A report released by the Veteran Affairs Office of the Inspector General Wednesday showed that the Central Alabama VA Health Care System kept veterans waiting an average of 109 days for outside medical consultations, leaders were aware of this and the issues went unaddressed.
The consultations were part of Non-VA Care Coordination (NVCC) services, “NVCC, formerly known as Fee Basis (FEE), is medical care provided to eligible veterans outside of VA when VA facilities and services are not reasonably available.”
The increase of open consults greater than 90 days had substantially increased from April 2014 to March 2015, the VA, “goal is to schedule and complete the appointment and link the results to the consult request in less than 90 days.”
Source: VHA Consult Switchboard
The inspector general also:
“[S]ubstantiated a lack of follow-up (defined as the requesting provider having documented knowledge of the NVCC consult results); delays getting NVCC care authorized; staff not verifying eligibility for NVCC care; some NVCC consults being cancelled because they had been open longer than 90 days; and some community-based outpatient clinic (CBOC) nurses scheduling patients directly with community providers, primarily because there were delays in processing NVCC consults. We also substantiated that the NVCC program did not have sufficient staffing to address an increase in workload.”
The consults that were cancelled due to being open for over 90 days are particularly troubling due to the fact that, “In some cases, this may require a substantial amount of rework. For example, an NVCC consult for orthopedics or PM&R may require that x-rays be no older than 90 days. Therefore, another radiograph would be required before the NVCC consult could be resubmitted.”
The report also found that an outside contractor used by the VA, “is completing inadequate initial history and physical (H&P) exams, and those reports are not always available in the patients’ VA [electronic health records].”
The poor and non-existent documentation conducted by the contractor put veterans care at risk the inspector general’s report found that of 720 patients referred to the private medical group conducting physicals, 422 of them had no record of the visit in their electronic health records.
The investigation found that many of the Central Alabama VA Health Care System (CAVHCS) leaders were aware of these issues and yet they frequently went unaddressed. The inspector general’s report,
“concluded that a fractured organizational culture contributed to the development and perpetuation of these issues. Long-standing resistance to the integration of the Montgomery and Tuskegee campuses into a single unified health system, coupled with recurrent changes in leadership, impaired CAVHCS’ ability to identify and respond to deficient conditions. CAVHCS needs highly skilled, permanent leaders who can lead systemic improvements and cultural change.”