PROSTHETIC SERVICES Almeta J. Mallory Assistant Chief Prosthetic & Sensory Aids Service
First Some Facts about FY10/11/12: The Prosthetic program in Salisbury spent $19.7 million dollars for this FY on items and services for our veterans Transactions for FY10 – 79,396 Transactions for FY11 – 109,125 Transactions for FY12 – 111,532 Receive on average 150-300 consults per day
What is Prosthetics? Our Mission The mission of the Prosthetic & Sensory Aids Service (PSAS) is to provide comprehensive support to optimize health and independence of the Veteran. Our vision is to be the premier source of prosthetic and orthotic services, sensory aids, medical equipment, and support services for Veterans.
What is Prosthetics? Prosthetic is an Administrative Department within the Veterans Health Administration that is responsible for the PURCHASE of Durable Medical Equipment for use in the home. Depending on the hospital we will have Clinical Staff in addition to our Administrative Staff.
What items/services are provided by Prosthetics? Medical equipment of all varieties: blood pressure monitors, hospital beds, bathroom safety equipment, ADL items, blind aids, walking aids, artificial limbs, orthotic devices such as bracing and shoes. We also administer several veteran benefit programs such as automobile adaptive equipment, clothing allowances and HISA (Home Improvement and Structural Alterations)
How does Prosthetics process electronic consults All items and services requested through Prosthetics must be made by submission of a complete Prosthetic Consult All consults submitted to Prosthetics require that action be taken within 5 business days If there is an action required prior to the 5 business days, Physicians have the ability to request urgent consults.
Important FYI’s regarding consults It is extremely critical that all information needed is provided on the consult. Because all items provided by Prosthetics require training for the veteran or his family, it is necessary that the consult is documented to reflect that The VA is Joint Commission Accredited and the delineation between the services provided in the home and equipment provided in the home depend on the training that is received.
A typical view of the system our Purchasing Agents work from…
Prosthetics Consult Process Consult received in the Prosthetic software system Consult is reviewed for item requested Prosthetics receives 150 – 300+ consults a day. The consult is received in VISTA
Prosthetics Consult Process Cont. We currently have 7 Purchasing Agents (PA) A PA has four major responsibilities 1. Order items Validate the consult for feasibility to ensure that information that is necessary is provided Ensure that company is viable source for purchasing Research to obtain price and HCPC for item to be ordered/compliance
Prosthetic Consult Process Cont. Create purchase order Fax order to the company to authorize purchase. If any step is not in order, the entire process has to stop. 2. Reconcile orders 3. Aged purchase orders 4. Compliance During this time they also follow the DUSHOM monitor regulations for timeframe in processing orders.
Benefit Programs AAE Auto Adaptive Equipment HISA Home Improvement and Structural Alterations NOT SAH Special Adaptive Housing CA Clothing Allowances
Benefit Programs Continued.... Each Benefit is determined by the Veterans Benefits Administration (VBA). The amount of and type of benefit is based on a Veterans Service Connected (SC) Condition. A Veteran who is Non-Service Connected (NSC) can still be eligible for some of these benefits however it will differ for each Veterans specific condition and SC percentage.
AAE Service Connect Determined by VBA. Indicated with approval of VA form10-4502. One time initial payment Eligible for total of 2 vehicles in a 4 year period Requires Drivers Evaluation via consult to RMS KT Reimbursement determined by SC
AAE Continued.... Non-Service Connected Veteran Authorized for Adaptive Equipment to the vehicle only Not authorized as a driver Requires consult from Primary Care Physician (PCP) One time purchase of AAE, requires approval/re- evaluation if replacement required. Review and approved through Major Medical Committee
HISA grant Process 1. Obtain a consult from the Primary Care Provider 2. Be evaluated through RMS OT for an assessment of needs. 3. Receive a VA HISA “package” from RMS OT. 4. Follow ALL of the directions 5. The rest of the process is dependent upon the “completed package”
HISA Continued... Completed HISA package is reviewed by the HISA committee For Non Service Connected Veterans, a purchase order will be created and additional detailed letters will be provided For Service Connected Veterans, due to the dollar amount of the purchase, the request will then be entered into the Planning Module for a Contractor to purchase. Approximate time for a HISA is 2-6 months. “IMPORTANT” to remember HISA grants are agreements between the Veteran and the contractor that they select.
SAH This is strictly a VBA program, However a Veteran can utilize this program in conjunction with the HISA grant. The SAH grant coordinators will provide one approved Contractor for the Veteran to use. The Veteran will be responsible for the completion of the paperwork for the HISA grant portion of the request. The same process will apply. WE DO NOT PROCESS SAH GRANTS.
CA’s 4 Major requirements 1. Must be SC 2. Must have qualifying equipment/medication issued 3. Must apply before July 31 st of the current year. 4. Must have Documentation of continued use. Number 4 is on one of the most important factors. The issuance of the equipment is considered a prescription. Prescriptions in the VA are active for 1 year.
CA’s Continued.... Changes in multiple CA’s Requesting Multiple CA’s will affect Veterans who previously received Static/recurring CA’s There is only one payment for 1 piece of equipment All other regulations still apply All applications that are received are documented on the Veterans Prosthetic record, it is reviewed for equipment and entered into the VETSNET payment system, where it requires two signatures to be released for payment. Once the approval is completed a letter is generated to inform the Veteran of the approval or the denial.
Points of interest that affect us both Veteran Education Knowing the Facts Timeliness Issues Rumor Control Proper Process Communication
Points of interest that affect us both Veteran Education - Although Prosthetics is very knowledgeable about most subjects within the VA, we cannot be a one stop shop for all Veteran education. It is very important to direct Veterans to the proper location for the medical request and information. The VA is a very large and difficult entity to address. Without proper guidance it can be over whelming for most Veterans. Veterans are accustom to following directions the problem is that most only receive vague directions leaving them angry and frustrated.
Points of interest that affect us both Knowing the facts - Most Veterans rely on word of mouth and their own interpretations. The 1173 is a primary source of information for Prosthetics. There are also other sources such as the National Prosthetic Website that are available for information specifically related to Prosthetics. Timeliness issues - If we haven’t fixed it, something may be wrong. Primary Care is always a Veterans first line of defense. Rumor Control - Re-direct all the I have a friend who... issues to documented sources. VA’s make mistakes, friends don’t always tell the whole story, etc.
Points of interest that affect us both Proper Processes – Prosthetics is an Administrative Department. In the examples that were previously given for HISA, AAE and CA’s. They all have processes that need to be perform. Communication – I could communicate with you for an hour just on communication. We did with Veterans daily that because of a lack of proper communication they are
Questions???? I have given you a lot of information, please feel free at this time to ask any questions you may have...
Prosthetics Assistance Prosthetics pledges to assist you with the ability to provide our Veterans with the best medical care that they deserve. If you have any additional questions, please feel free to contact us by e-mail at Andre.Judkins@va.gov or Almeta.Mallory@va.gov,Andre.Judkins@va.gov Almeta.Mallory@va.gov 704 638-9000 at ext 3106 / 2984 or 3796