Veteran Health Administration: Shortcomings in implant sourcing, tracking and vendor support
The Veterans Health Administration (VHA), part of the Veteran Affairs (VA), is one of the largest purchasers of medical devices. With 152 hospitals across the country, the VHA spent $562M on implants alone in 2012, a 28% increase from 2008.
However, the VHA recently came under fire from the Government Accountability Office (GAO) for how they purchase, track and use medical devices.
According to the GAO report, the VHA is being investigated on three fronts:
1) Failed to seek most competitive market prices for implants
The VHA is paying a higher than normal price for medical devices. Surgeons at VHA usually determine needs for surgical implants, request the implant of their choice for purchase, and perform the clinical procedures to implant the items. While VA has negotiated competitive contracts for a variety of implants, VA medical centers (VAMCs) can purchase a specific surgical implant requested by a clinician from the open market with appropriate clinical justification, rather than purchasing a similar item through a VA-negotiated competitive contract. Lack of VHA oversight and appropriate clinical justification for open market implant purchases has raised concerns.
2) Failed to sufficiently track veterans who receive implants
In addition, the VHA is not sufficiently tracking veterans who receive implants, meaning they may not be easily reached in the event of an implant defect or recall. Implant purchases are not being accurately documented, including recording serial and lot numbers, so veterans who have had implants can be easily identified in case of an U.S. Food and Drug Administration recall or other safety issues. As a result, the VHA has limited ability to identify and locate a patient who has received a surgical implant which has potentially significant patient safety and cost implications.
3) Allowed medical device reps to become too involved in patient care
Finally, surgical implant vendor reps (medical device reps) are getting too involved in patient care, which goes against industry practices. The GAO has raised concerns that medical device reps were participating in patient surgeries and procedures. The VHA has no documentation on file regarding vendor qualifications, training or other certifications and competencies for the medical device reps present in clinical areas. The report states that medical device reps were directly linked to being involved in patient care at three VAMCs between Feb. 2013 and Jan. 2014. Specifically in question was medical device reps directly applying skin grafts to patient wounds.
“As a VA orthopedic surgeon, my primary interest is in safe and efficient care of my veteran patients. Given the GAO findings, the VA has a duty to improve and take advantage of its competitive purchasing power, improve it’s tracking of prosthetics, and ensure that only licensed and credentialed personnel engage in direct patient care.” - Dr. Nicholas Giori, Orthopedic Surgeon, VA Palo Alto Health Care System
Sources: http://www.gao.gov/assets/670/660207.pdf; http://www.cnbc.com/id/101326624
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