From: Goff, James

Sent: Friday, November 20, 2015 9:24 AM

To: Pierce, Aaron M.; Wagner, Lana K.; Lin, Henry; Mao, Jenny T.

Cc: Hnatiuk, Oleh; Neis, Patricia C.; Esquibel, Edwin A.

Subject: RE: Cancelled Consults

I would recommend that your section meet with Henry to understand the

process.

We have a major issue with open consults greater than and we are going

through a facility wide herculean effort to resolve many old consults.

To be clear, the Integrated Care staff are not the bad guys here.

Do not shoot the messenger- get smart about the process

JMG

From: Pierce, Aaron M.

Sent: Friday, November 20, 2015 9:13 AM

To: Wagner, Lana K.; Goff, James; Lin, Henry; Mao, Jenny T.

Cc: Hnatiuk, Oleh; Neis, Patricia C.; Esquibel, Edwin A.

Subject: RE: Cancelled Consults

-I have had similar problems over the past week with multiple cancelled

outside referral consults. I have had multiple overnight oximetry studies

and PSG orders cancelled. Most of the orders are approaching 1 year old. Is

there something particularly important/relevant about a consult still being

open after a year?

-Regardless, I am getting frustrated at having to respond to these

inappropriately completed consult notifications and asking that they

(integrated care) reopen the consults. I have also been asked to replace the

consult if it is still indicated, however I think that doing that is

unacceptable for two reasons.

1) If it is really taking a year for Integrated Care/Triwest to complete

orders, that should be documented accurately in the EMR.

2) I do not have the time to reorder consults and review my

notes to appropriately justify the request. I do not need to repeat work.

-I would greatly appreciate help in resolving this issue.

ap

Aaron Pierce, M.D.

Sleep Medicine Services

New Mexico VA Medical Center

From: Wagner, Lana K.

Sent: Friday, November 20, 2015 8:56 AM

To: Goff, James; Lin, Henry; Mao, Jenny T.

Cc: Hnatiuk, Oleh; Neis, Patricia C.; Esquibel, Edwin A.; Pierce, Aaron M.

Subject: Cancelled Consults

All,

Can anyone shed light on what is happening with our consults? They are being

inappropriately cancelled. Here are some examples of the types of things

that I am talking about:

(1) Pt sent out for an oral appliance; consult was cancelled based on the

fact that sleep study (performed HERE) is in VISTA (the pt was sent out BASED

on that study).

(2) Overnight oximetry ordered >1 year ago; cancelled because it hadn’t

been performed/was expired/results were in (they weren’t). There are LOTS of

these.

(3) Pt sent out for study (no results); consult closed because a PCP note

says that Sleep Med had ordered the test.

It is distressing to find out that many of the studies that we ordered have

not been performed. It is horrifying to think that these patients are going

to fall through the cracks because these consults are being cancelled.

Surely we are not cancelling these >1yr old consults in order to make is seem

that care is not being delayed. It seems that our time as an institution

would be better spent trying to get the consults completed than trying to

find reasons to cancel them.

Can someone please help?

Lana

Lana K. Wagner, M.D.

Medical Director, Sleep Medicine Services

New Mexico VA Medical Center

Associate Professor, Internal Medicine

Division of Pulmonary, Critical Care, & Sleep Medicine

University of New Mexico School of Medicine