code. In addition, the OIG chose to examine a different aspect of HPC to determine whether completed HPC consults were linked to required stop codes used to measure HPC workload. The OIG found that 78.5 percent were appropriately linked to an HPC stop code and 21.5 percent were not. The OIG found that the administrative data did not reflect all HPC services provided by VHA. Inaccurate administrative data indicates that VHA has an incomplete understanding of how much HPC service it is providing or how much is needed, which could affect allocation of resources and planning. In summary, this review identified areas where VHA has opportunities to ensure that HPC consults are documented and coded accurately to account for HPC services. The OIG made one recommendation to the Under Secretary for Health to ensure the development and implementation of a consistent and standardized approach for hospice and palliative care documentation, consult management, and coding.