U.S. GOVERNMENT PRINTING OFFICE

WASHINGTON : 

For sale by the Superintendent of Documents, U.S. Government Printing Office

Internet: bookstore.gpo.gov Phone: toll free (866) 512–1800; DC area (202) 512–1800

Fax: (202) 512–2104 Mail: Stop IDCC, Washington, DC 20402–0001

75–615 2012

OPTIMIZING CARE FOR VETERANS WITH 

PROSTHETICS: AN UPDATE 

HEARING 

BEFORE THE

SUBCOMMITTEE ON HEALTH 

OF THE

COMMITTEE ON VETERANS’ AFFAIRS 

U.S. HOUSE OF REPRESENTATIVES 

ONE HUNDRED TWELFTH CONGRESS 

SECOND SESSION 

JULY 31, 2012 

Serial No. 112–72 

Printed for the use of the Committee on Veterans’ Affairs 

( 


anorris on DSK9Q6SHH1PROD with HEARING
ii 

COMMITTEE ON VETERANS’ AFFAIRS 

JEFF MILLER, Florida, Chairman 

CLIFF STEARNS, Florida 

DOUG LAMBORN, Colorado 

GUS M. BILIRAKIS, Florida 

DAVID P. ROE, Tennessee 

MARLIN A. STUTZMAN, Indiana 

BILL FLORES, Texas 

BILL JOHNSON, Ohio 

JEFF DENHAM, California 

JON RUNYAN, New Jersey 

DAN BENISHEK, Michigan 

ANN MARIE BUERKLE, New York 

TIM HUELSKAMP, Kansas 

MARK E. AMODEI, Nevada 

ROBERT L. TURNER, New York 

BOB FILNER, California, Ranking 

CORRINE BROWN, Florida 

SILVESTRE REYES, Texas 

MICHAEL H. MICHAUD, Maine 

LINDA T. SA ́ NCHEZ, California 

BRUCE L. BRALEY, Iowa 

JERRY MCNERNEY, California 

JOE DONNELLY, Indiana 

TIMOTHY J. WALZ, Minnesota 

JOHN BARROW, Georgia 

RUSS CARNAHAN, Missouri 

HELEN W. TOLAR, Staff Director and Chief Counsel 

SUBCOMMITTEE ON HEALTH 

ANN MARIE BUERKLE, New York, Chairwoman 

CLIFF STEARNS, Florida 

GUS M. BILIRAKIS, Florida 

DAVID P. ROE, Tennessee 

DAN BENISHEK, Michigan 

JEFF DENHAM, California 

JON RUNYAN, New Jersey 

MICHAEL H. MICHAUD, Maine, Ranking 

CORRINE BROWN, Florida 

SILVESTRE REYES, Texas 

RUSS CARNAHAN, Missouri 

JOE DONNELLY, Indiana 

Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public hearing records 

of the Committee on Veterans’ Affairs are also published in electronic form. The printed 

hearing record remains the official version. Because electronic submissions are used to 

prepare both printed and electronic versions of the hearing record, the process of converting 

between various electronic formats may introduce unintentional errors or omissions. Such occurrences are inherent in the current publication process and should diminish as the process 

is further refined. 


anorris on DSK9Q6SHH1PROD with HEARING
iii 

C O N T E N T S 

July 31, 2012 

Page 

Optimizing Care for Veterans with Prosthetics: An Update ................................ 1 

OPENING STATEMENTS 

Chairwoman Ann Marie Buerkle ........................................................................... 1 

Prepared statement of Chairwoman Buerkle ................................................. 18 

Hon. Michael H. Michaud, Ranking Democratic Member .................................... 6 

WITNESSES 

The Honorable Robert A. Petzel, M.D., Under Secretary for Health Veterans, 

Health Administration, U.S. Department of Veterans Affairs ......................... 3 

Prepared statement of Dr. Petzel .................................................................... 19 

Accompanied by: 

Mr. Philip Matovsky, Assistant Deputy Under Secretary for Health, 

Administrative Operations Veterans Health Administration, U.S. 

Department of Veterans Health 

Dr. Lucille Beck, Ph.D., Chief Consultant, Rehabilitation Services Director, Audiology and Speech Pathology Acting Chief Consultant, 

Prosthetics and Sensory Aids Service Veterans Health Administration, U.S. Department of Veterans Affairs 

Mr. C. Ford Heard, Associate Deputy Assistant Secretary for Procurement Policy, Systems and Oversight, Office of Acquisitions, Logistics and Construction 

MATERIAL SUBMITTED FOR THE RECORD 

Questions and Responses from the United States Department of Veterans 

Affairs .................................................................................................................... 21 

Summary of Plan to Merge Prosthetic and Sensory Aids Service and Office 

of Rehabilitation Services .................................................................................... 22 


anorris on DSK9Q6SHH1PROD with HEARING

anorris on DSK9Q6SHH1PROD with HEARING
(1) 

OPTIMIZING CARE FOR VETERANS WITH 

PROSTHETICS: AN UPDATE 

TUESDAY, JULY 31, 2012 

U.S. HOUSE OF REPRESENTATIVES, 

COMMITTEE ON VETERANS’ AFFAIRS, 

SUBCOMMITTEE ON HEALTH, 

Washington, DC. 

The Subcommittee met, pursuant to notice, at 4:40 p.m., in Room 

334, Cannon House Office Building, Hon. Ann Marie Buerkle 

[Chairwoman of the Subcommittee] presiding. 

Present: Representatives Buerkle, Roe, and Michaud. 

OPENING STATEMENT OF CHAIRWOMAN ANN MARIE 

BUERKLE, SUBCOMMITTEE ON HEALTH 

Ms. BUERKLE. The Subcommittee will come to order. Good afternoon and welcome to today’s Subcommittee hearing: Optimizing 

Care for Veterans With Prosthetics: An Update. Today’s hearing is 

a continuation of a discussion we began almost 3 months ago when 

this Subcommittee heard from veterans with amputations, members of our VSOs, and officials from the Department of Veteran Affairs to review the VA’s capability of delivering state-of-the-art 

prosthetic care to our veterans with amputations and the impact 

of the VA’s planned prosthetic procurement reforms. These reforms 

will, among other things, take prosthetic purchasing authority 

away from the prosthetic specialists and transfer it to contracting 

officers. 

As our veterans so eloquently described in May, prosthetic care 

is unlike any other care that VA may provide, and when we make 

the mistake of treating it as such, no less than the daily and ongoing functioning and quality of life of our veterans is at stake. I was 

very troubled to hear from our veterans such strong opposition to 

the proposed reforms, arguing forcefully that they would lead to 

substantial delays in care for veterans with amputations and clinical judgments regarding veterans’ needs being overridden by individuals with little or no experience in prosthetic care. 

In mid-June, following our hearing, I sent a letter, along with 

Ranking Member Michaud, to the Secretary, requesting that the 

Department respond to a number of questions and provide certain 

materials regarding the strategy, plans, and criteria used to develop, consider, design and evaluate the proposed reforms as well 

as the pilot programs that preceded them. 

Our goal was to understand the analysis VA employed to develop 

the reforms and what was behind the decision that they were the 


anorris on DSK9Q6SHH1PROD with HEARING
2 

best idea for our veterans, especially those who have experienced 

loss of limb as a result of service to our Nation. 

Sadly, the Department’s response, which came a week after the 

deadline requested in our letter, did not provide the information or 

the level of detail we asked for, and did nothing to assure me that 

the plan would be effective or that our veterans’ concerns were unfounded. To the contrary, a close review of the materials VA provided leads me to believe that the reforms were developed without 

careful and thorough consideration. 

It leads me to believe that they were developed without sufficient 

input from our veterans themselves, our veteran service organization advocates, or other stakeholders. It leads me to believe that 

they were developed and implemented after being tested for a very 

short period of time at a small number of locations, with very limited feedback. It led me to believe that they were developed without 

adequately measuring their impact on patient care. It led me to believe they were developed without safeguards in place to ensure 

that our veterans’ and clinicians’ wishes are respected and timeliness goals are met. 

It is concerning that VA would move forward with instituting 

such large-scale changes that so directly impact our veteran patients in this way. If my concerns are groundless, and I truly hope 

they are, I want the VA in explicit detail to explain why. 

During our last hearing, our veterans and VSOs spoke very loud 

and clearly. Now it is time for the VA to do the same. 

[The prepared statement of Ms. Buerkle appears on p. 18.] 

Ms. BUERKLE. Again, I thank you all for joining us this afternoon. Our Ranking Member, Mr. Michaud, is on the floor. We will 

give him an opportunity to provide remarks when he returns. 

Now I would like to invite our first and only panel to the witness 

table. 

Joining us from VA is the Honorable Under Secretary for Health, 

Dr. Robert Petzel. Dr. Petzel is accompanied by Philip Matovsky, 

the Assistant Deputy Under Secretary for Health, Administration 

Officers; Dr. Lucille Beck, Chief Consultant of Rehab Services, Director of Audiology and Speech Pathology, and the Acting Chief 

Consultant for Prosthetics and Sensory Aids Service; and Ford 

Heard, the Associate Deputy Assistant Secretary for the Office of 

Acquisition and Logistics. 

Thank you all very much for being here. 

Dr. Petzel, thank you for your service to our veterans and for 

taking the time out of your schedule to be here this afternoon to 

address what we consider an extremely important issue on behalf 

of our veterans. I look forward to hearing your testimony. 

You may proceed at this time. Thank you. 


anorris on DSK9Q6SHH1PROD with HEARING
3 

STATEMENTS OF HON. ROBERT A. PETZEL, M.D., UNDER SECRETARY FOR HEALTH, VETERANS HEALTH ADMINISTRATION, UNITED STATES DEPARTMENT OF VETERANS AFFAIRS, ACCOMPANIED BY PHILIP MATOVSKY, ASSISTANT 

DEPUTY UNDER SECRETARY FOR HEALTH, ADMINISTRATIVE OPERATIONS, VETERANS HEALTH ADMINISTRATION, 

UNITED STATES DEPARTMENT OF VETERANS HEALTH, LUCILLE BECK, PH.D., CHIEF CONSULTANT, REHABILITATION 

SERVICES DIRECTOR, AUDIOLOGY AND SPEECH PATHOLOGY, ACTING CHIEF CONSULTANT, PROSTHETICS AND SENSORY AIDS SERVICE, VETERANS HEALTH ADMINISTRATION, 

UNITED STATES DEPARTMENT OF VETERANS AFFAIRS, AND 

FORD HEARD, ASSOCIATE DEPUTY ASSISTANT SECRETARY, 

OFFICE OF ACQUISITIONS AND LOGISTICS, UNITED STATES 

DEPARTMENT OF VETERANS AFFAIRS 

STATEMENT OF HON. ROBERT A. PETZEL, M.D. 

Dr. PETZEL. Chairwoman Buerkle, Ranking Member Michaud, 

and Members of the Subcommittee, I want to thank you for the opportunity to speak about the Department of Veterans Affairs prosthetics procurement reform. Thank you, Madam Chairwoman, for 

introducing the people that are accompanying me. 

VA testified before this Subcommittee and the Subcommittee on 

Oversight and Investigations in May, 2012. We did this regarding 

our efforts to maintain the high quality of prosthetics VA provides 

to veterans while instituting reforms to improve compliance with 

the Federal Acquisition Regulations and the Competition in Contracting Act, and to improve our management of government resources. 

In follow-up to these hearings, the chairwoman and Ranking 

Member submitted a letter to VA on June 21, requesting a response by July 6 that would offer additional information about 

these reforms. On July 12, VA submitted information to the Subcommittee to begin to address the Subcommittee’s request. I apologize that submission was late and that it was not sufficient to address your concerns. 

Yesterday, at the Subcommittee’s request, we formally submitted 

additional information to provide a narrative account of our efforts, 

and we believe this will better meet your needs and provide for 

some further understanding. If you still have additional questions, 

we would be happy to respond. 

You also have asked for an update on the actions the Department has taken to reform the prosthetics procurement process 

since May 21 in the hearing. On May 23, 2012, VA issued a memorandum to the field advising them that it is VA’s policy that those 

engaged in the ordering of biological implants must comply with 

the FAR and VA acquisition regulations. That memorandum states 

that the VA official performing the purchasing activity is to comply 

with a physician’s prescription. 

Furthermore, in response to your advice to transition our warrant program with deliberation and caution, we extended the date 

for finalizing this transition from July 1 until September 30, 2012. 

This transition continues with ongoing communication and coordination within the VISNs to ensure that procurement services are 


anorris on DSK9Q6SHH1PROD with HEARING
4 

not disrupted. We are closely monitoring the staffing levels for our 

contracting organizations, the workload levels, and most importantly, the timeliness of procurement actions. If we find that we 

have insufficient resources to complete this transformation, we will 

extend the timeline to allow for a smooth transition. 

Finally, you asked me to address the potential impact these reforms could have on veterans. As we testified in May, we do not 

believe that veterans will be adversely impacted in any way. Indeed, this change should result in no visible effect for veterans. We 

believe that our reform efforts are acceptable to the major service 

organizations. 

Two proposals appear to have raised interest. First of all, our 

plans to standardize the purchasing of prosthetics and other devices; and secondly, our plan to transition procurement decisions to 

warranted contracting officers. On the first plan, many of the products VA purchases are already on contract in some way, shape, or 

form. They are either going to become a part of a veteran or they 

are going to be a critical part of their daily lives. We understand 

the critical value these devices offer and the independent clinical 

judgment of our providers will remain and must remain fully intact. 

A contracting officer will not have the capacity to override a physician’s order. This aspect guides a decision-making process of our 

leadership and will be preserved in our policies and in our procedures. Clinicians, in consultation with veterans, will decide what 

devices we procure. Our reforms are designed only to modify how 

we procure them. When products are generally available and interchangeable, competitive procurement may be appropriate. We are 

hoping that in the long term we can develop a catalog that will facilitate more cost-effective purchasing in those instances. 

On the second plan concerning the transition of procurement decisions, I, again, emphasize that this is only changing how we purchase, not what we purchase. By shifting to contracting specialists, 

we can ensure that we secure fair and reasonable prices for the 

products while still delivering the personalized state-of-the-art care 

that has been earned by these veterans. 

In conclusion, VA has been engaging in prudent and appropriate 

reform to improve the business processes governing the procurement of prosthetic devices for veterans. We take great care to ensure that these changes improve the accountability of these purchases while maintaining the high quality of care and clinical decision-making critical to veterans health care. Clinicians determine 

the prosthetic needs of veterans as a part of their clinical care, and 

VA procures the devices necessary to achieve personal clinical outcomes. Our reform efforts will not disturb this arrangement. 

We appreciate the opportunity to appear before you today to discuss this important program. My colleagues and I are prepared to 

answer your questions. 

[The prepared statement of Dr. Petzel appears on p. 19.] 

Ms. BUERKLE. Thank you very much, Dr. Petzel. 

I will now yield myself 5 minutes for questions. I guess my first 

question, as I am listening to your testimony today, as well as in 

the last hearing, is could you just briefly explain to me what 

prompted this change? 


anorris on DSK9Q6SHH1PROD with HEARING
5 

Dr. PETZEL. Certainly, Madam Chairwoman. The reform of VA’s 

procurement processes really began more than 2 years ago, and 

they started at the Department level with the procurement of 

equipment, with the procurement of pharmaceuticals. This is a 

systemwide effort to ensure that we have professional, certified 

contracting people doing the procurement. We have been criticized 

in the past by organizations such as the IG for not having a professional procurement force and for not following in all instances the 

Federal regulations or VA’s acquisition regulation. 

So the effort, in no way, is directed specifically at prosthetics. 

This began, as I say, with equipment. It has moved into pharmaceuticals. Prosthetics is really the last area of procurement within 

VA where we have not had certified warranted procurement officers doing the majority of the procurements above $3,000. 

Ms. BUERKLE. Thank you. When I hear words like ‘‘equipment’’ 

and ‘‘pharmaceuticals’’ and then ‘‘the development, possibly, of a 

catalog,’’ what you are talking about in those instances are so very 

different from the testimony we heard in the last hearing regarding 

the personal nature of a prosthetic. Amoxicillin is amoxicillin. A 

thermometer is a thermometer. But a prosthetic is unique to that 

person and to his needs or her needs. That is my concern with this 

process, that it will become just like any other procurement. This 

is a very different process. I think this is what concerns the VSOs 

and concerns the veterans. This is a uniquely personal service that 

we have to give to that veteran. What I am hearing here when you 

talk about cataloging purchases concerns me greatly. 

Dr. PETZEL. Madam Chairwoman, we absolutely agree with you. 

This is the most personal of work that the VA does. Crafting and 

fitting a prosthetic limb to an individual that has lost an arm or 

a leg is a very personal process. The reforms that we are talking 

about in terms of procurement will not interfere with that process. 

The physician orders the prosthetic. And that order can be very 

specific. The prosthetist works with the patient to determine where 

the best place is to purchase that. As you know, we have 600 contracts in the private sector, and not all, but most of our procurement occurs in the private sector. 

In the process of transitioning and during the pilots, we audited 

the orders that the physician had written; we audited the purchase 

contract, what was actually purchased; we looked at the timeliness 

between when that order was placed and when it was actually purchased; and we looked at the satisfaction, particularly of the prosthetist and the physicians, as to whether or not the needs of that 

veteran, as they described them, were met. And in the pilots we 

found that that was true; that that worked very well. 

The only misjudgment that we made in the pilots is that we expected a higher level of productivity from the contracting officers 

than we actually found, and we had to revise the number of contracting officers that we felt we needed because we felt that the 

four contracts per day that they originally were going to perform 

was more than was doable; that 2.5 is a better example. But, otherwise, the pilots indicated that things went very well. 

Ms. BUERKLE. Can you talk to us about the pilots? How many 

pilots were done? Over what period of time were the pilots conducted? Which VISNs were included in the various pilots? 


anorris on DSK9Q6SHH1PROD with HEARING
6 

Dr. PETZEL. Yes, Madam Chairman, we can, and I would like to 

turn to Mr. Matovsky to give you some of the details about the pilots. 

Thank you. 

Mr. MATOVSKY. Thank you, sir. We conducted three pilots, one 

of them in VISN 6, which is North Carolina, parts of Virginia, 

parts of West Virginia; VISN 11, which is Indiana—I am going to 

test my geography here—parts of Michigan as well; and then VISN 

20, which is the Upper Northwest on into Alaska. We selected 

them because they were a broad representation, some of them 

highly rural, some of they very large and growing. We also ran 

them from the period of January through the end of March, for 3 

months. I believe one of them scooted into April. 

We tested two different processes. So one process utilized fully 

the ECMS, or Electronic Contract Management System, to place 

the order and another one in VISN 6 used a slightly different process. That is the basis for it. 

We tested the onboarding of our staff, the training of our staff, 

the communication and the collaboration with the prosthetist, the 

prosthetics purchasing agent, and then the contracting management staff. As Dr. Petzel indicated, we did conduct some audits. 

For instance, we looked at the technical appropriateness of the contracting action. But more importantly, we looked at what percentage of the time did the contracting officer adhere to the physician’s 

prescription. A hundred percent of the time, the contracting officer 

adhered to the prescription. 

Ms. BUERKLE. Thank you. With that I will yield to the Ranking 

Member, Mr. Michaud, for any opening statement you might have 

and 5 minutes for your questions. 

Mr. MICHAUD. Thank you very much, Madam Chair. I apologize 

for being late. I was managing the veterans bill on the House floor. 

This is the earliest I could get back. 

OPENING STATEMENT OF HON. MICHAEL H. MICHAUD, 

RANKING DEMOCRATIC MEMBER 

I want to thank everyone for attending this very important hearing. This afternoon is a follow-up. And I also would like to thank 

the chairwoman for her persistence in holding the Department accountable on issues such as prosthetics, not just for care, but also 

for procurement, which is so important for the veterans. Every veterans’ needs are unique. VA should get this right. 

We have learned during the last hearing on this issue in May 

about VA’s proposed changes in the procurement of prosthetics. At 

that hearing, there was a high degree of concern expressed among 

some of our witnesses as to the effectiveness of these changes. We 

are alarmed by the possible negative impacts on patient care, including substantial delays in care and clinical judgments regarding 

veterans’ needs being overridden by individuals with little or no 

working knowledge of prosthetic care. And we sent a bipartisan letter to the Secretary outlining our concerns and soliciting answers 

to several of our questions. 

This is the third hearing in a handful of months on this particular issue, and I remain committed to working with the very 

dedicated staff at the Department of Veterans Affairs and the advoVerDate Mar 15 2010 07:01 Oct 05, 2012 Jkt 075615 PO 00000 Frm 00010 Fmt 6633 Sfmt 6633 I:\VA\75615.XXX GPO1 PsN: 75615

anorris on DSK9Q6SHH1PROD with HEARING
7 

cacy community to assure that our veterans are getting the best 

care that we can deliver in a timely way. In this joint effort and 

joint challenges this Subcommittee stands ready to help. 

And I read through your testimony and I just have a few questions, if I might. In your testimony you said: We believe that many 

of our reform efforts are acceptable to all concerned parties. When 

you say ‘‘we believe,’’ have you worked with the VSOs and the veterans to find out what their concerns are? 

Dr. PETZEL. Congressman Michaud, we have. Since the May 

hearing, there have been multiple meetings with the service officer 

representatives. I have a breakfast monthly with six of the largest 

service organizations. We made a presentation and a discussion at 

that breakfast earlier in July. And then just a day ago, on Monday, 

at a conference call with the service organizations—the American 

Legion, VFW, PVA, the DAV, Amvets, and the Blind Veterans of 

America—to discuss what we want to do. And I can say that there 

was no objection at that meeting and at that conference to our proposed reforms. 

Mr. MICHAUD. Thank you. My next question actually is two, but 

it is a related issue. Is the VA central office instructing VISNs to 

restrict access to contract prosthetics or orthotists? If not, what 

about the VISNs? Are the VISNs restricting access to contracts for 

prosthetics for veterans who rely on those prosthetics? 

Dr. PETZEL. Congressman Michaud, our policy that is this is a 

veteran’s choice. That we have, as I mentioned earlier, 600 contracts. Most of the prosthetics actually are fabricated and fitted by 

private vendors. Our policy very clearly states that there must be 

available in every one of the medical centers a list of the contractors, and this must be explained to the veteran, that they have a 

choice in doing that. 

The practice that I think you may be hearing about from some 

of the vendors is that around the country, how this interaction occurs is variable. In some instances, in rural areas, where we do not 

have prosthetists that do fitting, et cetera, people from the outside, 

from the private sector, are invited into the prosthetics clinic and 

are actually involved in the discussions with patients because we 

don’t have the personnel to do that. At our larger medical centers 

where we have a large cadre of prosthetists, it would be less likely 

that the vendors would be invited in to participate in the clinic because we have the personnel to do that. But if there is a connection 

between a patient and a prosthetist, that individual is invited in 

and is welcome to come to the clinic and welcome to be a part of 

whatever activities are involved in our prosthetic clinic. 

Mr. MICHAUD. Thank you. My other question. As you know, we 

invest a significant amount of funding into the VA for fabricating 

prosthetics. Do you believe it is more cost effective for the VA to 

consolidate prosthetics fabrication internally within the VA, or is it 

more cost-effective to continue to rely on contracts? 

Dr. PETZEL. Congressman Michaud, let me first say that I think 

it is essential that the VA retain the capacity to fabricate and to 

fit prosthetic limbs. We must be able to do that. And quite frankly, 

in years passed, I think that our capacity to do that had really 

slipped. And I must say that over the a last 7 or 8 years, the VA 

has improved its capacity to do both fitting and fabrication. 


anorris on DSK9Q6SHH1PROD with HEARING
8 

The question about whether or not the VA can do it less expensively than the private sector I think remains unknown. The IG 

had a limited amount of data to look at and made a statement that 

it was less costly to do it within the VA than it was in the private 

sector. But I think we would all have to agree that there was not 

all of the sufficient data to make that comparison. My personal belief is that it is more cost effective, but we need to have all the data 

to say that definitively. 

Mr. MICHAUD. I see I am running out of time, so thank you very 

much, Madam Chair. 

Ms. BUERKLE. I now yield to the gentleman from Tennessee, Dr. 

Roe. 

Mr. ROE. Just a couple of very quick questions. The idea, the reason for doing this was back to what the IG, is that right, Dr. 

Petzel, is trying to standardize the procedures, not only in this but 

in other areas in contracting that the VA does? Am I right on that? 

Dr. PETZEL. To standardize procurement, not procedures per se, 

but to professionalize and standardize the way we procure material. We have been criticized, as I said, in the past by important 

groups of people, including some congressional committees, on our 

procurement strategies. This systemwide effort was to try and professionalize that, yes. 

Mr. ROE. So I guess what the chairwoman said is correct. There 

is obviously a prosthetist sitting right to your left. That is a very 

individualized therapy. And I know as a physician, this has to be 

tailored per person. I am sure there is some standardization to it, 

and this is not going to, in any way, slow that process down or 

make that process not as effective or available to our veterans. Am 

I correct on that? 

Dr. PETZEL. Yes, sir, you are correct. 

Mr. ROE. And so a patient will be able to come into the clinic, 

and that patient won’t know the difference. The time won’t make 

any difference. There is not going to be a difference in timeliness. 

The fact that it costs more than $3,000, that is not going to deflect 

the time; that that veteran that comes in that needs a limb or a 

prosthetic device is going to get that device? 

Dr. PETZEL. Yes, sir, that is correct. 

Mr. ROE. I think that is extremely important. Secondly, once you 

have cataloged this, is there a way to go outside? In other words, 

here is what is in our catalog. If the doctor and the prosthetist look 

at this patient and say, This is what they need, it is not right in 

this little book right here, can they get that? Because this technology is changing faster than cardiac stints are changing. It is 

amazing the technology now on prosthesis. As that new technology 

occurs, it is like these things right here, as soon as you buy it, it 

is out of date. 

And so I see the same thing in prostheses. People are doing 

amazing things with this. Once it goes in the Sears and Roebuck 

catalog that Sears has, that the VA has, can that person get something from the new catalog or something brand new that happens? 

Dr. PETZEL. Dr. Roe, absolutely. One of the nice things about the 

VA and the procurement regulations is 8123, which basically says 

that with the proper justifications, we do not have to do competiVerDate Mar 15 2010 07:01 Oct 05, 2012 Jkt 075615 PO 00000 Frm 00012 Fmt 6633 Sfmt 6633 I:\VA\75615.XXX GPO1 PsN: 75615

anorris on DSK9Q6SHH1PROD with HEARING
9 

tive buying; that we can buy specifically what the doctor has ordered. 

So while we may have a catalog of things that are appropriate 

in certain kinds of circumstances, the important part of all of this 

is the doctor writes an order, and we will procure for that patient, 

what the doctor has ordered. 

Mr. ROE. So this is not going to negate new technology that occurs? 

Dr. PETZEL. Absolutely not. 

Mr. ROE. So our veterans can get the cutting edge. They are not 

going to get stuck in ‘‘it’s not in the book, so you can’t have it.’’ 

Dr. PETZEL. Absolutely not, Congressman. Just to give an example, there are two relatively new knees that were jointly developed 

by the VA and the Department of Defense, the X2 and the Genium. 

Those are absolutely cutting-edge technology for an artificial knee. 

They are available to any veteran who needs and wants that kind 

of a prosthesis. 

Mr. ROE. So it is one thing to have all the colonoscopes look exactly like. That was one of the issues when I first got here. We had 

that issue that came up. This is a little different than that. I guess 

the other question I have, and then I will have no more is that you 

said that you don’t believe that the veterans will be negatively impacted. Will they be positively impacted by this? Will this improve? 

I know the VA feels like it will be positively impacted, but will the 

veteran be positively impacted by this, or will they even know the 

difference? 

Dr. PETZEL. First of all, Congressman, they should not know a 

difference. It should be absolutely transparent to them. But there 

are a couple of things that I think will happen that will, even if 

they don’t notice it, improve prospects, I expect that once we get 

this up and running and under our belt that we are going to cut 

down on the procurement time, on average. That is number one. 

Number two is that any money that might be saved by getting 

a fair price—and that is not our intention, but if that should happen—is money that can be put back into the system to provide 

more care to more veterans. 

Mr. ROE. One quick question. When will we know that? When 

will you evaluate that and know when it goes in and up and running, a year from now? Or 2 years from now? 

Dr. PETZEL. Congressman, I think there are going to be two different kinds of valuation. One is that in an ongoing fashion we 

have to monitor the things that we described before: Timeliness, 

was a physician’s order actually followed 100 percent of time, was 

there a level of satisfaction that was appropriate on the part of the 

patient, the provider, the doctor, and the contracting officer, and 

certain other technical things about the contract. That is going to 

be an ongoing process. 

When we have been into this, say, for a year or 6 months, we 

will have to look, and 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 doing before. So there will 

be two levels of evaluation. 

Mr. ROE. Thank you. I yield back. 


anorris on DSK9Q6SHH1PROD with HEARING
10 

Ms. BUERKLE. Thank you. I am going to yield myself five minutes 

for a second round of questioning, if that is okay. Just a couple of 

things. First of all, I am concerned about a 3-month pilot that you 

mentioned and whether or not that is going to give us the scope 

of the situation, and whether or not this is working. It seems to 

me that 3 months is a very short period of time. And I will let you 

address that question in a minute. 

In your opening testimony, you talked about the potential if we 

find insufficient resources to have been allocated after you implement the changes. What period of time are you talking about to 

evaluate that? 

Dr. PETZEL. Madam Chairwoman, let me answer first the second 

part of your question. What I was saying is, if in a network or at 

a facility we do not have sufficient, well-trained contracting personnel to do this, we won’t do it until we have the resources we 

need in contracting to do this in a timely, professional fashion. And 

that will occur as we begin to extend this into the other networks. 

So if there is a network, whatever that might be, where two or 

three of the facilities do not have sufficient people, we won’t institute this in those two or three facilities until we have the appropriate, adequate trained personnel. That is that I meant to say. 

The first part of your question, and I will ask Mr. Matovsky to 

comment on this in a minute, is, were the pilots of sufficient 

length? 

There was a run-up period of preparation in terms of training, 

et cetera. So this was 3 months of actual doing the work. And yes, 

we think we got a good feel for how this worked, what the issues 

might be, and what the potential problems might be. 

Mr. Matovsky, do you want to make any comment about the 

length of the pilots? 

Mr. MATOVSKY. We continued running them after the duration. 

So the official time period, we wanted 3 months, but we continued 

running them. As we have concluded, we then standardized the 

process for ordering in VISN 6 so that it conformed to VISN 11 and 

VISN 20. And we saw improved performance by using that new 

process. And we really saw it stabilize as well. So our best performing month in terms of average timeliness was July, across the 

board. 

So it was the official time period for the pilot, and then as it was 

there and running, we left it running and observed how it was running. 

Ms. BUERKLE. Do you know in that period of time how many actual transactions there were; how many prosthetic devices were obtained or tried to be procured? 

Mr. MATOVSKY. I do know that. I am not going to find it in my 

notes right now. And we can provide it for the record. But we do 

know the specific numbers, yes, ma’am. 

Ms. BUERKLE. I do want to address a much broader concern, and 

that is the question of leadership within the VA with regard to 

prosthetics. As I read through the introductions, and I read Dr. 

Beck’s introduction, the many hats that you wear, I am concerned 

that you are acting in multiple capacities, and there is not one person focused on prosthetic procurement and the whole prosthetics 

issue within the VA. 


anorris on DSK9Q6SHH1PROD with HEARING
11 

If you could speak to direction of leadership for the VA? Is this 

something Dr. Beck will take on herself and then someone else will 

relieve her of some of the other duties? It seems like Dr. Beck is 

wearing many hats, I am concerned with regard to the level of 

leadership. 

Dr. PETZEL. Thank you, Madam Chairman. You are absolutely 

right, she is wearing a lot of hats. Very talented, incredibly energetic lady, but she has a lot of things that she has to do. 

I want to ask Dr. Beck to comment in a minute about leadership 

in prosthetics. But I do want to commend the job that she has done 

since she has been in that role. There really has been a palpable 

change for the better in the way we do our prosthetics. I think that 

Lu has done really a fabulous job. 

The bench is not as strong as we would like to have it in prosthetics, so that we can turn most of the operating parts of prosthetics over to someone else. 

I would like you to make a comment about that, Dr. Beck. 

Ms. BECK. Thank you, Dr. Petzel, and thank you, Madam Chairwoman, for your concern. I have had a lot of support from my leadership, up to Dr. Petzel, as I have taken on this initiative. We have 

developed a plan to have a comprehensive office of rehabilitation 

and prosthetics. In that office, we will have a national program director and a large staff devoted to prosthetics and sensory aid service so that we will be managing the clinical practices, the procurement and contracting, their regulatory issues, and the development 

of all of the programs. So we have a plan that is just in the approval stages now that will give us the resident resources and expertise and leadership roles in the prosthetics office. 

One of the important things that we are doing, and I think one 

of the veterans service organizations talked about this in their testimony, is that prosthetics and sensory aids is a very dynamic service. It is an important clinical support service to all of the programs 

in VHA. And so it touches almost every provider, from our primary 

care teams to our rehabilitation teams to many of our specialists. 

And for that reason we are linking prosthetics to rehabilitation 

services so that we can assure that we have the proper collaboration and coordination under the direction of Patient Care Services, 

which is responsible for all of the clinical activity in VA. 

Dr. PETZEL. So just to elaborate for a minute, Dr. Beck would be 

responsible for rehabilitation services and prosthetics in the larger 

sense. There will be specific leadership in prosthetics and an office 

and the staff necessary to administer that program appropriately. 

And that plan, as I understand it, is coming shortly to my desk. 

Ms. BUERKLE. That was going to be my next question; what 

would be the expectation for implementation of that plan? 

Dr. PETZEL. Very soon. I hesitate to give you a specific date, but 

I understand the request for people in the organizational chart is 

on its way to me. We will review that, and as soon as it is signed 

off on, the process of hiring those people and beginning to do that 

will begin. So the process will certainly begin shortly. I can’t predict how long it will take to hire the right person, but we will begin 

shortly. 

Ms. BECK. I would just like to reinforce that. We currently have 

many very excellent people in the prosthetics and sensory aids 


anorris on DSK9Q6SHH1PROD with HEARING
12 

service who are working everyday with me to accomplish all of our 

goals, and also to say that in rehab services, we have defined leadership and subject matter expertise for each of the offices. So our 

physical medicine and rehabilitation office has a physician leader. 

So the leadership, as Dr. Petzel says, in prosthetics and sensory 

aids service will be devoted to the clinical support services that we 

are doing in prosthetics and sensory aids. 

Ms. BUERKLE. Thank you very much. Just briefly, and then I am 

going to yield to the Ranking Member. You mentioned that yesterday you had a conference call and that you have been in touch with 

the veterans service organizations. As you recall, at the last hearing there were grave concerns, and in my opening comments, I expressed the concerns the VSOs have. In one of the questions you 

just answered, you talked about this ongoing process and you 

talked about timeliness and physicians’ orders and the contracting 

officers. But, again, there is no contact, there is no connection, 

there is no ongoing—there doesn’t seem to be ongoing communication with the veterans service organizations, with the veterans 

themselves. It is one thing to do this operation and to look at it 

objectively, and to look at a plan on paper, but the most important 

ones we need to hear from are the veterans who are requiring this 

service, because that is what is key here. 

Dr. PETZEL. Thank you, Madam Chairman. Two responses to 

that. One is I have ongoing meetings with veteran service organizations. We do two things: Every month I have a breakfast, 2-hour 

meeting with the leaders of the six largest service organizations. 

Then every quarter we have a bigger meeting, again, about 21⁄2

hours, with a broader range of service organizations. And we will 

keep in touch with them through this. It is important to all of 

them, but particularly the Disabled American Veterans, the PVA, 

and the Blinded Veterans. Prosthetics is an essence of the service 

that the members of those organizations need. 

In terms of the veterans, Troy Elam, who was present, by the 

way, on the phone call, who had testified earlier, I think said it at 

the first hearing, and I had not really heard anybody articulate it 

quite as well as she did. And that is, that we have to have, as part 

of our ongoing look at this transition, we have to have a mechanism for asking the veterans what they experienced, not just with 

this transition, but with prosthetics itself. 

Perhaps Dr. Beck could just briefly comment on the instrument 

that we are going to use. 

Ms. BECK. Yes. Thank you, Dr. Petzel. The instrument we are 

going to use is called uSPEQ. That is an acronym for the Stakeholder Participation and Experience Questionnaire. This is a national benchmarked questionnaire that is used by the Committee 

on Accreditation for Rehabilitation Facilities, which is a national 

organization that accredits rehabilitation facilities. We have recently received approval from the Office of Management and Budget to use that survey to gather information about satisfaction, and 

we have arranged a contract which is now in place with CARF, the 

acronym for Committee on Accreditation of Rehab Facilities, and 

we are beginning the training of our staffs around the country so 

that they will be able to implement the utilization of this questionVerDate Mar 15 2010 07:01 Oct 05, 2012 Jkt 075615 PO 00000 Frm 00016 Fmt 6633 Sfmt 6633 I:\VA\75615.XXX GPO1 PsN: 75615

anorris on DSK9Q6SHH1PROD with HEARING
13 

naire, not only for amputation and prosthetics care, but for many 

elements of the rehabilitative care that we provide in VA. 

One very important aspect of this is that it is a valid survey. 

Data are collected from all facilities all over the country, not just 

VA facilities, and we are able to benchmark our care with the care 

that is provided across the country related to rehabilitation. So 

that is important for us. And it is patient satisfaction. And so it 

asks the patient what they think. 

Ms. BUERKLE. And if I could respectfully suggest, in addition to 

the organizations that you are communicating with, that you would 

include the newer organizations: The Wounded Warrior Project, the 

IAVA. It seems to me they should be included in this discussion 

and their feedback should be obtained as well. 

Dr. PETZEL. Yes. Thank you. 

Ms. BUERKLE. I yield now to the Ranking Member. 

Mr. MICHAUD. Thank you very much, Madam Chair. In answering Mr. Roe’s question about procurement time, you said it will cut 

down on procurement time. Do you have any idea how much time 

it might cut down on the procurement time? 

Dr. PETZEL. I would, Congressman Michaud, have to ask Mr. 

Matovsky if he has any thoughts on that. I don’t. 

Mr. MATOVSKY. As we were watching the pilots as they were running in the most recent month in VISN 20, for instance, our average timeliness was down inside of 3 days to procure, which was 

pretty quick. I think the other thing that we would expect to find, 

frankly, and it came out of these pilots, was a collaboration between logistics and prosthetics so that we could better tune the inventory management process as well. We will see how that goes. 

We will study that. 

But what that would allow us to do is it would allow us if we 

have better visibility into our inventory avoid a stock-out situation. 

A stock-out situation is where we run out of something. And I 

think that is where we really have the benefit of being able to have 

greater visibility into what we have available and what kinds of inventory control points would allow us to have a situation where we 

are managing at a minimum inventory level. We are seeing that 

in VISN 20 in the Upper Northwest, sir. 

Mr. MICHAUD. Thank you. The OIG in their recommendations 

recommend that some VISNs contract out between three and five. 

When you look at VISNs that are actually contracting out with the 

private sector providers more than the three or five that was recommended, does that show that there is a greater demand among 

the veterans community to go to the private sector, or is that because veterans pretty much in the rural areas are accessing those, 

therefore you have a lot of contracts with private providers? Or, is 

the need continuing to increase dramatically? 

Dr. PETZEL. Dr. Beck, could you take that? 

Ms. BECK. Thank you, yes. The contracts have been established 

to provide access, to be sure there was access close to the patient’s 

home or close to the veteran’s home. And that is the reason for the 

large number of contracts that we have had. 

Mr. MICHAUD. Thank you. My last question is in reviewing your 

testimony, Dr. Petzel, you stated that VA is instituting more audits 

of purchases to ensure that we are getting the best value for our 


anorris on DSK9Q6SHH1PROD with HEARING
14 

dollars when we procure prosthetics or other devices. Can you tell 

me how many more audits you are doing now compared to before, 

who is performing those audits, and who is analyzing those audits 

as well as the types of measurements that you are using for those 

audits? 

Dr. PETZEL. Let me, in a general sense, respond, Congressman, 

then I would ask Mr. Matovsky to provide some detail. The things 

that we are going to be looking at are the things that I mentioned 

earlier, was the product that was ordered and delivered, the product that the physician ordered. In other words, what is the consonance between what the physician ordered and what was obtained? 

Timeliness will be an ongoing audit. Satisfaction from the point 

of view of the patient, the physician provider, the prosthetist, and 

the contracting officer will be an ongoing audit. In the cases where 

we use 8123 where we don’t have to be competitive, was there an 

adequate justification for a noncompetitive acquisition, et cetera. 

Those are the things that we in an ongoing way are going to audit. 

In terms of how frequent we are going to be doing that, I would 

turn to Mr. Matovsky for a comment about that. 

Mr. MATOVSKY. We will be running those every month on a cycle. 

We run within VHA two systems of audits that occur every month 

and then the Department, under Mr. Heard, has another audit that 

comes in and reviews. Ours is probably a little bit more tactical 

than the Department’s. 

We look at primarily two things: First, where there is a justification for other than full and open under FAR part 6 using 8123, did 

the contracting officer comply with the prescription? That is number one. Number two, we are looking at other elements that are 

procurement reform-oriented. Is there an adequate work-up for the 

justification? Was there a price negotiation performed? Et cetera. 

And those are the things that we are looking at. 

Over time, I think where we would see additional efficiencies, at 

this point theoretical; again, the most important thing, did we conform to the 8123 justification? But over time, looking at things 

where we are buying many things repeatedly without a covering 

contract using 8123, do we have an opportunity to structure an 

agreement there. And I think those are the ones that we would 

look at over time. 

But to your question, every month it cycles through the VISN 

level contracting manager, every month it cycles through the VHA 

system of national audits. I review every month in detail one of our 

VISN’s contracting results. This is one of those results I now review. Mr. Doyle, who is here, also reviews through his system the 

audit results. 

Mr. MICHAUD. Thank you. I have no more questions. Thank you. 

Ms. BUERKLE. I am going to yield myself another 5 minutes, and 

then if Mr. Michaud has other questions, he may ask them. We 

keep talking about the contracting officer. What is a contracting officer? 

Dr. PETZEL. I would ask Mr. Heard if he would, please, Madam 

Chair, to answer that question. 

Ms. BUERKLE. And if you could speak to their qualifications, 

their training, and the agreement they have. Because initially, I 


anorris on DSK9Q6SHH1PROD with HEARING
15 

heard there would be a 100 percent compliance with the physician 

order for the prescription. Now I am hearing that is going to be 

monitored. Does the contracting officer have any discretion, or why 

wouldn’t he adhere 100 percent of the time the physician’s prescriptions for which a prosthetic device is being prescribed for the 

veteran? 

Mr. HEARD. Sure. Madam Chair, we have to look at the acquisition workforce first to determine what their qualification skill-sets 

are. Going back to 2000, the Clinger-Cohen Act that went into 

place actually professionalized the acquisition workforce by putting 

a positive education requirement in place. That positive education 

requirement for a GS–12 or below is either a degree in any field 

of study at an accredited college, or 24 hours of business. At a GS– 

13 and above, it requires both an undergraduate degree and 24 

hours of business. The Clinger-Cohen Act also required experience 

and also training to be an integral part of that acquisition professional contract specialist requirement. 

The actual warranting of a contracting officer, that is a delegation. A delegation is based on a need defined by the head of a contracting activity. In the VA, there are six heads of contracting activity. For Veterans Health Administration, which oversees all of 

the hospital acquisitions, including prosthetics, that HCA is Norb 

Doyle, who is here. Norb is designated by the senior procurement 

executive for the Department of Veteran Affairs, Jan Frye. The 

warranted contract individuals that are identified based on a need 

have to show and demonstrate their experience, their education, 

and training. 

Training is also a very elaborate criteria requirement that was 

identified by OMB back around 2007, called the Federal Acquisition Certificate in Contracting. Those individuals climb to a level 

of FACC level 3. Again, a very rigorous, robust education training 

requirement, a curriculum identified by the Federal Acquisition Institute. Once you are certified, you are eligible for a warrant at various levels. 

Our level 1 warrant holders probably have the lesser amount of 

training, but they can be warranted up to $150,000. That is commensurate with the simplified acquisition threshold. So these are 

warranted individuals that are warranted on behalf of the Federal 

Government to act as an agent to procure on behalf of the Federal 

Government to ensure that contracts are awarded with a fair and 

reasonable price, to seek competition, to comply with the FAR and 

the VAR. 

Prosthetics is a unique requirement. We are really identifying 

special needs for our veterans. Those requirements can be anything, as we talked about today, artificial limbs, but also products 

that are also commercial in nature, which could be walkers, canes, 

and crutches. Some of those are available commercially. They are 

obtained off Federal supply schedules. But then the others are really very specific to the surgery that is required for a veteran or 

other therapeutic requirements. 

Ms. BUERKLE. So why wouldn’t there be automatically 100 percent compliance with a physician’s order? Why is that even a concern? You are talking about someone with a bachelor of science degree who maybe has 24 hours of business classes, that they have 


anorris on DSK9Q6SHH1PROD with HEARING
16 

discretion to override or to not comply with the physician’s order 

with regard to the prosthetic? 

Dr. PETZEL. Madam Chairwoman, I can just take that for a moment, first, and then we will see if either Mr. Heard or Mr. 

Matovsky have anything to add. 

The issue there is fair and reasonable price. That is their only 

responsibility in that case, would be to ensure that in purchasing 

that specific thing that the physician has ordered, that we are getting a fair and reasonable price. And that might entail negotiating 

with that provider—with that prosthetic provider. 

Ms. BUERKLE. So I guess I am concerned, because if there is a 

prosthetic available that is maybe less money, are we looking at 

the quality, are we looking at the prosthetic itself, or are we just 

negotiating a price about the same—— 

Dr. PETZEL. We are negotiating, in this case, a price, Madam 

Chairwoman, around the specific thing that the physician has ordered. That is what determines what we buy. The contracting officer’s responsibility is to see that we get a fair price for it. But when 

he is not going to be, or she is not going to be buying something 

different because it is less costly. Again, we look at what was the 

physician’s order, and that is what we buy. 

Ms. BUERKLE. So you would expect 100 percent compliance with 

the physician order? 

Dr. PETZEL. Absolutely. 

Ms. BUERKLE. Do you have any further questions? 

Mr. MICHAUD. No. That is a good way to sum it up. I think it 

is very important that the physician is the one who decides, so I 

do want to thank you, Dr. Petzel, for all that you are doing to help 

our veterans, as well as the other three panelists here today for 

your efforts in this regard, so thank you very much. 

Ms. BUERKLE. I thank the Ranking Member, and I also want to 

thank the panel for being here this afternoon. I, again, would just 

like to ask, I think it is very important that we get as many veterans’ service organizations involved in this discussion, as many 

perspectives as possible. You know, what you have mentioned, with 

all due respect, is great, but I think we have got additional veterans’ service organizations that need to be included in this discussion and to make sure there is nothing more important than the 

veterans and making sure when they come home without a limb 

because they have served this Nation, that they have what they 

need, that they are not dealing with some contracting officer who 

has got some discretion to give him less of a device than he deserves. So that is all of our concern here—that we get our veterans 

exactly what they need. 

We heard the last time from veterans who talked about—we are 

talking about—the ability of someone to walk his daughter down 

the aisle. We are talking about intensely personal prosthetics and 

an intensely personal segment of the care that our veterans need, 

so there is nothing more important. 

And while we are all concerned with regard to costs, that we 

make sure our veterans who have served this Nation get exactly 

what they need so they can return to their maximum potential 

after they have sacrificed so much for this Nation. 


anorris on DSK9Q6SHH1PROD with HEARING
17 

With that, I ask unanimous consent that all members have 5 legislative days to revise and extend their remarks and to include extraneous material. Without objection, so ordered. 

Before I close the hearing, I would like to make a request that 

you submit to this Health Subcommittee and to the Veterans’ Affairs Committee the plan that you are talking about. We would like 

to see that to make sure that the veterans’ best interests are 

served. 

Dr. PETZEL. We will do that, Madam Chairwoman. 

Ms. BUERKLE. Thank you, again, to our witnesses for being here, 

to our audience members, and to the Subcommittee members, to 

my Ranking Member, for joining in today’s conversation. 

This hearing is now adjourned. 

[Whereupon, at 5:33 p.m., the Subcommittee was adjourned.] 


anorris on DSK9Q6SHH1PROD with HEARING
(18) 

A P P E N D I X 

Prepared Statement of Chairwoman Ann Marie Buerkle 

Good morning and welcome to today’s Subcommittee on Health Hearing, ‘‘Optimizing Care for Veterans with Prosthetics: An Update.’’ 

Today’s hearing is a continuation of a discussion we began almost 3 months ago 

when this Subcommittee heard from veterans with amputations, members of our 

veterans service organizations (VSOs), and officials from the Department of Veterans Affairs (VA) to review VA’s capability of delivering state-of-the-art prosthetic 

care to veterans with amputations and the impact of VA’s planned prosthetic procurement reforms. 

These reforms will, among other things, take prosthetic purchasing authority 

away from prosthetic specialists and transfer it to contracting officers. 

As our veterans so eloquently described in May, prosthetic care is unlike any 

other care that VA provides and, when we make the mistake of treating it as such, 

no less than the daily and ongoing functioning and quality of limb of our veterans 

is at stake. 

I was very troubled to hear our veterans voice such strong opposition to the proposed procurement reforms, arguing forcefully that they would lead to substantial 

delays in care for veterans with amputations and clinical judgments regarding veterans needs being overridden by individuals with little to no experience in prosthetic care. 

In mid-June—following our hearing—I sent a letter, along with Ranking Member 

Michaud, to the Secretary requesting that the Department respond to a number of 

questions and provide certain materials regarding the strategy, plans, and criteria 

used to consider, develop, design, implement, and evaluate the proposed reforms and 

the pilot programs that preceded them. 

Our goal was to understand the analysis VA employed to develop the reforms and 

what was behind the decision that this was the best idea for our veterans, especially 

those who have experienced loss of life as a result of service to our country. 

Sadly, the Department’s response—which came a week after the deadline requested in our letter—did not provide the information or the level of detail we asked 

for and did nothing to assure me that the plan would be effective or that our veterans concerns were unfounded. 

To the contrary, a close review of the materials VA provided leads me to believe 

that the reforms were developed without careful and thorough consideration. It 

leads me to believe they were developed without sufficient input from veterans 

themselves, veteran service organization advocates, or other stakeholders. 

It leads me to believe that they were developed and implemented, after being tested for a very short time, at a small number of locations, with very limited feedback. 

It leads me to believe they were developed without adequately measuring their impact on patient care. It leads me to believe they were developed without safeguards 

in place to ensure veterans and clinician’s wishes are respected and timeliness goals 

are met. 

It is concerning that VA would move forward with instituting large-scale changes 

that so directly impact veteran patients in this way. If my concerns are groundless—and I hope that they are—I want VA, in explicit detail, to explain why. 

During our last hearing, our veterans and VSOs spoke loud and clear. Now it is 

time for VA to do the same. 


anorris on DSK9Q6SHH1PROD with HEARING
19 

Again, I thank you all for joining us this afternoon. I now recognize our Ranking 

Member, Mr. Michaud for any remarks he may have. 

f 

PREPARED STATEMENT OF HON. ROBERT A. PETZEL, M.D. 

Chairwoman Buerkle, Ranking Member Michaud, and Members of the Subcommittee: thank you for the opportunity to speak about the Department of Veterans Affairs’ (VA) prosthetics procurement reforms. I am accompanied today by Mr. 

Philip Matkovsky, Assistant Deputy Under Secretary for Health for Administrative 

Operations, Veterans Health Administration (VHA); Dr. Lucille Beck, Chief Consultant, Rehabilitation Services, Director, Audiology and Speech Pathology, and Acting 

Chief Consultant, Prosthetics and Sensory Aids Service, VHA; and Ford Heard, Associate Deputy Assistant Secretary, Office of Acquisition and Logistics. 

VA testified before this Subcommittee and the Subcommittee on Oversight and Investigations in May 2012 regarding our efforts to maintain the high quality of prosthetics VA provides to Veterans while instituting reforms to improve compliance 

with the Federal Acquisition Regulation (FAR), the Competition in Contracting Act, 

and to improve our management of government resources. In follow-up to those 

hearings, the Chairwoman and Ranking Member submitted a letter to the Department on June 21, 2012, requesting a response by July 6, 2012, that would offer additional information about these reforms. On July 12, 2012, VA submitted information to the Subcommittee on Health to begin to address the Subcommittee’s request. 

Our interest was in responding as quickly as possible to your request, and we regret 

our submission of July 12, 2012, did not sufficiently address your concerns. 

You also have asked for an update on the actions the Department has taken to 

reform the prosthetics procurement process since the May hearings. I am pleased 

to report that on May 23, 2012, VA issued a Memorandum to the field advising 

them that it is VA’s policy that those engaged in the ordering of biological implants 

comply with the FAR and VA Acquisition Regulation (VAAR). This Memorandum 

provides further information and guidance to staff to ensure they understand our 

objectives and procedures. That Memorandum states that the VA official performing 

the purchasing activity is to comply with a physician’s prescription when it is indicated. Furthermore, in response to your advice to transition our warrant procurement program with deliberation and caution, VA extended the date for finalizing 

this transition from July 1 until September 30, 2012. This transition continues with 

ongoing communication and coordination with the Veterans Integrated Service Networks to ensure that procurement services are not disrupted. We are closely monitoring the staffing levels for our contracting organizations, the workload levels, and 

most importantly, the timeliness of the procurement actions. 

Finally, you asked me to address the potential impact these prosthetics procurement reforms could have on Veterans. As we testified in May, we do not believe that 

Veterans will be adversely impacted in any way. We believe that many of our reform efforts are acceptable to all concerned parties. For example, VA is instituting 

more audits of purchases to ensure that we are getting the best value for our dollar 

when we procure a prosthetic or other device. We also will begin tracking our purchasing trends to identify when and where we can enter into negotiated contracts. 

Further, we are streamlining and standardizing elements of the procurement process to reduce variation and accelerate purchases so Veterans can receive their devices and equipment faster. 

The proposals that have raised interest are our plans to standardize the purchasing of prosthetics and other devices, and our plan to transition procurement decisions to warranted contracting officers. On the first plan, many of the products VA 

purchases are either going to become a part of a Veteran or will be a critical part 

of their daily lives, helping them walk, work, and interact with their families. We 

understand the critical value these devices offer, and the independent clinical judgment of our providers will remain fully intact. This aspect guides the decision-making of our leadership and will be preserved in our policies and procedures. Clinicians, in consultation with Veterans, will decide what devices we procure. Our reforms are designed only to modify how we procure them. When products are generally available and interchangeable, competitive procurements may be appropriate, 

and we are hoping that in the long term we can develop a catalog that will facilitate, more cost effective purchasing decisions. 

On the second plan, concerning the transitioning of procurement decisions, I again 

emphasize that this is only changing how we purchase, not what we purchase. By 

shifting to contracting specialists, we can ensure that we secure fair and reasonable 

prices for products while still delivering state-of-the-art care. 


anorris on DSK9Q6SHH1PROD with HEARING
20 

In conclusion, VA has been engaging in prudent and appropriate reform to improve the business processes governing the procurement of prosthetic devices for 

Veterans. We take great care to ensure that these changes improve the accountability of these purchases while maintaining the high quality of care and clinical 

decision-making critical to Veterans’ health care. Clinicians determine the prosthetic 

needs of Veterans as a part of their clinical care, and VA procures the devices necessary to achieve personal clinical outcomes. Our reform efforts will not disturb this 

arrangement, which will remain the centerpiece of prosthetics care in VA. We appreciate the opportunity to appear before you today to discuss this important program. My colleagues and I are prepared to answer your questions. 


anorris on DSK9Q6SHH1PROD with HEARING
21 

Deliverables from the United States Department of Veterans Affairs 

Date: August 23, 2012 

Source: Hearing Deliverables 

Inquiry from: HVAC Health 

Context of Inquiry: During the HVAC Health prosthetics hearing three 

deliverables were noted: 

There were three deliverables from yesterday’s prosthetics hearing: 

1. How many prosthetic devices were procured during the pilot? 

2. Please forward the new organizational plan to merge prosthetics and rehabilitation. 

3. Please provide a timeline for how long it will take to complete the new organization. 

Response: 

Question: How many prosthetic devices were procured during the pilot 

Response: The table below provides this information. 

It is important to recall that only those purchases above $3,000 will transition to 

a VHA Contracting Officer. There are roughly 90,000 prosthetics transactions executed per year that are greater than $3,000. 

Table: Number of Prosthetics Purchases made by VHA Contracting Officers 

VISN 11 VISN 20 VISN 6 Totals 

January 57 131 145 333 

February 122 149 224 495 

March 263 174 299 736 

Subtotal 442 454 668 1,564 

April 268 166 194 628 

May 283 207 358 848 

June 226 273 314 813 

July (partial month) 149 150 272 571 

TOTAL 1,368 1,250 1,806 4,424 

Question: Please forward the new organizational plan to merge prosthetics and 

rehabilitation 

Response: Veterans Health Administration (VHA) has aligned Prosthetic and 

Sensory Aids Service (PSAS) with the Office of Rehabilitation Services (ORS), to become the Office of Rehabilitation and Prosthetic Services. The reason for this change 

is to align both prosthetic and clinical programs together in order to optimally coordinate and deliver programmatic services, policies, and guidance for medical 

equipment/items and medical rehabilitative services that promote the health, independence, and activities of daily living for Veterans and Servicemembers. This realignment of existing VHA resources will further improve management and oversight of prosthetic purchasing, inventory control, and clinical coordination in order 

to better utilize appropriated resources. The cost of this realignment is budget neutral, the newly aligned office will remain within VHA Office of Patient Care Services, and the administrative processes (e.g., budget, HR, planning and programming, 

etc) for PSAS and ORS will be completely aligned by September 30, 2012. 

Please see the attached document for a summary of the plan to merge prosthetics 

and rehabilitation. 

Question: Please provide a timeline for how long it will take to complete the new 

organization 

Response: The Office will be completely aligned by September 30, 2012. 

f 


anorris on DSK9Q6SHH1PROD with HEARING
22 

Summary of Plan to Merge Prosthetic and Sensory Aids Service and Office 

of Rehabilitation Services 

Health Subcommittee, House Committee on Veterans’ Affairs 

Deliverable from July 31, 2012 Hearing 

Prosthetic and Sensory Aids Service (PSAS) is core to the mission of VA and affects millions of Veterans and Servicemembers on a short-term, long-term, and ongoing basis. PSAS should be realigned to most effectively support clinical services 

and engineer optimal programmatic policies, guidance, and regulations to advance 

the full continuum of health care practices in VHA. The Office of Patient Care Services will merge with the Office of Rehabilitation Services (ORS) and become the Office of Rehabilitation and Prosthetic Services in the Office of Patient Care Services. 

This alignment will improve management and oversight of prosthetic purchasing, 

inventory control, and clinical coordination in order to better utilize appropriated resources. Transition of PSAS under ORS, with appropriate staffing, will position 

VHA to most effectively accomplish that mission. The Prosthetic and Orthotic Program will be aligned as a separate clinical section under ORS. 

The Office of Inspector General (OIG) recently completed reviews, and Congress 

has subsequently held hearings regarding concerns about oversight and management of procurement, inventory management, and prosthetic services in VHA. Consequently, the pressing need for improved management, coordination, and alignment 

of PSAS within clinical services has become increasingly important. 

The transition of PSAS to a national program office under ORS will: 

• Establish and improve processes for providing prescribed and clinically appropriate, state-of-the-art prosthetic devices, sensory aids, and equipment in the 

most economical and timely manner; 

• Manage national contracting processes for prosthetic devices including strategic 

sourcing; 

• Maintain a system of information management for procurement requests; and 

• Align standards of care and clinical practices and PSAS purchasing. 

PSAS does not currently have the appropriate organizational structure or staffing 

to support clinical services aligned with programmatic policies. If PSAS is realigned 

with ORS, the resulting programmatic re-engineering of regulations and policies, 

contracting processes, clinical prescription practices, budget accounting, information 

technology, and reallignment of key staff will: (1) leverage pre-existing infrastructure and resources and (2) identify and mitigate vulnerabilities. 

Dr. Lucille Beck, Chief Consultant, will lead this realignment and the Office of 

Rehabilitation Services will become the Office of Rehabilitation and Prosthetic Services (OR&PS). Implementation of this realignment will commence, with initial organizational restructure completed within 30 days. Personnel recruitment actions will 

be initiated to fill existing personnel vacancies. The existing PSAS budget will be 

realigned under OR&PS, with accountability fully transitioned by the beginning of 

fiscal year (FY) 2013. 

The success of this realignment will be monitored through a number of strategic 

outcomes, including: improved timeliness in providing prescribed items to Veterans; 

increased numbers of national contracts and compliance with contracts; compliance 

and accuracy in recording and tracking serial numbers of critical items (e.g., surgical implants); accurate budget execution to ensure appropriate allocation for specific purpose funds (i.e., prosthetic items, devices, and equipment) and balance of expenditures to obligations; and implementation of data accuracy monitors to track 

and compare issuance codes for consistency across national averages. Further, programmatic policies, regulations, and processes for prosthetic services will be aligned 

with those of clinical services to improve consistency and continuity of services to 

Veterans—from clinical prescription, to procurement, provision, and verification of 

receipt of appropriate prosthetic items. 

Æ 


anorris on DSK9Q6SHH1PROD with HEARING