Healthcare Inspection: Inadequate Coordination of Care Orlando VA Medical Center Orlando, Florida

摘要

The VA Office of Inspector General (OIG) Office of Healthcare Inspections (OHI) reviewed allegations of delay of medical care and inadequate care management for Fee Basis Service (FB), Interfacility Consults (IFC), and Project Health Effectiveness through Resource Optimization (HERO) at the Orlando VA Medical Center (OVAMC), in Orlando, Florida. The purpose of this inspection was to determine whether the allegations had merit. The complainant alleged that: OVAMC lacks an adequate care management system to coordinate care between VA providers and FB providers; majority of patients receiving FB referrals did not receive an authorization letter, did not understand the letter or could not find a doctor willing to see them; OVAMC has not established a system to ensure timeliness of care for veterans requiring IFCs and Project HERO is not meeting its contractual obligations for timely referrals and communication with FB providers. We substantiated the allegation that OVAMC lacks an adequate care management system to coordinate care between VA providers and FB providers which led to delays in care, but found no evidence that patients were harmed. FB was a new function that transferred to OVAMC in October 2009. We found that there were gaps in the communication and coordination of care as evidenced by our interviews and review of medical records for four patients identified by the complainant. We noted numerous communication breakdowns that included: missing FB results, delays of up to 120 days for scanning of consult records, and missing progress notes in the medical record on consult results or status. We found instances that medical care was affected or delayed due to communication breakdowns: a patient had to undergo a second biopsy because the original FB pathology results could not be located; a patient arranged for care at another VA outside of his geographic region due to FB delays; and delays in finding FB services in the community. We substantiated the allegation that patients experienced difficulties with either understanding the authorization letter or finding FB providers in the community. We did not find evidence that patients had not received an authorization letter. The FB authorization letters provided little guidance for locating a FB provider and there was no follow up by FB staff to determine why consults were not being performed. We noted a large backlog of open FB consults. We substantiated the allegation that OVAMC has not established a system to ensure timeliness of care for veterans requiring IFCs. OVAMC reported referral difficulties to the James A. Haley Veterans Hospital (JAHVH) after the October 2009 transition that led to IFC backlogs. IFC reports documented a reduction in availability of IFC consults at JAHVH by approximately 67% for orthopedics and ophthalmology.