Review of Highly Rural Community-Based Outpatient Clinics' Limited Access to Select Specialty Care

The VA Office of Inspector General (OIG) reviewed the accessibility of dermatology, orthopedics, and urology specialty care for patients in the 17 Veterans Health Administration (VHA) community-based outpatient clinics (CBOCs) classified as highly rural. The OIG also reviewed accessibility, barriers, and the availability and utilization of resources for the time frame March 1, 2018 (or from the date the CBOC became highly rural), through February 28, 2019. VHA utilized clinical consults, electronic consults (eConsults), telehealth, and community care to provide specialty care at the highly rural CBOCs. Sites in this review mostly utilized referrals to their parent facility and community specialty providers. These sites rarely used telehealth, inter-facility consults, and eConsults. Staff identified limited access to community providers as the top barrier in the selected specialties. The OIG identified discrepancies regarding site operating days and hours among the available listing locations for clinic operations. Of the five highly rural CBOCs located in a non VA community hospital or health care center, not all community resources available at the sites were used. The OIG completed a review of the environment of care at the 16 sites visited and found they generally met the standards reviewed. Four recommendations were made to the Under Secretary for Health related to assessing specialty care needs including internet bandwidth and telehealth equipment, ensuring validation of the VHA Site Tracking system, ensuring the maintenance of accurate and current information on VA websites, and assessing whether highly rural CBOCs located in non-VA health care centers fully utilized resources in the facilities. Following the conclusion of this review, VHA implemented the Office of Emergency Management coronavirus disease 2019 Response Plan. Four of the 17 highly rural CBOCs closed and 13 listed pre-pandemic operations on their websites.