VA lacks reasonable assurance that outpatient clinics adhere to VA's standard of care and provide consistent, quality care.

by Larry Scott, VA Watchdog dot Org

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On July 28, 2010, the VA's Office of Inspector General (VAOIG) released the following report:

Veterans Health Administration Audit of Community-Based Outpatient Clinic Management Oversight -- Report Number 09-02093-211, 7/28/2010 | Summary | Report (PDF)

This report, with two reports from earlier this week, paints a disturbing picture:

VAOIG ISSUES UNFLATTERING REPORTS ON 16 MORE VA CLINICS -- The VA outpatient clinics are located in California, Texas, Florida, Ohio and Indiana.

This report makes me wonder if it isn't time to "tear it down."

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Report Highlights: Audit of VHA’s Community-Based Outpatient Clinic Management Oversight

Why We Did This Audit

Community-based outpatient clinics (CBOCs) are a key part of the Veterans Health Administration’s (VHA’s) health care delivery system because they increase veterans’ access to care and allow veterans to receive care closer to their homes and communities. Based on the best available VA data, VHA spent over $2.9 billion to provide services to about 2.8 million patients at 783 VA- and contractor-staffed CBOCs in FY 2009.

This audit evaluated the effectiveness of VHA’s management oversight of CBOCs. The audit objectives were to evaluate VHA CBOC monitoring and evaluation policies and processes and examine CBOC management controls related to the Primary Care Management Module (PCMM) and the completion of required traumatic brain injury (TBI) and military sexual trauma (MST) screenings.

What We Found

VHA lacks a comprehensive CBOC management control system with which to effectively evaluate and manage CBOC performance and address operational problems. As a result, VHA lacks reasonable assurance that CBOCs adhere to VHA’s one standard of care and provide consistent, quality care in accordance with VA policies, regulations, and procedures. Problems identified during our evaluation of CBOC PCMM data and the completion of TBI and MST screenings at CBOCs demonstrate the need for VHA to establish CBOC-specific monitors and evaluations that can identify systemic problems and deviations from the standard of care.

We found that CBOC PCMM data maintained by medical facility and CBOC staff and used to make VHA budgetary and resource management decisions contained significant inaccuracies. Moreover, Network and CBOC staff did not ensure the prompt completion of required TBI and MST screenings, and in some cases, allowed the improper billing of veterans for MST related care.

What We Recommended

We recommended the Under Secretary for Health establish comprehensive CBOC management controls and monitoring mechanisms and strengthen CBOC PCMM data management, TBI and MST screening, and MST billing management controls.

Agency Comments

The Under Secretary for Health agreed with our findings and recommendations and plans to complete all corrective actions by January 1, 2011. We consider the planned actions acceptable and will follow up on their implementation.

(original signed by:) BELINDA J. FINN
Assistant Inspector General
for Audits and Evaluations

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