Nevada veterans with prosthetics faced delays

Many patients referred to outside vendors

LAS VEGAS (KTNV) - A new example of taxpayer waste has been uncovered at the VA. Contact 13 details on the special class of veterans who were impacted.  

The Prosthetics Laboratory at Southern Nevada's VA Hospital helps veterans recover from life-changing sacrifices.  It's where soldiers who lost a limb while defending our country can be fitted with a prosthetic arm or leg. But an Inspector General investigation (click here for full report) found the VA did not provide timely and cost-effective services to many of the 7,000 veterans who rely on it. 

Contact 13 was able to tour the prosthetics lab back in 2014.  It was touted as state of the art.  A source of pride for the new hospital.  

But according to a report released this week by the Inspector General, the lab needlessly relied on outside vendors for items taxpayers had already paid for in existing stock.  Critical inventory, like compression garments and orthotic shoes, just sat unused.  An inventory in 2016 showed 300 compression garments in stock, but only two were issued while 287 were outsourced. 

Between October 2014 and May 2016, the Inspector General also found veteran care was delayed on average 24 days with some veterans waiting up to 46 extra days for specialty shoes and compression garments from outside vendors, despite stock being readily available at the VA.  

The VA says poor decision-making by laboratory employees, underutilized laboratory personnel, and unused inventory went undetected because the former chief of prosthetics did not effectively monitor the laboratory's operations.

One audit estimates the unnecessary outsourcing could cost taxpayers about $240,000.

The Southern Nevada VA told us all the Inspector General's findings have been reviewed, addressed and corrected with major improvements. They provided the following statement:

On June 26, the VA Office of the Inspector General (OIG) Office of Audits and Evaluations released a report titled: VA Southern Nevada Healthcare System's Alleged Unnecessary Use of Outside Vendors to Purchase Prosthetics [va.gov].

The report was in response to allegations that the VA Southern Nevada Healthcare System’s (VASNHS) prosthetics laboratory did not provide timely and cost-effective services to Veterans for frequently prescribed compression garments and orthotic shoes. VASNHS fully cooperated with the OIG and their review of the allegations substantiated the following:

- That between October 2014 and May 2016 that the laboratory showed a needlessly high reliance on outside vendors for items that it could have provided from existing stock.
 
- About 99 percent of prescribed compression garments and 75 percent of orthotic shoes, accounting for 91 percent of VASNHS’ spending for these items, went to outside vendors during this period.
 
- Sending veterans to outside vendors was not justified because VASNHS had sufficient personnel and inventory to provide the prescribed compression socks and orthotic shoes.
 
- Poor decision-making by laboratory employees, underutilized laboratory personnel, and unused inventory went undetected because the former chief of prosthetics did not effectively monitor the laboratory’s operations.
 
- An incorrect use of a program code (NR018) by purchasing employees to close consults resulted in some cases being closed prematurely and a risk of delayed care for Veterans.

VASNHS and VISN 21 leadership concurred with the OIG findings, and submitted action plans based on the OIG’s recommendations. The OIG found the action plans acceptable and has closed this matter.

The OIG recommended that VASNHS continue to improve its oversight and use of resources in the laboratory and highlighted in its report release that in the two years since the audit period a new chief of prosthetics at the VA Southern Nevada Healthcare System has implemented sweeping changes to the laboratory. As a result of these actions, reliance on outside vendors dropped to 14 percent after June 2016. 

Since June 2016, VASNHS has implemented the following actions to address the findings in the OIG report and ensure Veterans have better access to services:

1. VASNHS has taken major steps to monitor the compression stockings and orthotic shoes. During fiscal year 2017 only 45 orders for compression stockings and 76 orders for orthotic shoes were sent to outside vendors with the rest being completed in-house. Additionally, during fiscal year 2018 through March, only 11 compression stockings and 25 orthotic shoe orders have been sent to outside vendors. These rare instances were either due to travel issues, complexity of stockings or, in the case of shoes, other devices being attached.

2. VASNHS examined 4,530 consults closed by purchasing employees using the NR018 code from October 2014 through May 2016 and has taken necessary action to ensure veterans received their prescribed prosthetic or orthotic item(s). Where appropriate, this included notifying the provider to reexamine the veteran for medical need and, in the cases where there was still a medical need, new consults were entered.

3. The Chief of Prosthetics and Administrative Officer for Prosthetics now conduct daily monitoring of prosthetics activity and coding to ensure compliance with guidelines and stay on top of all issues. During fiscal year 2017, the NR018 code that was previously used incorrectly was only used 14 times, and during fiscal year 2018 through March, had not been used at all. In the instances the NR018 code has been used since 2016, it has been determined the code was used properly in accordance with business practice guidelines.

4. VASNHS manages more than 70,000 prosthetics consults annually, and since the timeframe involved the OIG report, prosthetics has made the following changes locally to ensure Veterans receive quicker access to specialty rehabilitation services and prosthetics equipment:

Recently, VASNHS became one of the first VA facilities in the nation to enact direct scheduling for amputation care and wheelchair services, allowing Veterans to access care without a consult. As such, Veterans no longer need a primary care referral or to make extra trips the VA to get a consult to access these services.

The North Las Vegas VA Medical Center now offers same-day access for orthotist/prosthetist clinical services. For those seeking same-day access, a new kiosk is available for Veteran check-in and the facility currently has 120-150 Veterans per day accessing these services.

In closing, VASNHS takes our mission of providing high quality, safe and compassionate care in a timely manner to the Veterans we serve seriously. We appreciate all the work and progress our new prosthetics chief and staff have made in the two years since the timeframe referenced in this report to ensure that our Veterans are receiving the highest quality care they have earned and deserve.

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