The House Committee on Veterans Affairs, Subcommittee on Health, held a hearing May 16 to examine the current capabilities of the Department of Veterans Affairs (VA) to provide state-of-the-art care to veterans with amputations. The Committee heard testimony concerning VA’s proposal to change procurement processes for prostheses. The change is set to take effect July 30, 2012.
In her testimony, Lucille Beck, PhD, acting chief consultant Prosthetics and Sensory Aids Service (PSAS), Veterans Health Administration (VHA), VA, outlined three procurement practices reform strategies. First, VHA is transferring purchasing authority from PSAS prosthetics purchasing agents to contracting specialists for any purchase more than $3,000. Beck said this change will “extract better prices and more competition in obtaining the devices and supplies veterans need when appropriate.” Second, VHA is pursuing a phased approach to standardize and define commodities for its products where appropriate. Third, VHA is updating policies and directives to better guide clinical and procurement staff on the proper use of Title 38, United States Code (U.S.C.), section 8123, the procurement of prosthetic appliances. “These updates will allow us to more accurately and timely provide services to the benefit of veterans,” Beck said.
According to a press release from the House Committee on Veterans Affairs, currently, VA provides care to about 42,000 veterans with limb loss. As of August 2011, 1,506 service members had experienced amputations on active duty from Operations Enduring and Iraqi Freedom. An additional 2,248 veterans underwent major amputations at VA in 2011. VA prosthetic costs have more than doubled in the past five years, yet, VA’s care has fallen behind that of the Department of Defense (DoD).
Several veterans who testified before the Subcommittee expressed their concern about VA’s ability to perform under the proposed changes to the procurement processes and that the changes might adversely affect veterans with amputations.
“Prosthetics are a truly individualized extension of one person’s body and mobility, not your typical bulk-supply purchase,” testified Jim Mayer, a Vietnam veteran, bilateral amputee, and wounded warrior advocate and mentor. “When today’s warriors are referred to VA and seek the newer, cutting-edge, technologically superior prosthetics they have been accustomed to [through DoD], will VA be able to meet that demand?”
Jonathan Pruden, a retired Army captain who lost his right leg to an improvised explosive device in Iraq in 2003, and an alumni manager for the Wounded Warrior Project, also expressed his concerns to the subcommittee over a planthat might only offer a “modest savings.” These changes, he said, “will, at a minimum…lengthen the time between when the clinician and prosthetist see and evaluate a veteran for a new device and when he actually receives it. Even more problematic, the change heightens the risk that a fiscal judgment will override a clinical one….”
“VA has been struggling to keep pace with the rising demands of younger and more active veterans with amputations,” said Representative Ann Marie Buerkle (R-NY), chairwoman of the Subcommittee on Health. “VA must continue to provide multidisciplinary care to maintain long-term and lifetime quality of life. Placing prosthesis procurement into the hands of contracting officers is alarming. VA has been a leader in helping veterans with amputations regain mobility and achieve maximum independence. This is why I am troubled by VA’s proposed changes in procurement policies and procedures, which shift the emphasis from the doctors to contracting officers.”
Norbert Doyle, chief procurement and logistics officer, VHA, VA, said that they have learned from the pilot programs that were first instituted and “we’re implementing changes to ensure that care is not impacted.”
