Healthcare Inspection

Summarization of Select Aspects of the VA Pacific Islands Health Care System Honolulu, Hawaii

From Department of Veterans Affairs Office of Inspector General Report No. 15-04655-347

September 22, 2016

The VA Office of Inspector General Office of Healthcare Inspections conducted a review of the VA Pacific Islands Health Care System (VAPIHCS), Honolulu, Hawaii. The purpose of the review was to collect and summarize supplementary data in support of a Combined Assessment Program review completed in August 2015 (1) and to respond to letters sent by Senator Mazie K. Hirono expressing concerns about access to care, travel benefits, cultural diversity, homeless services, and mental health care. We also reviewed the Veterans Health Administration’s 6-point plan to address capacity and access to care within VAPIHCS primary care clinics.

VAPIHCS provides medical and mental health care across the Hawaiian Islands, Guam, American Samoa, and Saipan. In addition to the logistical challenges of coordinating care spanning multiple islands and thousands of miles, leadership and staff consistently reported difficulty in recruiting and retaining qualified employees due to the cost of living, distance, and isolation of island life. Further, VAPIHCS staff reported the lack of adequate space at almost all locations to manage the volume of patients seeking care.

We found that VAPIHCS has many of the same administrative and clinician availability issues found across the VA system for non-VA care. At VAPIHCS, these challenges are compounded by a shortage of VA-based providers and enrolled non-VA providers, the complexity of island logistics, and the diversity of the population served. VAPIHCS was in the process of hiring and embedding additional non-VA care staff at the community based outpatient clinics to enhance the timeliness and management of non-VA care.

VAPIHCS Beneficiary Travel Program expenditures are substantial due to the logistics of providing care for patients across multiple islands. VAPIHCS acknowledged a delay in processing travel benefit claims, but staff were expected to resolve the backlog by January 2016. As of August 2016, all but 21 of the unprocessed claims had been resolved.

We found that while there may be occasions when a provider’s management of a situation could potentially lack cultural sensitivity and competence, interviewees did not report that this was a wide-spread problem. We also found that VAPIHCS:

• Offers a comprehensive array of programs and services across the islands for homeless veterans. 
• Offers a variety of general and specialty mental health services across the islands that, despite staffing challenges, meet mental health access metrics. 
• Has improved staffing in the Suicide Prevention Program in the past year to address past deficiencies and expand its outreach efforts.

In February 2014, VAPIHCS had one of the largest wait lists VA-wide for patients wanting primary care appointments. VAPIHCS implemented a 6-point plan to increase primary care panel sizes, extend clinic hours, increase primary care staffing at the community based outpatient clinics, contact and schedule appointments for wait-listed veterans, and educate veterans on the importance of keeping their appointments or calling to cancel prior to the scheduled time.

In August 2015, VAPIHCS had substantially improved access to care from 77.57 percent appointments completed within 30 days of the preferred date in FY 2014 to a 95.18 percent completion rate within 30 days for new patients awaiting primary care appointments.

We made one recommendation.

Comments

The Veterans Integrated Service Network and System Directors concurred with our recommendation and provided an acceptable action plan. (See Appendixes A and B, pages 20–22 for the Directors’ comments.) We will follow up on the planned actions.

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1) VAOIG, Combined Assessment Program Review of the Pacific Islands Health Care System, Honolulu, Hawaii, Report No. 15-00626-28, November 10, 2015.