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Generally, we are pleased with the progress to
date with this new concept for managing the prosthetic program,
and we feel it holds great promise for the future. For this management
concept to be effective however, it is essential that the VPR
be authorized to manage the prosthetic budget for the network
and make appropriate staff level and salary decisions. The necessary
tools are in place to allow PSAS SHG to accurately monitor prosthetic
activities and advise the USH of any problems or deficiencies
that may develop
BVA continues to be frustrated by the abject
defiance of some Network Directors regarding the responsibilities,
authority, and scope of operation for these VPR positions. Such
Directors have chosen to ignore directives from the USH regarding
these issues and there is no evidence they are being held accountable
for their actions.
Mr. Chairman, we also question the level of support
for the Prosthetics program demonstrated by most Network Directors.
Since the adoption of the Eligibility Reform Act, the Prosthetic
workload has increased by 87 percent with only a 13 percent increase
in FTEE to manage this increased workload. First quarter Delayed
Order Reports for PSAS show more than 11,000 delayed orders. The
reason given for more than 8,000 of those orders is excessive
workload and inadequate staffing. Although facility and Network
Directors no longer have the financial burden of paying for prosthetics
with the return to centralized funding, they absolutely must support
the service with appropriate staffing levels. Further complicating
the staffing situation is the refusal on the part of many high-level
managers to properly grade the prosthetic purchasing agent positions.
Consequently, PSAS is experiencing an unusual rate of turnover.
Employees are working numerous unreported overtime hours, both
paid and unpaid, in an effort to keep up. They are becoming quickly
burned out and look for other employment opportunities with higher
pay and more reasonable workloads.
Despite the positive improvements, such as centralized
funding and the establishment of VPR positions, one of the most
significant problems confronting prosthetics is the lack of qualified
professionals to assume the duties of Prosthetic Representative.
The Prosthetic training program that operated very successfully
for many years has been discontinued. This action has eliminated
an excellent source of highly trained and qualified personnel
prepared to move into these valuable positions. Failure to restore
the training program and accompanying funding will certainly result
in increasingly unqualified individuals being selected to fill
prosthetic representative positions. The quality of service to
disabled veterans assuredly will suffer as a direct consequence.
Mr. Chairman, I discussed in some detail the
BRS Outcome Project which is developing a functional outcome database
from which management decisions conceivably can be made. We believe
the next step in this process is to enable the database to talk
or interface directly with the NPPD. Both are powerful tools for
monitoring their respective activities. Think how much more effective
and efficient each service might be if blind rehab professionals
could analyze functional outcomes not only in terms of the rehab
model employed, but the impact of prosthetic aids and appliances
prescribed on the rehab outcomes.
With this in mind, BVA is very pleased by the
new initiative underway within Prosthetics Service. Specifically,
it has launched the Prosthetic Clinical Management Program whose
focus is on the quality of prescriptions rather than solely on
the dollars expended. Panels of experts in each network will be
established to review prescriptions and their impact on the overall
well-being and improvement in the quality of life of veterans.
We are convinced this is where the focus should be and believe
this will contribute dramatically to improved quality of care.
We are particularly interested in this approach because the chapter
in the new PSAS Handbook related to the provision of aids for
the blind is unacceptably restrictive. Specifically, it denies
qualified local providers from prescribing or providing certain
aids for the blind without the approval of a BRC Chief. Now, with
the ability to accurately monitor prescriptions at each facility
through the NPPD, inappropriate prescription and issuance practices
can be exposed and properly dealt with. BVA is very pleased the
VA, PSAS, and BRS will be conducting a national training program
later this summer in conjunction with the BVA 56th National Convention.
The organization is hopeful that the philosophical and process
differences can be resolved, assuring blinded veterans have timely
access to essential prosthetic services at the most appropriate
level of service delivery.
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