Veterans Administration 101

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By Jeffrey M. Brandt, CPO

Since founding Ability Prosthetics & Orthotics Inc. in 2004, I have become increasingly intrigued by the Veterans Administration (VA) hospital system and how it procures providers of O&P care. We all have read numerous articles over the years about how to procure a VA contract. After I founded Ability, I too began the process of reading, networking, and making sure Ability was structured in a way that would allow us to do business with the government.

Last year, we submitted three contracts and were awarded two. Through this experience, I found the procurement process did not reflect the quickly changing O&P profession. Many of the solicitations are error-laden and contain outdated terminology. Specifically, Form 2793, Shop Data Sheet, is no longer applicable, as our practitioners work in offices, not shops. Ability's offices have non-fabricating labs; we use central fabrication facilities for our devices. Our model, like many offices, is patient-centered, while the VA procurement process still reflects the practices of our fabrication-centric shop predecessors. The form reveals additional outdated questions such as, "Do you have a band saw?" or "Is your shop located in a private residence?" or, my personal favorite, "Have your limb fitters attended any post-graduate courses in prosthetics?"

With modular componentry, advanced prosthetic designs, and central fabrication, band saws are no longer a "must-have" tool-or at least, no longer a prerequisite for being awarded a VA contract (I hope Clayton Wright, my prosthetics technician instructor at Spokane Falls Community College, is not reading this). I know someone right now is asking, "What about exoskeletals?" Ask Ohio Willow Wood why they finally discontinued their ankle blocks after 100 years. In this day of quality assurance measures, business practice standards, ADA standards, accreditation, and liability, should anyone really be treating veterans from a shop at a residence? Even if the limb fitter is superbly qualified, it doesn't seem like a wise idea in 2008.

Finally, and perhaps most important, is the issue of qualification (relax, this is not an ABC-BOC debate). The limb fitter should have a master's degree or certificate from an NCOPE-accredited school along with documentation of completed prosthetic residency. While these qualifications may not ensure a talented, compassionate, or hard-working limb fitter, it does ensure the veteran will receive care from an academically, foundationally, and multidisciplinary-trained prosthetist.

The Conference

As most of us know, both the VA and military hospitals recently have come under scrutiny for their alleged and sometimes proven poor treatment of veterans. One of my partners, Jeffrey T. Quelet, CPO, and I recently had an opportunity to be a part of the solution by attending the Department of Veterans Affairs' first amputation-focused conference. Presented by the Veterans Health Administration Employee Education System Prosthetic and Clinical Logistics Office and Patient Care Services, the conference theme was "VA Amputation Care: Teams, Treatment & Technology."

The goal of the conference, held December 11-13, 2007, in Clearwater Beach, Florida, was to educate more than 125 VA specialists on the following current and emerging issues facing the treatment of veterans with amputations from the wars in Iraq and Afghanistan:

  1. Improving the delivery of an interdisciplinary approach to amputation care.
  2. Defining an ideal model of amputation care and rehabilitation across the continuum of interdisciplinary professionals.
  3. Assistance with optimal functional improvement and community re-entry for our troops/veterans.
  4. Promoting future multidisciplinary collaboration in evaluation and amputation treatment of wounded veterans.
  5. Using new and emerging technologies.

The conference was attended primarily by prosthetic manufacturers. We were one of three patient care companies in attendance. As exhibitors, we were not permitted into the conference sessions, so over the two days, employees of varying disciplines from VAs across the country spoke with us at our display table.

During these conversations, Jeff and I gained insight into how many of the VA hospitals across the country operate in-house O&P departments. We spoke to a senior healthcare inspector from the Office of Inspector General (OIG) about how facility accreditation affects VA O&P departments and credentialing of existing VA orthotists and prosthetists. We also described Ability's paperless and patient-centric practice model to Chief Prosthetics and Clinical Logistics Officer Frederick Downs Jr. and many Veterans Integrated Service Network (VISN) chiefs.

As providers, we need to continue to better our practices and strive to demonstrate a high level of care to veterans as the VA looks to private providers with which to contract.

Jeffrey M. Brandt, CPO, is president and founder of Ability Prosthetics & Orthotics Inc., headquartered in Gettysburg, Pennsylvania. Contact him at  jeff.brandt@AbilityPO.com