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601 Highway 6 West

Iowa City, IA 52246


In Reply Refer To: 636A8/00

The Honorable Charles Grassley
United States Senator
135 Hart Senate Office Building December 3, 3018
Washington, D.C. 20510

Dear Senator Grassley:

Thank you for your letter regarding a recent report in the USA Today that referenced the Iowa
City VA. Your inquiry was reviewed by Iowa City VA Health Care System (ICVAHCS)
radiology department.

In your inquiry, you requested that the Iowa City VA address three questions. The following
are responses to your questions:

The Iowa City VA claims that cancellations of Radiology appointments happened in a "small
number of instances."
Q: How many total cancellations occurred?
A: From January to February of 2017, there were 4051 orders cancelled in the southern
tier of VISN 23.

Q: How many of these cancellations were determined to have been made in error?
A: There was one instance in Iowa City where a patient showed up for an appointment
that had been canceled, and the staff reacted quickly to ensure the patient got the care
they needed immediately.

Q: How did the Iowa City VA determine that a Radiology appointment was improperly
A: In the case where a patient showed up for a Radiology appointment and the order
had been cancelled, the issue was that the order that needed to be cancelled was a
duplicate order, and both parties cancelling the order believed they were cancelling the
duplicate order. Once the team realized this error, they immediately contacted the
physician to submit a new order and proceeded with the Veteran's appointment, getting
the patient the care they needed at the time it was needed. In this case, measures were
taken to correct the staff mistake and appropriate personnel actions were taken and staff
reviewed the cancellations to ensure every order that required action was reviewed
appropriately by a radiology provider.

Q: In addition, please detail the process that the Iowa City VA is using to follow up with a
Veteran to ensure they are receiving proper imaging care.
A: When a provider enters an order for a CT, MRI, or Ultrasound radiology test in Iowa
City, the order is reviewed by a Radiologist according to Iowa City VA scheduling
protocol to determine if the order is appropriate. If not, radiology will contact the ordering
provider who will determine to proper course of care for the patient.

If the order is appropriate, it is sent to scheduling and the Veteran is called to

make an appointment for a test. A letter is sent to the patient informing them of the date

For more information about Iowa City VA Health Care System VA Clinics, visit:
and time of the appointment, and a text and email reminder is sent to the patient 24
hours prior to the appointment.

If the patient does not show up to the appointment, the order is cancelled and a
notification letter is sent to the patient and a cancellation note is entered into the medical
record for the provider to cosign. The ordering provider will determine the next course of
action for the patient. These no-show rates are tracked closely by the ICVA and any
trends are addressed in a timely manner.

We appreciate your inquiry as it affords us the opportunity to improve the care we deliver. If you
have any other questions regarding the information contained within this letter, please contact
Bryan Clark, Public Affairs Officer, 319-339-7104. We appreciate your continued support of our


Judith L. Johnson-Mekota, FACHE