This report provides an overview of the impetus for the Department of Veterans Affairs (VA) to establish CBOCs, describes how they are managed and administered, discusses medical services provided at CBOCs, and summarizes what is known about the quality and cost of providing care in CBOCs compared to primary care clinics at Department of Veterans Affairs Medical Centers (VAMCs). Lastly, it describes the process for developing a new CBOC. The VA's health care system is organized into 21 geographically defined Veterans Integrated Service Networks (VISNs). VA also began developing a strategy to expand its capacity to provide outpatient primary care, especially for veterans who had to travel long distances to receive care at VA facilities. To facilitate access to primary care closer to where veterans reside, VHA began implementing a system for approving and establishing CBOCs. Generally a CBOC is defined as a fixed health care site that is geographically distinct or separate from its parent medical facility. This site can be VA-operated, contracted, or a combination of the two; however, CBOCs are required to have the necessary professional medical staff, access to diagnostic testing and treatment capability, and referral arrangements to ensure the continuity of care for current and eligible veteran patients. A CBOC can provide primary care, specialty care, subspecialty care, mental health, and pharmacy benefits. It should be noted that services can vary from clinic to clinic. There are currently 783 active CBOCs throughout the United States and its territories, including American Samoa, Guam, Puerto Rico, and the Virgin Islands. Over 2.8 million patients were seen at CBOCs during FY2008. Care is directed toward health promotion and disease prevention, management of acute and chronic medical conditions, and pharmacological management. Ensuring Quality of Care

VA's intent in establishing Community-Based Outpatient Clinics was to increase access to primary care and health services for veterans. The results and recommendations made by OIG are intended to ensure that CBOCs are "operated in a manner that provides veterans with consistent, safe, high-quality health care in accordance with VA policies and procedures."
In the early 1990s, the Veterans Health Administration (VHA)—one of the three administrations of the Department of Veterans Affairs (VA)—began developing a strategy to expand its capacity to provide outpatient primary care, especially for veterans who had to travel long distances to receive care at VA facilities. To facilitate access to primary care closer to where veterans reside, VHA began implementing a system for approving and establishing Community-Based Outpatient Clinics (CBOCs).
A CBOC is a fixed health care site that is geographically distinct or separate from its parent VA medical facility. A CBOC can be either VA-owned and VA-staffed or contracted to Healthcare Management Organizations (HMO). Regardless of how it is administered, a CBOC must have the necessary professional medical staff, access to diagnostic testing and treatment capability, and the referral arrangements needed to ensure continuity of health care for current or eligible veteran patients. VA policies require all CBOCs to be operated in a manner that provides veterans with consistent, safe, high-quality health care.
CBOCs are managed at the Veterans Integrated Service Network (VISN) level, and planning and development of a new CBOC is based on the VA's need, available resources, local market circumstances, and veteran preference.
In FY2010, VA expects to have a total of 833 operational CBOCs throughout the United States and its territories to serve over 2.8 million veteran patients. In addition to primary care, CBOCs provide mental health services, management of acute and chronic medical conditions, and pharmacy benefits, among other services. It should be noted that the type of medical services available at a CBOC can vary from clinic to clinic.
This report provides an overview of VA's rationale in establishing CBOCs, describes how they are managed and administered, discusses medical services provided at CBOCs, and summarizes what is known about the quality and cost of providing care in CBOCs compared to primary care clinics at VA Medical Centers. Lastly, it describes the process for developing a new CBOC. This report will be updated if events warrant.