Healthcare Inspection – Physical Medicine and Rehabilitation Services Consult Process Concerns, Central Texas Veterans Health Care System, Temple, Texas

OIG conducted a healthcare inspection in response to complaints regarding consults at the Central Texas Veterans Health Care System (system), Temple, TX. The complainant provided 14 examples of patients at the Olin E. Teague Veterans’ Medical Center (facility) for whom he/she believed Physical Medicine and Rehabilitation Services (PMRS) consults were not scheduled timely and appointments were delayed as a result. We substantiated the allegation that 12 of the 14 patients experienced delays in scheduling consult appointments and in receiving care. Although patients experienced delays in PMRS consults, primary care teams continued to manage patients. We found the problem of delayed consult appointments was a systemic problem within PMRS. Some of the facility’s PMRS consult procedures did not comply with system policy and could have contributed to the delay in appointment scheduling. Multiple provider and managerial positions were filled by temporary personnel, and an absence of a fully staffed department affected the functioning of the service and contributed to the delays. Facility managers were aware of these problems and attempted to correct them by forming a Consult Management Committee to review consult data, and by requesting another Veterans Health Administration (VHA) facility review PMRS. Although facility managers provided Advanced Medical Support Assistants who scheduled appointments with additional scheduling training, they continued to be confused about scheduling procedures and did not meet scheduling competency evaluation requirements. We recommended that the Facility Director ensure that (a) consult clinical reviews and appointment scheduling for patients are conducted in compliance with VHA directives and policies, (b) PMRS have sufficient staffing to arrange for timely consults and appointments within the service, and (c) facility staff who schedule PMRS patient appointments receive annual scheduling competencies to ensure understanding of the correct process for compliance with VHA directives and staff are monitored for compliance.