D.18 Outpatient Scheduling Processes and Procedures 02.pdf

D.18 OUTPATIENT SCHEDULING PROCESSES AND PROCEDURES

36C25923R0040

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Department of Veterans Affairs Veterans Health Administration Washington, DC 20420

VHA DIRECTIVE 1230(2)

Transmittal Sheet

July 15, 2016

OUTPATIENT SCHEDULING PROCESSES AND PROCEDURES

1. REASON FOR ISSUE: This Veterans Health Administration (VHA) directive establishes policy for outpatient clinic appointment scheduling processes and procedures in Veterans Health Information Systems and Technology Architecture (VistA).

2. SUMMARY OF MAJOR CHANGES: This revised VHA directive updates policies, responsibilities, and definitions for outpatient scheduling processes and procedures.

a. Amendment dated July 12, 2019 adds and/or clarifies minimal scheduling efforts for outpatient appointments:

(1) Appendix C, paragraph 12.c., Scheduling Business Rules;

(2) Appendix I, paragraph 1.., No Show Process Business Rules;

(3) Appendix K, paragraphs 9 and 11, Recall Reminder Application Business Rules;

and

(4) Appendix P, paragraphs 7.a and 7.c., New Enrollee Appointment Request List Business Rules;

(5) The addition of Appendix S, Minimum Scheduling Efforts for Outpatient Appointments; and

(6) Separated Vista Clinic Profile Request Template into its own Appendix M, and renumbered the remaining appendices, M through S.

b. Amendment dated July 12, 2019 adds/clarifies outpatient clinic scheduling resources:

(1) Paragraph 5.d.(2), Responsibilties, VA Medical Facility Director

(2) Paragraph 5.i.(1), Responsibilities, Scheduling Manager/Supervisor/Group Practice Manager (GPM)

(3) Paragraph 5.k.(1), Responsbilities, Scheduler/Primary Care Management Module (PCMM) Coordinator

(4) Appendix R, Scheduling Supply and Demand Reports

(5) The addition of Appendix T, Outpatient Clinic Scheduling Resources

AMENDED

1/22/2020

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July 15, 2016 VHA DIRECTIVE 1230(2)

c. Amendment dated January 22, 2020 adds and clarifies appointment scheduling for eligible walk-in Veterans by adding Appendix U: Standardization of Appointment Scheduling for Eligible Veteran Walk-In Enrollments at the VA Medical Facility.

d. Major changes are as follows:

(1) Paragraph 2.e, Background and 4.c, Definitions: Establishes Clinically Indicated Date (CID).

(2) Paragraph 2.e, Background and 4.h, Definitions: Use of Preferred Date (PD) versus Desired Date (DD).

(3) Paragraph g.3, Associate Chief of Staff/Service Line Chief/ Manager/ Provider:

Responsibilities Provider must enter the CID and/or EAD in CPRS.

(4) Paragraph 12.a, Appendix C. Schedulers document two efforts to contact patients to make appointments.

(5) Paragraph 6, Appendix O. The scheduling of all appointment requests originating from fully processed VA Form 10-10EZs (known as the date VA determines eligibility) must be initiated within 7 calendar days.

(6) Definitions: “No show” definition added, was formerly referred to as “missed opportunity.”

(7) Added appendices A-Q: Scheduling Business Rules for scheduling practices.

(8) Audit requirements have changed. See section D.

3. RELATED ISSUES: VHA Directive 1231, Outpatient Clinic Practice Management, dated November 15, 2016; VHA Directive, 1232 Consult Processes and Procedures, dated August 24, 2016; VHA Directive 2007-033, Telehpone Service for Clinical Care, dated October 11, 2007; and H.R. 3230 Veterans Access, Choice and Accountability Act of 2014.

4. RESPONSIBLE OFFICE: The Deputy Under Secretary for Health for Operations and Management (10N) is responsible for the contents of this directive. Questions relating to this directive may be referred to Executive Director of Access and Clinic Administration Program Office via email at 10NC10Action@va.gov.

5. RESCISSIONS: VHA Directive 2010-027, dated June 9, 2010 is rescinded.

6. RECERTIFICATION: This VHA directive is scheduled for recertification on or before the last working day of July 2021. This directive will continue to serve as national VHA policy until it is recertified or rescinded.

mailto:10NC10Action@va.gov

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/s/ David J. Shulkin, M.D.

Under Secretary for Health

NOTE: Amendments to this directive are considered policy and will remain in effect until this directive is recertified. Applicable 10N memoranda are located on the Office of Veterans Access to Care (OVAC) SharePoint site at the following link:

https://vaww.vha.vaco.portal.va.gov/sites/DUSHOM/10NA/ACAO/10N%20Memo%20an d%20Directive%20Archive/Forms/AllItems.aspx. NOTE: This is an internal Web site that is not available to the public.

NOTE: All references herein to VA and VHA documents incorporate by reference subsequent VA and VHA documents on the same or similar subject matter.

DISTRIBUTION: Emailed to the VHA Publications Distribution List on 07/15/2016.

https://vaww.vha.vaco.portal.va.gov/sites/DUSHOM/10NA/ACAO/10N%20Memo%20and%20Directive%20Archive/Forms/AllItems.aspx https://vaww.vha.vaco.portal.va.gov/sites/DUSHOM/10NA/ACAO/10N%20Memo%20and%20Directive%20Archive/Forms/AllItems.aspx i

CONTENTS

OUTPATIENT SCHEDULING PROCESSES AND PROCEDURES

1. PURPOSE

2. BACKGROUND

3. POLICY

4. DEFINITIONS

5. RESPONSIBILITIES

6. REFERENCES

APPENDIX A

RESOURCES ..............................................................................................................A-1

APPENDIX B

GENERAL SCHEDULING BUSINESS RULES............................................................B-1

APPENDIX C

SCHEDULING BUSINESS RULES............................................................................. C-1

APPENDIX D

SCHEDULER TRAINING BUSINESS RULES ............................................................ D-1

APPENDIX E

CORRECTING SCHEDULING ERRORS BUSINESS RULES ....................................E-1

APPENDIX F

CONSULT MANAGEMENT BUSINESS RULES..........................................................F-1

APPENDIX G

“CANCEL BY CLINIC” BUSINESS RULES................................................................. G-1

APPENDIX H

DISPOSITION OF DECEASED PATIENTS BUSINESS RULES ................................ H-1 ii

APPENDIX I

NO SHOW PROCESS BUSINESS RULES ................................................................... I-1

APPENDIX J

ELECTRONIC WAIT LIST BUSINESS RULES............................................................ J-1

APPENDIX K

RECALL REMINDER APPLICATION BUSINESS RULES...........................................K-1

APPENDIX L

CLINIC PROFILE MANAGEMENT BUSINESS RULES............................................... L-1

APPENDIX M

VISTA CLINIC PROFILE REQUEST TEMPLATE....................................................... M-1

APPENDIX N

CLINIC PROFILE INACTIVATION BUSINESS RULES .............................................. N-1

APPENDIX O

TRANSITIONING SERVICE MEMBERS/VETERANS: VA HEALTH CARE

APPOINTMENTS BUSINESS RULES ........................................................................ O-1

APPENDIX P

NEW ENROLLEE APPOINTMENT REQUEST LIST BUSINESS RULES ...................P-1

APPENDIX Q

VISTA REPORTS: SCHEDULING OUTPUT ............................................................. Q-1

APPENDIX R

SCHEDULING SUPPLY AND DEMAND REPORTS .................................................. R-1

APPENDIX S

MINIMUM SCHEDULING EFFORT REQUIRED FOR OUTPATIENT APPOINTMENTS

.....................................................................................................................................S-1

APPENDIX T

OUTPATIENT CLINIC SCHEDULING RESOURCES..................................................T-1 iii

APPENDIX U

STANDARDIZATION OF APPOINTMENT SCHEDULING FOR ELIGIBLE VETERAN

WALK-IN ENROLLMENTS AT THE VA MEDICAL FACILITY .................................... U-1

OUTPATIENT SCHEDULING PROCESS AND PROCEDURES

1. PURPOSE

a. This Veterans Health Administration (VHA) directive updates policy concerning Veterans Health Information Systems and Technology Architecture (VistA) outpatient scheduling standards for Veterans eligible for health care services. This directive represents VHA’s policy for scheduling processes and procedures. All national or local policies or memos are superseded to the extent that they conflict with this directive, and will not be followed. AUTHORITY: 38 U.S.C. 7301(b).

b. Exemptions: Due to the unique scheduling requirements, the following programs are exempt from the requirements of this directive:

(1) Home Based Primary Care-HBPC (Stop Codes 170-177)

(2) Hospital in Home-HIH (Stop Code 354)

(3) Medical Foster Home-MFH (Stop Code 162)

(4) Community Residential Care-CRC (Stop Code 121)

(5) VA-Adult Day Health Care (Stop Code 190)

(6) Health care for Homeless Veterans (HCHV) Program (Stop Code 555)

(7) Compensation and Pension (C&P) (Stop Code 450)

(8) DBQ Referral Clinic (Stop Code 443)

(9) C&P via Clinical Video Telehealth (CVT) Patient Site (Stop Code 444)

(10) C&P via Clinical Video Telehealth (CVT) Provider Site (Stop Code 445)

(11) IDES (Integrated Disability and Evaluation System) via Clinical Video Telehealth (CVT) Patient Site (Stop Code 446)

(12) IDES (Integrated Disability and Evaluation System) via Clinical Video Telehealth (CVT) Provider Site (Stop Code 447)

(13) Integrated Disability Evaluation System Exam (Stop Code 448)

(14) Purchased Care Programs

(a) Purchased Skilled Care (POV 70 & 74) (EWL Stop Code 682)

(b) Homemaker Home Health Aide (POV 71) (EWL Stop Code 682)

(c) Outpatient Home Respite (POV 72, 73 & 79) (EWL Stop Code 682)

(d) Contract Adult Day Health Care (Stop Code 191) (POV 76)

(e) Veteran Directed Home & Community Based Care (POV 27) (EWL Stop Code 682)

(f) PACE (POV 26)

(g) Purchased Home Hospice (POV 77 & 78)

(h) Community Nursing Home (POV 40, 41, 42, 43, 44)

2. BACKGROUND

a. VHA is committed to providing timely, high quality outpatient care for all enrolled Veterans. This requires a sound Veterans Health Information Systems and Technology Architecture (VistA) scheduling system, and business practice and processes that meet patients’ needs without delay.

b. VistA is an integrated electronic health record information technology system created and used by VHA with approximately 200 application/modules. The VistA Scheduling module is designed to assist in the set-up of outpatient clinics, scheduling of patients for clinic appointments, and the collection of related workload data for reporting purposes.

c. Public Law (Pub. L.) 104-262, the Veterans Health Care Eligibility Reform Act of 1996, mandated VHA establish and implement a national enrollment system to manage the delivery of health care services to Veterans.

d. The Veterans Access Choice and Accountability Act of 2014, Pub. L. 113-146, was signed into law to help improve Veterans’ access to care. This legislation created the framework for the Veteran’s Choice Program; a temporary program offering Community Care to Veterans who meet specific eligibility requirements.

e. VHA measures patient wait times using a number of enterprise wide timestamps such as the Preferred Date (PD) and, the Clinically Indicated Date (CID), as initial reference points in pending or completed appointments. As the second reference point, VHA publishes wait times according to the method prescribed in the Federal Register, https://www.federalregister.gov/articles/2014/11/05/2014-26274/publication-of-wait-times-for-the-department-for-the-veterans-choice-program.

3. POLICY

It is VHA policy that Veterans’ appointments are scheduled timely, accurately, and consistently with the goal of scheduling appointments no more than 30 calendar days from the date an appointment is deemed clinically appropriate by a VA health care provider (Clinically Indicated Date), or, in the absence of a Clinically Indicated Date (CID), 30 calendar days from the date the Veteran requests outpatient health care service (Preferred Date).The scheduling of all appointment requests originating from https://www.federalregister.gov/articles/2014/11/05/2014-26274/publication-of-wait-times-for-the-department-for-the-veterans-choice-program https://www.federalregister.gov/articles/2014/11/05/2014-26274/publication-of-wait-times-for-the-department-for-the-veterans-choice-program fully processed VA Form 10-10EZs must be initiated within 7-calendar days. NOTE:

See Appendix U for procedures on scheduling for eligible Veteran walk ins at VA medical facilities.

4. DEFINITIONS

a. Blind scheduling. Blind scheduling occurs when an appointment is scheduled without negotiating the date and time with the patient. Blind scheduling is prohibited.

b. Cancelled by Clinic. Cancelled by clinic is an appointment cancelled by the clinic, not the patient. Preset VistA reasons for cancelled by clinic are: appointment is no longer required; clinic is cancelled; clinic staffing; inpatient status; other; patient death;

patient ineligible; scheduling conflict/error; transfer outpatient (OPT) care to other VA; or weather.

c. Cancelled by Patient. Cancelled by patient means the patient has requested a currently scheduled appointment be cancelled. The patient may or may not reschedule the appointment.

d. Clinic Profile. The clinic profile is the customized parameters in VistA Scheduling that define outpatient clinic parameters. These include clinic name, start date/time, provider, location, frequency of the clinic, operating times, Stop Codes, overbooking allowance, count or non-count clinic, billable or non-billable for first party copays, billable or non-billable for third party billing, appointment lengths, users, etc.

e. Clinically Indicated Date. The Clinically Indicated Date (CID) is the date an appointment is deemed clinically appropriate by a VA health care provider. The CID is contained in a provider entered Computerized Patient Record System (CPRS) order indicating a specific return date or interval such as 2, 3, or 6 months. The CID is also contained in a consult request.

f. Count Clinic. Count clinic is a clinic set up to transmit patient care encounter (PCE) workload. Count clinics meet the definition of an encounter or occasion of service.

g. Desired Date. The date the patient or provider wants the patient to be seen.

Desired date has been replaced with Preferred Date(PD) to indicate when the patient wants to be seen and clinically indicated date to indicate the date the provider wants the patient to be seen.

h. Electronic Wait List. The Electronic Wait List (EWL) is VHA’s official list to track patients who have been waiting for more than 90 calendar days for an appointment.

Requests on the EWL consist of patients who have not been seen in the stop code within 24 months (new patients) and established patients seen within 24 months of the same stop code grouping but referred for a new clinical problem. NOTE: The Veterans Choice List (VCL), local facility “transfer lists” and Non-VA Care Continuum (NVCC) lists are also names of electronic lists used by the VHA for defined purposes. These lists are set up in non-count clinics. These lists employ EWL software, but they are not official wait lists subject to the business rules described in Appendix J.

i. Emergent Care. Emergent care is care for a condition for which immediate treatment is required to prevent the loss of life or limb or is required to prevent the progression of a disease process that could lead to the loss of life.

j. Encounter. An encounter is a professional contact between a patient and a provider vested with responsibility for diagnosing, evaluating, and treating the patient’s condition. Encounters occur in outpatient and inpatient settings (including Residential Rehab Treatment centers). NOTE: Refer to VHA Directive, 1082 Patient Care Data Capture, dated March 24, 2015..

(1) Contact can include face-to-face interactions or those accomplished via telecommunications technology.

(2) Contact can be through Secure Messaging which is available through the My HealtheVet (MHV) personal health record (PHR). These non-urgent communications must meet the definition of an encounter. A review of the health record is done by the physician or qualified non-physician and clinical decision making is performed at some level. The care plan is communicated with the patient electronically. (The Secure Message that is related to a visit within the last 7 calendar days cannot be captured as workload as it is considered part of the actual face-to-face visit). NOTE: Veteran requirements – must be an established patient with the provider, be registered on My HealtheVet as a user, and have upgraded access by completing the requirements for In- Person Authentication.

(3) Encounters are neither occasions of service nor activities incidental to an encounter for a provider visit. For example, the following activities are considered part of the encounter itself and do not constitute encounters on their own: taking vital signs, documenting chief complaint, giving injections, pulse oximetry, administering medications, etc.

(4) A telephone contact between a provider and a patient is only considered an encounter if the telephone contact is documented and that documentation include the appropriate elements of a face-to-face encounter, namely history and clinical decision-making. Telephone encounters must be associated with a clinic assigned to one of the telephone stop codes and are to be designated as count clinics.

k. Established Patient Appointment. An appointment is defined as an established patient appointment when the patient that has had a prior completed appointment within the same Stop Code within 24 months.

l. Late Arrival. Late arrival occurs when a patient presents after their scheduled appointment time is passed, but before the end of the clinic session.

m. Licensed Provider. A licensed provider is an individual at any level of professional specialization who requires the official or legal permission to practice in an occupation as evidenced by documentation issued by a State in the form of a license and/or registration. A practitioner can also be a provider. NOTE: Refer to VHA Directive 1082 Patient Care Data Capture.

n. Missed Opportunity. See No Show.

o. New Patient Appointment. A new patient appointment is defined as a patient that has not completed an appointment in Stop Code over the past 24 months.

p. No Show. A no show occurs when a patient does not present for a scheduled appointment by the time the appointment was scheduled to start. In order to distinguish a no show from a late arrival, schedulers are encouraged to enter no shows at the end of the day. The formula for calculating no shows is those appointments marked as a no show by the scheduler, plus appointments cancelled by clinic after the scheduled appointment time, plus appointments cancelled by patient after the scheduled appointment time. NOTE: Formerly referred to as a missed opportunity.

q. Non-Count Clinic. A non-count clinic is a clinic established for internal use only, i.e., managing clinics and not transmitted to National Patient Care Database (NPCD).

This clinic’s workload does not meet the definition of an encounter or an occasion of

r. Non-Licensed Independent Provider. A non-licensed provider is an individual without the official or legal permission to practice in an occupation and supervised by a licensed or certified individual in deliver care to patients. NOTE: Refer to VHA Directive 1082 Patient Care Data Capture.

s. Non-Service Connected. A non-service connected (NSC) Veteran is one who does not have a VA adjudicated illness or injury incurred in, or aggravated by, military

t. Occasion of Service. Formerly known as ancillary service, an occasion of service is a specified identifiable instance of technical or administrative service involving the care of a patient or consumer which is not an encounter and not requiring independent clinical judgment in the overall diagnosing, evaluating, and treating the patient's condition(s).

(1) Occasions of service are the result of an encounter. Examples are: clinical laboratory tests, radiological studies, physical medicine interventions, medication administration, and vital sign monitoring are all examples of occasions of service.

(2) Occasions of service, such as clinical laboratory, radiology studies, and tests are automatically loaded to the PCE database from other VistA packages. NOTE: Refer to VHA Directive 1082 Patient Care Data Capture.

u. Preferred Date. The preferred date (PD) is the date the patient communicates they would like to be seen. The PD is established without regard to existing clinic schedule capacity.

v. Priority Groups. Priority groups are established by Title 38 United States Ccode (U.S.C.) 1705 to determine which categories of Veterans are eligible to be enrolled. All enrolled Veterans will be placed in the highest priority group(s) for which they are qualified. NOTE: Refer to VHA Handbook 1601A.03, Enrollment Determinations.

w. Primary Provider. A Licensed Independent Provider, who is the attending and/or supervising provider, is always to be listed as the primary provider for all encounters provided by a Medical Resident, Psychology Resident, Psychology Intern, and when the patient is seen in conjunction with another qualified health care provider such as a nurse during the same appointment visit. For instance, if the Veteran is being seen by a Physician Assistant and a Physician within the same Clinic visit, the Physician would be the primary provider with the Physician Assistant listed as a secondary provider.

However, if the Veteran is being seen by a Physician Assistant and is treated only by the Physician Assistant, the Physician Assistant is the primary provider of record.

NOTE: Refer to VHA Directive 1082 Patient Care Data Capture.

x. Recall Reminder Application. A recall reminder (RR) application is an electronic function of the VistA scheduling system that serves to queue or hold appointment requests for scheduling at a future time closer to the time the appointment is intended be completed.

y. Return To Clinic Date. Refer to Clinically Indicated Date (CID).

z. Scheduler. A scheduler is any staff member assigned the VistA Scheduling Menu Options, “ Make Appointment”, EWL, Recall Reminder. Schedulers make, reschedule, cancel, and no show Veteran appointments and/or enter patients on EWL. Schedulers have successfully completed required scheduler and soft skills training.

aa. Service-Connected Veteran. A service-connected (SC) Veteran is one who has an illness or injury incurred in, or aggravated by, military service as adjudicated by the Veterans Benefits Administration.

bb. Stop Code. Stop codes are codes that define clinical work units and measure workload for costing purposes. A primary stop code and secondary stop code compose the six dig Stop Code and are assigned by Medical Cost Accounting (MCAO) staff.

Each clinic must be set up with appropriate Stop Code Identifiers.

(1) Primary Stop Code. A primary stop code is the first three digits of the Stop Code and designates the main clinical group responsible for the care. Three numbers must always be in the first three characters of a Stop Code for it to be valid.

(2) Secondary Stop Code. A secondary stop code is the last three digits of the stop code and designates the secondary or credit stop code which serves as a modifier to further define the work. A VA medical center can use the secondard Stop Code as a modifier of the work provided in the primary clinical care work unit (identify by the primary Stop Code.

(3) Credit Pair. Credit pair is the common term used when two Stop Codes , a primary and secondary code, are utilized when establishing outpatient clinics in the VistA software.

cc. Stop Code Grouping. Logical groupings of stop codes defining a particular type of health care as established by the VHA Stop Code Council.

dd. The Relevant other Licensed Independent Provider. The relevant other Licensed Independent Provider. e.g., Psychologist, Pharmacist, Licensed Clinical Social Worker, is to be listed as the primary provider for any trainees they supervise (e.g., Psychology Intern, Pharmacy Resident) or any other non-licensed independent provider (NLIP) under their supervision. NOTE: Refer to VHA Directive 1082, Patient Care Data Capture.

ee. Urgent Care. Urgent care is care for an acute medical illness or mental health need or for minor injuries for which there is a pressing need for treatment to manage pain or to prevent deterioration of a condition where delay might impair recovery.

5. RESPONSIBILITIES

a. Deputy Under Secretary for Health for Operations and Management. The Deputy Under Secretary for Health for Operations and Management has overall responsibility to oversee and improve access. Access indicators include but are not limited to: wait time measures, clinic utilization, cancelled by clinic, no shows and measures of patient satisfaction at the National level.

b. Director, Access and Clinic Administration Program. The Director, Access and Clinic Administration Program (ACAP), is responsible for day-to-day support of national issues and programs in the general areas of scheduling policy, procedures, education, applications and oversight across VHA. In addition, the Director assists the Deputy Under Secretary for Health for Operations and Management to oversee and improve access within the VHA.

c. Veteran Integrated Service Network Director. The Veterans Integrated Service Network (VISN) Director is responsible for ensuring: VistA Scheduling applications are maintained in accordance with nationally distributed software and software patches.

(1) Oversight of the scheduling program and patient wait times in order to ensure timely access to care for eligible veterans.

(2) Monitoring compliance with this directive and requesting assistance from ACAP when needed.

(3) Performance and management of Insurance Capture Buffer (ICB) “Exceptions List” and “Patient Update.”

d. VA Medical Facility Director. The VA medical facility Director is responsible for ensuring:

(1) Providing appropriate resources to adequately perform scheduling tasks to meet the needs of Veterans. This includes overall responsibility for appropriately managing the EWL, community care referrals and clinic access.

(2) Ensuring that each VA medical facility assesses scheduling resource levels no less than yearly. This review is intended to ensure appropriate staff are scheduling appointments. Monthly monitoring is recommended. See appendix T for additional outpatient clinic scheduling resource requirements.

(3) Managed process for ongoing staff training and scheduling competency. See Appendix D.

(4) Continuous auditing and improvement process of scheduling activities such as the timeliness and appropriateness of scheduling actions, accuracy of CID or PD dates and telephone call quality.

(5) Annual review of all clinic profiles for accuracy, necessity and appropriate utilization.

(6) Ongoing review of access to care indicators.

(7) Monitoring compliance with this directive and reporting non-compliance to the VISN Director.

e. Facility Revenue Manager. The Facility Revenue Manager is responsible for

(1) Whether the new clinic is billable/non-billable or upon clinic changes.

(2) Conducting an annual review, at a minimum, of all active Clinic profiles in collaboration with the respective Associate Chief of Staff/Service Line Chief/Manager (ACOS/SLC/M) and the Medical Cost Accounting Office Staff (MCAO).

f. Chief of Staff. The Chief of Staff and/or designee is responsible for ensuring:

(1) The Clinical staff document a CID order in CPRS, encounter data elements, and progress note patient’s medical record in order for timely scheduling of appointments and workload transmission to PCE.

(2) Clinical staff involved in scheduling processes comply with national scheduling training requirements and include scheduling activities in their functional statement.

(3) The Associate Chief of Staff/Service Line Chief/Manager/Provider complies with clinic profile management business rules.

g. Associate Chief of Staff/Service Line Chief/Manager/Provider. The Associate Chief of Staff/Service Line Chief/Manager/Provider and/or designee is responsible for

(1) Providers submit template request(s) for new Clinic establishment or existing clinic changes in accordance with Appendix L, Clinic Profile Management Business Rules.

(2) The ACOS/SLC/M must approve requests for Clinic Profile Inactivation consistent with Appendix M, Clinic Profile Inactivation. Inactivation requests should include date of and reason for inactivation, and follow up care needed for patients with appointments remaining in clinic.

(3) Providers enter the CID for future appointment requests in the Computerized Patient Record System (CPRS) Order. The provider makes a CID determination based upon the clinical needs of the patient. The CID may not be changed by the scheduler due to lack of availability of appointments. The date may only be changed if it was entered in error.

(4) The sending/referring provider enters the Earliest Appropriate Date (EAD)/CID in the CPRS Consult request. The sending provider makes an EAD/CID determination based upon the clinical needs of the patient. The EAD/CID may not be changed by the receiving provider or scheduler due to lack of availability of appointments. The date may only be changed if it was entered in error. Erroneously entered EAD/CID can be corrected by either the sending or receiving service using the Cancel/Resubmit process.

(a) Appointment availability timeframes are monitored in order to identify clinics with wait times of greater than 30 calendar days and improve access.

(b) Annual review of respective service clinics in collaboration with MCAO staff and Facility Revenue Manager (FRM).

h. Medical Facility Associate Director. The Medical Facility Associate Director is responsible for ensuring:

(1) Development of a process to request and authorize the establishment of new clinics, modifications, and/or inactivation’s in accordance with Appendices L-M.

(2) Maintenance of and an annual review of the Master List of staff having scheduling authority and subsequent review and certification that listed staff with scheduling authority have completed required training.

(3) Security of VistA access menus and keys to “make appointment” option in Scheduling software to those staff having need to fulfil job requirements and have successfully completed scheduling training requirements.

i. Scheduling Manager/Supervisor/Group Practice Manager (GPM). The Scheduling Manager/Supervisor/Group Practice Manager (GPM ) is/are responsible for

(1) Adherence to business rules outlined in Appendices A-T.

(2) Day to day scheduling processes and oversight.

(3) Performance and management of the recall reminder system in accordance with published procedures.

(4) Establishment of EWL clinics as appropriate in accordance with Appendix J.

(5) Minimizing access to the VistA Scheduling options for scheduling appointments, PCMM menu options, and EWL entries to ensure staff competency to perform these duties.

(6) Mail group messages from nightly background jobs are addressed in order to correct problems, issues, changes identified in scheduling activities.

(7) Scheduler position descriptions include responsibilities relative to scheduling, PCMM assignments, Recall and EWL.

(8) Schedulers complete scheduler training prior to being released to work unit.

(9) Annual scheduler competency assessment is completed relative to scheduling, PCMM assignments, Recall and EWL entries as appropriate.

j. MCAO Manager. The MCAO Manager is responsible for:

(1) Reviewing labor mapping of active and inactivated clinics making appropriate changes in accordance with MCAO guidelines in collaboration with ACOS/SLC/M and

FRM.

(2) Assigning Stop Code(s) to newly established or modified clinics in accordance with Appendix L.

(3) Conducting annual review of all active clinic profiles in accordance with Appendix L in collaboration with FRM ensuring accuracy of MCAO codes, labor mapping adjustments.

k. Scheduler/Primary Care Management Module (PCMM) Coordinator. The Scheduler/PCMM Coordinator is/are responsible for ensuring:

(1) Adherence to business rules detailed in appendices A-T.

(2) Successfully completing national Talent Management System (TMS) scheduling modules and Soft Skills trainings. Maintaining documentation of evidence of required minimum training.

(3) Scheduling errors are corrected in accordance with Appendix E, Correcting Scheduling Errors in Business Rules.

(4) Patient no shows are entered in VistA Scheduling prior to the end of the workday in accordance with Appendix I and VHA Directive 1232, Consult Processes and Procedures.

(5) Electronic Wait List (EWL):

(a) Veterans Choice Program (VCP) policy regarding EWL and Choice processes are followed when appointments cannot be scheduled within 30 calendar days of the CID or PD.

(b) Patients are removed from the EWL, in accordance with Appendix J, after an appointment has been made for the patient, or when unable to contact Veteran after making the required number of contact attempts or if the Veteran is deceased.

(c) Appointments are made from EWL requests beginning with highest priority level, (PL1-8), then by chronological date, in accordance with Appendix J.

(d) EWL Reports are reviewed daily in accordance with Appendix J.

(e) Clinic grids are scanned daily to identify appointment availability in order to schedule an appointment and remove patients from the EWL.

(f) PCMM Coordinator promptly schedules new enrollees from the NEAR List, EWL patients requesting Primary Care.

l. HAS Application Specialist/Clinic Profile Manager/Clinical Application Coordinator. The HAS Application Specialist/Clinic Profile Manager/Clinical Application Coordinator is responsible for:

(1) Establishing clinic profiles in VistA in accordance with Clinic Profile Template in Appendix L.

(2) Ensuring VistA scheduling nightly software background jobs run accordingly, and mail groups notify appropriate staff so that appropriate action can be taken from the nightly runs.

(3) Minimizing and monitoring access to the VistA Scheduling options for scheduling appointments, PCMM menu options, Recall, and EWL entries to ensure staff competency in performing these duties. Assign “view only” options to those staff who do not require access to make appointments.

(4) Timely completion of clinic cancellation requests approved by respective

ACOS/SLC/M.

m. Facility Talent Management System (TMS) Administrator/TEMPO. The facility TMS Administrator/TEMPO must:

(1) Document employee scheduling training.

(2) Maintain and validate annually the facility Master Scheduler List. This list includes all individuals, including direct supervisors, with assigned VistA menu options to create outpatient appointments, make entries to Electronic Wait List (EWL) or make entries to the Primary Care Management Module (PCMM).

(3) Enter Soft Skills training completion into TMS from sign-in sheets of participants who took face-to-face training into the Talent Management System (TMS).

6. REFERENCES

a. Public Law 104-262, 113-146, 105-368

b. Public Law 110-181 National Defense Authorization Act of 2008

c. Public Law 113-146 Veterans Access, Choice and Accountability Act of 2014

d. Veterans Access Choice and Accountability Act of 2014, 38 CFR 17.1510.

e. 38 U.S.C. 1703, 1705 1710

f. Code of Federal Regulations (CFR) 17.52, 17.100, 17.36, 17.37, 17.38, 17.49

g. VA Handbook 6340, Mail Management, dated September 11, 2017.

h. VA Financial Policy, Volume XIII, Cost Accounting, Appendix E, VHA Standardization of Stop Codes.

i. VHA Directive 1231, Outpatient Clinic Practice Management, dated November 15, 2016.

j. VHA Directive 1232, Consult Processes and Procedures, dated August 23, 2016.

k. VHA Directive 2007-033, Telephone Service for Clinical Care, dated October 11, 2007.

l. VHA Directive 1082, Patient Care Data Capture, dated March 24, 2015.

m. VHA Handbook 1601A.03, Enrollment Determinations, dated September 25, 2015.

n. ACAP SharePoint Scheduler Training information https://vaww.vha.vaco.portal.va.gov/sites/DUSHOM/10NA/ACAO/AdministrativeAccess/ Scheduler%20Training/Forms/AllItems.aspx?InitialTabId=Ribbon%2EDocument&Visibili tyContext=WSSTabPersistence

o. Insurance Capture Buffer (ICB) training and job aids information:

https://vaww.cboebusiness.fsc.va.gov/SitePages/ICB.aspx https://vaww.vha.vaco.portal.va.gov/sites/DUSHOM/10NA/ACAO/AdministrativeAccess/Scheduler%20Training/Forms/AllItems.aspx?InitialTabId=Ribbon%2EDocument&VisibilityContext=WSSTabPersistence https://vaww.vha.vaco.portal.va.gov/sites/DUSHOM/10NA/ACAO/AdministrativeAccess/Scheduler%20Training/Forms/AllItems.aspx?InitialTabId=Ribbon%2EDocument&VisibilityContext=WSSTabPersistence https://vaww.vha.vaco.portal.va.gov/sites/DUSHOM/10NA/ACAO/AdministrativeAccess/Scheduler%20Training/Forms/AllItems.aspx?InitialTabId=Ribbon%2EDocument&VisibilityContext=WSSTabPersistence

p. Scheduling Community of Practice on VA PULSE at the following link:

https://www.vapulse.net/community/acap/acap-scheduling https://www.vapulse.net/community/acap/acap-scheduling

A-1

APPENDIX A

RESOURCES

a. VA Software Document Library: http://www.va.gov/vdl/section.asp?secid=1

b. Scheduling User Manual: http://www.va.gov/vdl/application.asp?appid=100

c. EWL User Manual: http://www.va.gov/vdl/application.asp?appid=131

d. Recall Reminder System User Guide:

http://www.va.gov/vdl/application.asp?appid=100

e. Supervisors Menu: http://www.va.gov/vdl/application.asp?appid=100

f. Appointment Menu: http://www.va.gov/vdl/application.asp?appid=100

g. Registration Menu: http://www.va.gov/vdl/application.asp?appid=100

h. Ambulatory Care Reporting: http://www.va.gov/vdl/application.asp?appid=100

i. NEAR Manual: http://www.va.gov/vdl/application.asp?appid=100

j. Transitioning Service Members/Veterans: Making Appointments (November 2015) http://vaww.va.gov/hec/Library/pubs/AppointmentScheduling/10- 634_scheduling_appointments_for_transitioning_service_members.pdf. NOTE: This is an internal VA Web site that is not available to the public.

k. VA Pulse: ACAP Community: https://www.vapulse.net/community/acap

l. Health care Operations Dashboard:

https://bioffice.pa.cdw.va.gov/default.aspx?bookid=ae854f2f-2cd0-444d-a7c7-bfd7b1b00e0c|ispasFalse|report61060160-deea-4d45-903a- 776f97f33415|ws4|wsb0|isDisabledAnalyticsFalse|isDashboardPanelOnTrue

m. VSSC: Access and Clinic Administration: http://vssc.med.va.gov/. NOTE: This is an internal VA Web site that is not available to the public.

n. Supervisor Audit Tool:

https://vaww.app.dev.dwh.cdw.portal.va.gov/BISL_SCHEDAUD/APP/v1/#/home.

NOTE: This is an internal VA Web site that is not available to the public.

o. Scheduling Trigger Tool:

http://reports2.vssc.med.va.gov/ReportServer/Pages/ReportViewer.aspx?%2fSysRD%2 fWaitTimes%2fScheduling+Trigger+Tool&rs:Command=Render. NOTE: This is an internal VA Web site that is not available to the public.

http://www.va.gov/vdl/section.asp?secid=1 http://www.va.gov/vdl/application.asp?appid=100 http://www.va.gov/vdl/application.asp?appid=131 http://www.va.gov/vdl/application.asp?appid=100 http://www.va.gov/vdl/application.asp?appid=100 http://www.va.gov/vdl/application.asp?appid=100 http://www.va.gov/vdl/application.asp?appid=100 http://www.va.gov/vdl/application.asp?appid=100 http://www.va.gov/vdl/application.asp?appid=100 http://vaww.va.gov/hec/Library/pubs/AppointmentScheduling/10-634_scheduling_appointments_for_transitioning_service_members.pdf http://vaww.va.gov/hec/Library/pubs/AppointmentScheduling/10-634_scheduling_appointments_for_transitioning_service_members.pdf https://www.vapulse.net/community/acap https://bioffice.pa.cdw.va.gov/default.aspx?bookid=ae854f2f-2cd0-444d-a7c7-bfd7b1b00e0c%7CispasFalse%7Creport61060160-deea-4d45-903a-776f97f33415%7Cws4%7Cwsb0%7CisDisabledAnalyticsFalse%7CisDashboardPanelOnTrue https://bioffice.pa.cdw.va.gov/default.aspx?bookid=ae854f2f-2cd0-444d-a7c7-bfd7b1b00e0c%7CispasFalse%7Creport61060160-deea-4d45-903a-776f97f33415%7Cws4%7Cwsb0%7CisDisabledAnalyticsFalse%7CisDashboardPanelOnTrue https://bioffice.pa.cdw.va.gov/default.aspx?bookid=ae854f2f-2cd0-444d-a7c7-bfd7b1b00e0c%7CispasFalse%7Creport61060160-deea-4d45-903a-776f97f33415%7Cws4%7Cwsb0%7CisDisabledAnalyticsFalse%7CisDashboardPanelOnTrue http://vssc.med.va.gov/ https://vaww.app.dev.dwh.cdw.portal.va.gov/BISL_SCHEDAUD/APP/v1/%23/home http://reports2.vssc.med.va.gov/ReportServer/Pages/ReportViewer.aspx?%2fSysRD%2fWaitTimes%2fScheduling%2BTrigger%2BTool&rs%3ACommand=Render http://reports2.vssc.med.va.gov/ReportServer/Pages/ReportViewer.aspx?%2fSysRD%2fWaitTimes%2fScheduling%2BTrigger%2BTool&rs%3ACommand=Render

B-1

APPENDIX B

GENERAL SCHEDULING BUSINESS RULES

1. Provide Veterans non-emergent outpatient health care service in accordance with the enrollment determination Priority Groups 1-8 defined in VHA Handbook 1601A.03, Enrollment Determinations, or subsequent policy issue.

a. Priority scheduling of any Service Connected (SC) Veteran will not affect the medical care of any previously scheduled Veteran.

b. Emergent and urgent health care needs take precedence over a service connected priority status.

2. Provide Veterans care in accordance with the Comprehensive Mental Health Strategic Plan of 2004 and VHA Handbook 1160.01, Uniform Mental Health Services in VA Medical Centers and Clinics, or subsequent policy issue, each of which places a high priority on enhancing mental health services for returning Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) Veterans, as well as for those who served in prior eras.

3. The VHA wait time goal is 30 calendar days or less from the date that an appointment is deemed clinically appropriate by a VA health care provider, which is the Clinically Indicated Date (CID), or in the absence of a CID, the Veteran’s Preferred Date (PD).

NOTE: See Appendix U for goals on scheduling walk in appointments for Veterans at VA medical facilities.

4. Organizationally align scheduler positions as close to the facility service having primary responsibility and oversight of scheduling processes as possible, e.g., Health Administration Service (HAS) or the Community Care.

5. Staff assigned VistA menu options and keys for active access to scheduling, Recall Reminder (RR), and EWL must have documented evidence of completing the required minimum national Talent Management System (TMS) training modules, and team building concepts.

6. Maintain facility Master Scheduler List in order to identify staff assigned VistA menu options and keys for scheduling processes.

7. Create and capture outpatient appointments, meeting the definition of an encounter, in count clinics using VistA Appointment Management to result in timely processing of workload capture by Patient Care Encounter (PCE) and National Patient Care Database (NPCD).Refer to VHA Directive 1082 Patient Care Data Capture.

8. Assign the “View only” VistA scheduling option to staff who need to view patient information and appointments only. The “view only” option negates requirements for scheduler training, competency assessment, and auditing.

C-1

APPENDIX C

SCHEDULING BUSINESS RULES

1. Schedule appointments immediately but no later than three calendar days after the request. NOTE: Schedule appointment requests generated through the Consult package in accordance with VHA Directive 1232, Consult Processes and Procedures.

See Appendix U for procedures on scheduling eligible Veterans who walk in at VA medical facilities.

2. Validate and update at each appointment the patient’s demographics, e.g., address, contact information, and health insurance when applicable utilizing the Insurance Capture Buffer (ICB) software.

3. Make future appointments based on the Clinically Indicated Date (CID) entered by the provider in the Computerized Patient Record System (CPRS) order entry. Date ranges are not acceptable.

a. At check out, complete the CID order by offering to make the appointment “on the spot” or at a later time with patient’s input.

b. Unless otherwise specified by provider, the CID date is defined to mean the patient can be scheduled within 30 calendar days of that CID date.

c. Providers must enter the CID in the CPRS orders tab.

d. Schedulers must use the CID documented in CPRS orders to make future appointments, or enter the CID into the appropriate Recall Reminder (RR) field, if the patient requests to make an appointment at a future time. These activities must be done at the time of checkout.

e. If the Veteran wishes to make the appointment beyond 30 calendar days from the CID, the scheduler should notify the ordering provider for approval to ensure appropriate clinical care and an adequate supply of medications.If VA is not able to offer an appointment within 30 days of the CID/PD, the patient may be eligible for the Choice program. In this case, the scheduler must ask the patient if they would prefer to make an appointment in the community or wait beyond 30 days for a VA appointment.

f. If the patient chooses the community referral, the scheduler must enter the request on the Veterans Choice List (VCL).

g. If the Director has approved the single booking process for Choice appointments and the patient chooses to make a VA appointment beyond 30 days, then the scheduler includes the string “ #COO#” (meaning Choice Opt Out) in the comment section of the pending appointment. In this case, the patient’s request is NOT entered on the VCL.

4. Schedulers must transcribe the CID located in CPRS order into the CID/PD field of VistA Scheduling or RR. Do not change the CID or PD unless the patient cancels and

C-2 reschedules the appointment. NOTE: In the future, the “Desired Date” field label in VistA will change to “CID/PD.”

5. Schedule appointments for new or established patients, or for established patients requesting appointments where no CID is available according to the Veteran’s preferred date (PD). Enter the PD in the (CID/PD) field of VistA Scheduling.

6. Schedule clinic appointments requested through an inpatient discharge event according to the provider’s CPRS order entry. This order contains the CID.

7. Use the “Next Available” (NA) VistA appointment option when a patient or a provider specifically requests a next available appointment or EWL appointment requests with “as soon as possible” (ASAP) as the “DD”. When entering a NA request, the default for the PD is “Today” and the clinic grid in VistA will open to the first available appointment in the provider’s schedule. Schedule appointment with patient input for that date/time.

In order to use the NA option best in the legacy VistA Application:

a. Identify open capacity by running VistA’s “Display of Clinic Availability” report.

Provide report to providers and triage staff once or twice daily as needed for their information about when clinic slots become open in the future.

b. Schedulers use this information to inform patients when the provider’s schedule has open capacity in order to negotiate future appointments with patients.

8. Schedule walk-in or or call-in appointments according to Licensed Provider (LP) or Registered Nurse (RN) directions. For example, a walk-in or call-in patient is triaged by the provider or nurse who determines the appointment date. Schedulers will enter the LP/RN’s request in the appointment comment section when scheduling the appointment.

9. If a provider requests a patient’s RTC on a specific date, schedule the RTC exactly as specified. NOTE: If the clinic is full on the requested date, the scheduler must overbook the request. Clinic profiles must include be set up to allow overbooks.

10. Enter “cancelled by patient” when a patient originates the cancellation request.

Also, Enter preset cancellation reason: Death in family, Other, Transfer Outpatient (OPT) care to other VA; Travel difficulty, Unable to keep appointment, Weather. NOTE:

Use of “other” requires additional comment.

11. Schedule all patient appointments with patient’s input. Do not blind schedule appointments.

a. Document two contacts (one phone call and a contact letter) occurring on separate days via VistA scheduling comment field or electronic Progress Note template per local policy.

b. Monitor undeliverable and returned letters to the facility and document in patients, “Bad Address Indicator.”

C-3

c. After 14-calendar days without patient’s response to letter, provider enters a disposition of the appointment status in patient’s record. (See Appendix S)

d. Scheduler enters this disposition in scheduling comment field. Remove from RR or EWL, or respond to consult as appropriate.

12. Search VistA clinic grids daily to identify open appointments resulting from patient cancellations or unscheduled appointments. Offer these open appointments to:

a. Patients on the EWL by Priority Level Groups 1-8, then by chronological date.

Schedule if Veteran accepts the offered appointment date/time and remove patient from the respective EWL. If Veteran declines, assure individual of future contact for an

b. Patients with future appointments seeking an earlier appointment.

c. Same day consults, walk-ins.

13. Enter ‘Unscheduled’ visit for a walk-in patient for the current date.

14. If patient requests a new appointment, cancel appointment “by patient,” make a new appointment with the patient’s new PD. NOTE: Wait time is measured from the patient’s new PD and the original CID is cancelled.

15. Supervisors should monitor reports including those found in Appendix Q to review supply and demand, access data, scheduling errors addressing issues accordingly.

16. Schedulers must not hold appointment slots with “Test Patients”, “ZZ Test Patients” or anything other than an eligible Veteran. The following link provides a list of test patients scheduled in live VistA accounts:

https://securereports2.vssc.med.va.gov/reportserver?%2fSystems+Redesign%2fTest+a nd+Deceased+Patient+Appointments+-+Summary&rs:Command=Render.

NOTE: It is recommended that all clinics develop scheduling Standard Operating Procedures (SOP) that align with this directive. SOP’s allow clinical decisions made by the team to be implemented in a standard way. For example, an SOP may guide schedulers in handling walk-in patients or specify streamlined procedures for flu shots.

https://securereports2.vssc.med.va.gov/reportserver?%2fSystems%2BRedesign%2fTest%2Band%2BDeceased%2BPatient%2BAppointments%2B-%2BSummary&rs%3ACommand=Render…