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As we step into May, we celebrate our serving Veterans and those who once served with two special holidays this month: National Armed Forces Day on May 21st and Memorial Day on May 30th.
As we remain steadfast to our commitment to better serve our Veterans, I am continuously impressed with our Referral Coordination Teams (RCT) and the impact they are making on Veterans' health care journeys. Implementing RCTs at your VA medical centers ensures that we are being truly Veteran-centric. By discussing all health care options with Veterans, RCT staff empower Veterans to make health care choices that align with their values and wishes.
I’m excited to share that our team has been hard at work as the Referral Coordination Initiative (RCI) program has expanded to make the SharePoint site easier for you to navigate.
Key improvements include:
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New Layout: RCI material has been put into specific categories, allowing users to navigate needed materials more quickly and effectively.
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Updated Supporting Documents: Materials have been streamlined to improve implementation and knowledge
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Role Based Learning Paths: Direct links to training materials based on specific roles and responsibilities
I encourage you to spend time exploring the SharePoint and utilizing the resources. We welcome your feedback to make the information even better. I’m confident you’ll find the revamped SharePoint more user-friendly.
Thank you for your continued commitment and hard work.
Lisa Arfons, M.D.
Acting Executive Leadership Team
Integrated Veteran Care
Continue reading this month’s newsletter for more details.
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The RCI Guidebook is a guide for Department of Veterans Affairs (VA) staff that highlights how to establish, operate and manage RCTs.
As VA strives to continuously improve, the national RCI team re-designed the guidebook and updated it based upon input from Veterans Integrated Service Network (VISN) and VA medical center (VAMC) staff. The guidebook provides systematic RCI business and clinical processes for VA staff to coordinate Veteran care across the referral continuum.
In addition, RCI one pagers were developed as supplemental resources to the guidebook. They can easily be accessed via links in the RCI Guidebook or through the new RCI SharePoint.
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We heard you! A new and improved SharePoint is rolling out this May with streamlined access to resources. The newly structured SharePoint provides a new look and feel with a more user-friendly format allowing for one-click access to key areas.
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RCI Guidebook Page. Allows users direct access to the RCI Guidebook and supplemental documents that provide national guidance about RCI roles and responsibilities, implementation tasks, consult management processes, data and reporting, and additional resources with samples.
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RCI Communications Page. Provides nationally approved communications materials and tools to assist staff when communicating RCI's goals and benefits.
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RCI Data Page. Provides the reports needed to monitor and analyze RCI data to ensure Referral Coordination Teams are operating effectively and efficiently.
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RCI Training Resources Page. Provides trainings and resources on the purpose, goals, benefits, and impact of RCI.
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RCI Office Hours (OH) and Upcoming Events Page. Allows users to review and download previous OH materials and a list of upcoming RCI events.
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RCI VISN/VAMC RCI Point of Contact (POC). Resource for VISNs/VAMCs to connect through a Community of Practice and/or allow VISNs/VAMCs Referral Coordination teams to collaborate.
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RCI Question and Answer (Q&A) Database. Allows users to search RCI Frequently Asked Questions (FAQs) and submit RCI questions in centralized location.
If you have any questions, please use the new RCI Q&A Database available on the RCI SharePoint.
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The Veterans Health Administration (VHA) provided guidance for associating consults in addition to stop code 669 in the December 2021 memorandum “Additional Stop Codes for Community Care”.
Per the Managerial Cost Accounting Office (MCAO), consults for care rendered in the community must be assigned stop code 669 to designate community care. Exceptions to this designation include dialysis care per MCAO guidance.
Subsequent stop codes can be assigned to further specify the types of care rendered. When additional stop codes are added, VAMC staff improve data mining capabilities for their community care consults and referrals.
Benefits of these community care consult updates include:
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Comparative Data Availability. Improves the ability to capture and compare the types of care being referred to community care against the types of care being provided within the VAMC.
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Comprehensive Utilization Analysis. Strengthens VAMC internal services and targets enhancement of appointment options by understanding the volume and types of care referred to community care.
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Improved Consult Structure. Enhances community care consult setup by confirming that consults are appropriately created, named and appropriate stop codes assigned to capture the type of community care.
When applying additional stop codes and for accurate data collection, include details of a specific consult and its services so the stop code meets a similar level of specificity but note they do not apply to internal VA-provided clinic consults.
Sites that add stop codes to their consults can filter the data in the RCI VHA Support Services Center (VSSC) Dashboard to compare trends that specify the types of consults and care rendered, such as clinical procedures or community care.
For additional resources, please reference the Office of Community Care Field Guidebook, Specialty Program Section 1.3. A report to monitor the assignment of additional stop codes to community care consults can be found in the RCI VSSC Dashboard - OCC Stop Code Assignment.
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RCI promising practices were collected through reviewing all VISNs and interviewing staff across six VISNs, to include all hospital complexity levels, that showed consistency and improvements in their ability to sustain RCI successfully. Promising practices were captured from eight VAMCs based on their positive outcomes that achieved our mission of successfully empowering Veterans to make informed health care decisions, improving timeliness of appointments, and offering additional assistance to Veterans when needed. While this article highlights the promising practices that were gathered from these interviews, we are continuously looking for other promising practices to share.
Sharing promising practices is critical to continuous improvement and supports other VAMCs in performing at an optimal level. Below highlights the three main promising practices captured from the interviews:
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Leadership Support. The RCT Champion provides supportive and encouraging guidance across multiple service lines which fosters a collaborative environment between specialties and the Clinical RCT. This plays a vital role in the success of building a seamless clinical triage process. The collaboration guided by the RCT Champion results in the successful understanding of processes, creation of guidance, and improved collaboration, morale, and trust between service lines.
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Inclusion. The RCT Champion develops a workgroup which includes specialty service and Community Care key leadership staff to discuss challenges with incomplete or inappropriately forwarded consults to community care. Together, the teams work to develop processes to ensure forwarded consults are accurately completed and clinically appropriate. The inclusion of Community Care helps provide overall knowledge and understanding of the program, foster open lines of communication, and improved collaboration between the departments. These efforts have decreased consult request errors and improved scheduling timeliness of Veteran care.
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Collaboration of Resources. The VISN RCT Sponsor works with local VAMC RCT sponsors to create a Centralized Interfacility Consult (IFC) RCT. This team establishes a VISN-level Menu of Services to offer available VA care options to Veterans. The team triages each consult for VA and community care availability and discusses all eligible care options with Veterans. Veterans consistently shared that having the discussion with the IFC RCT members empowered them to make more informed health care decisions pertaining to their eligible care options.
For additional details, refer to RCI Promising Practices.
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Following a RCI Change Management Sequester in November 2021, the RCI team conducted assessments of all VISNs. After analysis of both qualitative (e.g., Healthcare Operations Center VISN submissions and Office of Inspector General questionnaire responses) and quantitative (e.g., RCI implementation checklist status and trends in RCI outcome measures) criteria, the team was able to identify areas of focus for each VAMC and facilities that would benefit from additional support implementing RCI. The results were reviewed by network and VAMC leadership. Sites that were selected to receive additional RCI implementation support further narrowed down the areas of focus to a priority topic for in-depth support. In response to the highest priority area selected by each facility for RCI support, the RCI team provided tailored discussion topics such as training, education, and change management implementation activities.
To best meet the needs of the VISNs, the RCI team hosted various options for collaborative workshops. For the more popular topics, like Community Care timeliness and funding, recruitment and retention, the team hosted larger learning sessions for subject matter experts (SMEs) and VAMCs to share promising practices with other facilities receiving support in the same topic. For other topics, the RCI team held 1:1 virtual workshops to dive into their area of interest. These 1:1 workshops allowed for direct partnership with VAMCs to discuss their needs and connect them with the best tools and SMEs to answer their questions.
Following each workshop and learning session, the RCI team sent a follow-up email with the slides discussed during the virtual workshop, additional resources, and recommendations to the facilities in their journey to implementing RCI. The RCI Team will continue to provide support to facilities as requested.
If you have any questions about the RCI process or would like to speak with a SME about a part of the process, please submit your question through the RCI Q&A Dashboard.
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