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Crucial to the rehabilitation of blinded veterans
is the proper prescription of sensory aids and appliances. As
outlined above, it is the blind rehabilitation specialist that
prescribes the appropriate adaptive equipment to assist in overcoming
the handicap of blindness. Fundamental to the process is the timely
and accurate procurement of these devices. The professional service
that manages this activity is Prosthetics and Sensory Aids Service
(PSAS).
More than 10 years ago, the Senate Committee
on Veterans Affairs conducted an oversight hearing on Prosthetic
Services because of numerous reports of severely disabled veterans
not receiving essential prosthetic devices in a timely manner.
Indeed, many of these veterans had to wait months for prosthetic
limbs and other appliances critical to independent functioning.
That hearing exposed the fact that dollars allocated to the local
facilities for prosthetics were being utilized for other medical
center functions rather than for essential prosthetic services.
Many of the major VSOs testified at that hearing, reporting on
the failure of VA to provide these services and the ensuing consequences
that was having on the quality of life for our Nation's severely
disabled veterans. We also testified in support of centralized
funding for Prosthetics Services to insure sufficient dollars
for these services, and to ensure that appropriated funds for
prosthetics were appropriately utilized to purchase prosthetic
equipment rather than to support other medical center functions.
Further, we believed the method of funding these vital services
would lend itself to closer monitoring of these appropriated dollars.
As a direct result of the hearing and its
findings, VA did in fact implement centralized funding for Prosthetic
Services. A dramatic reduction in the number of complaints surrounding
delayed orders and difficulties in receiving prosthetic devices
was experienced almost immediately. Despite this significant improvement
in service delivery, VA management, particularly at the local
level, has attempted to have the prosthetic funds decentralized
once again and nearly every year thereafter. Obviously, the motivation
is to have the opportunity to utilize those funds for purposes
other than for providing prosthetic services. Clearly, this is
just another symptom of the magnitude of the under-funding of
veterans health care. Despite the vigorous opposition by the major
VSOs and the Federal Advisory Committee on Prosthetics and Special
Disabilities Programs, Dr. Kizer decentralized prosthetics funding
to the networks.
Mr. Chairman, BVA was encouraged by the action
taken by Dr. Kizer to strengthen the PSAS program and eliminate
the problems identified last year. He began by returning Mr. Fred
Downs to the Chief Consultant for the PSAS Strategic Health Group
(SHG) position. Dr. Kizer also provided two additional FTEE for
the VAHQ staff. This has enabled PSAS to monitor more aggressively
prosthetic activities in the field. Further, an aggressive Prosthetic
Program Reengineering Project (PPRP) was implemented. This has
resulted in significant improvements and provided electronic methods
for tracking prosthetic expenditures, insuring appropriate uses
of these dollars. A direct outcome of the PPRP project has been
the development of the National Prosthetic Patient Database (NPPD).
This is an extremely powerful tool to assist PSAS managers. They
can virtually monitor prosthetic activities, which provides invaluable
data regarding not only who ordered an item, for whom it was intended,
when the order was placed, and whether the order was properly
coded.
As mentioned above, BVA has strongly supported
centralized funding for PSAS. We were very encouraged by Dr. Garthwaite's
decision last summer to resist pressures from the field and re-centralize
Prosthetic funding, as the dollars being spent resulted in an
increase in delayed orders. Additionally, BVA is also encouraged
by the decision to establish lead prosthetic representatives for
each network. These positions are referred to as VISN Prosthetic
Representatives (VPR). These individuals are responsible for developing
an integrated network prosthetic plan that would include the budget,
PSAS activities at each facility within the network, and educational
and training needs for staff. The selection of these positions
has been slower than anticipated, however, and this seems directly
related to efforts on the part of several networks to assign VPR
duties collaterally to an existing Prosthetic Representative.
Clearly, this new position must be full-time and filled by an
individual with a strong background in prosthetics as well as
management. As in other positions we have described above, there
has been a tendency to try to fill these new positions with individuals
who do not meet these basic criteria.
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