VA Says It Loud and Clear, Patients Will Get Prosthetics Ordered By Their Physicians

by U.S. Medicine

September 6, 2012

By Sandra Basu

WASHINGTON — It should always be what the doctor orders.

 That was the message that VA delivered to a House subcommittee concerned about procuring the best prosthetics for patients who need them.

“We understand the critical value these devices offer, and the independent clinical judgment of our providers will and must remain fully intact,” Robert Petzel, MD, VHA undersecretary for health, told the Committee on Veterans’ Affairs Subcommittee on Health.

Petzel testified at a recent hearing where lawmakers wanted an update on VA’s planned prosthetic procurement reforms.


Orthotist Scott Gray adjusts the prosthetic leg of Tristan Wyatt during a fitting at the VA San Diego Healthcare System. Wyatt, who was wounded in Fallujah, Iraq, in 2003, is now assistant chief of prosthetics at VASDHS. VA photo by Christopher Menzie

The new policy requires prosthetic items that cost more than $3,000 to be purchased by a contracting officer, rather than the prosthetics service purchasing officers who usually handle these purchases.

The changes are designed to save money and provide better oversight for purchasing prosthetics. Some veterans’ groups complained at a hearing earlier this year, however, that the new process might cause unneeded delays in delivering prosthetics and could even mean the contracting officer’s judgment would override clinical judgment, if price is an issue.

Petzel told the subcommittee that the VA expects 100% compliance from contracting officers when it comes to the physician’s order.

“The contracting officer’s responsibility is to see that we get a fair price for it. He or she will not buy something different because it is less costly. We look at what is the physician’s order, and that is what we buy.”

Subcommittee chairwoman Rep. Ann Marie Buerkle (R-NY) opened the hearing by stating her concerns “that the reforms were developed without careful and thorough consideration” had not been quelled by a recent review of information provided by the VA.

Petzel explained, however, that the procurement reforms are a “systemwide effort” to ensure that VA has professional, certified contractors doing procurement. Prosthetics is “the last area” of procurement within VA that has not had certified warranted procurement officers handling items that cost more than $3,000, he said.

“We have been criticized in the past by organizations such as the [Inspector General] for not having a professional procurement force and for not following, in all instances, the federal regulations or VA’s acquisition regulations,” he said. “The effort is in no way directed specifically at prosthetics.”

VA Says It Loud and Clear, Patients Will Get Prosthetics Ordered By Their Physicians

Prosthetics Are Different

Buerkle said she is concerned, because prosthetics are different from other items ordered and need to be treated that way.

“Amoxicillin is amoxicillin. A thermometer is a thermometer. But a prosthetic is unique to that person and to his needs or her needs. That’s my concern with this,” she said.

Petzel said he agreed this is “the most personal of work that VA does.”

“The reforms that we are talking about will not interfere with that process. The physician orders the prosthetic, and that order can be very specific,” he said.

In a pilot that took place in three VISNs, Petzel said physician satisfaction was measured about whether they felt the prosthetic they ordered had been purchased.

The pilot found that, “100% of the time, the contracting officer adhered to the prescription,” Matt Matovsky, VHA assistant deputy undersecretary for Health, Administrative Operations, told the subcommittee.

Petzel said that VA will continue to monitor whether physicians’ orders are followed, as well as the timeliness of purchases and whether the patient and provider are satisfied.

“When we have been into this for a year or six months, we will look at the overall process and see what it has accomplished and see if, indeed, we are doing, overall, a better job of purchasing than we were before,” he said.

Veteran service organizations were not represented at the hearing to testify, but Petzel said VA officials have met with some VSOs recently, and they are on board with the reforms. Buerkle, however, suggested that VA officials make sure that they include more VSOs in conversations about the process.

“There is nothing more important than the veterans and making sure that, when they come home without a limb because they have served this nation, that they have what they need and that they are not dealing with some contracting officer who has some discretion to give him less of a device than he deserves,” Buerkle said.

VA officials also told the subcommittee that a plan for a comprehensive office of rehabilitation and prosthetics has been developed and is in “approval stages,” according to Lucille Beck, PhD, acting chief consultant for VA’s Prosthetics and Sensory Aids Service.

“In that office, we will have a national program director and large staff devoted to prosthetics and sensory-aid service. It will be managing the clinical practices, the procurement and contracting, the regulatory issue and development of all of the programs,” Beck said.  

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