Comprehensive Healthcare Inspection Summary Report: Evaluation of Care Coordination in Veterans Health Administration Facilities, Fiscal Year 2020

This Office of Inspector General (OIG) Comprehensive Healthcare Inspection Program report provides a focused evaluation of Veterans Health Administration (VHA) facilities’ selected requirements and guidelines for care coordination. This evaluation focused on compliance with program requirements related to life-sustaining treatment decisions for hospice patients. This report describes care coordination findings from healthcare inspections initiated at 36 VHA medical facilities from November 4, 2019, through September 21, 2020, and electronic health record review at five additional randomly selected facilities. Each inspection involved interviews with facility leaders and staff and reviews of clinical and administrative processes. The results in this report are a snapshot of VHA performance at the time of the fiscal year 2020 OIG reviews. During the time frame of this retrospective review, VHA policy required certain elements of goals of care conversations to be documented in patients’ electronic health records. However, in March 2020, VHA revised its policy to require fewer elements. The OIG observed general compliance with the selected requirements after these rules were updated during the review period. However, under the original VHA requirements in place when patients received their care, the OIG estimated that providers did not consistently • identify a surrogate should the patient lose decision-making capacity; • address previous advance directives, state-authorized portable orders, and/or life-sustaining treatment plans; or • address the patient or surrogate’s understanding of the patient’s condition. The OIG did not issue recommendations but developed this summary report for leaders to consider when improving operations and clinical care at VHA facilities.