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Rep. Ann Kirkpatrick

Rep. Ann Kirkpatrick, Ranking Member, Subcommittee on Oversight and Investigations

Thank you Mr. Chairman.

This morning, the Subcommittee on Oversight and Investigations will be looking into VA practices regarding purchasing surgical implants.  In addition, the Subcommittee will be looking into allegations that surgical implant vendor representatives had participated in direct patient care.

On Monday, the Government Accountability Office (GAO) released a report entitled VA Surgical Implants: Purchase Requirements Were Not Always Followed at Selected Medical Centers and Oversight Needs Improvement

The GAO looked at four VA medical Centers and found that these hospitals did not always follow VHA policy regarding documenting open market purchases of surgical implants, including obtaining the necessary waivers to purchase items not covered by a VA-negotiated contract.  Last year, VA instituted a new policy regarding purchases above the Federal Acquisitions Regulation’s (FAR) micro-purchase threshold of $3,000 and below the simplified acquisition threshold of $150,000.  Medical facility and regional office officials “attributed noncompliance mainly to insufficient VHA guidance and VA staff’s inexperience” in completing the new requirements.

This is a familiar litany to members serving on this subcommittee.  It has been noted before that it does not matter how good and thorough the policy and standards are if no one follows them and there are seemingly no consequences for noncompliance.  And this is what I would like to explore today in addition to looking at the specific allegations and looking at ways to improve the process.

Surgical implants, and the larger issue of medical procurement, provides us with a classic balancing act of patient and provider choice on one hand, and efficiency and savings on the other.  These are not, in my view, mutually exclusive concepts, but also, there are, ultimately, very few easy answers.

Should there be a greater level of centralization on procurement matters, or should we provide greater local autonomy while ensuring that policies are followed?  Indeed, how do we ensure that VA employees are provided the tools to do their jobs and help our veterans but are also held accountable if they do not comply with established policies.

On the issue of surgical implants, what policies and structures are in place to ensure that VA staff is kept fully-up-to-date on advances in the field of surgical implants, and the availability of different options, while also ensuring that VA’s contracting efforts are directed toward items that are clinically advantageous and necessary for patient care.  Are decisions regarding which items to include in a VA-negotiated committed-use contract made from the top down, or the bottom up, and more importantly, are these decisions made rigorously and systematically?  How effective is the recently instituted program executive office and does this effort have the staffing level and financial resources to make a difference and improve the process?

GAO reported that VHA spent approximately $563 million on surgical implants in fiscal year 2012, an increase of 28 percent over fiscal year 2008 levels.  I would like to hear from our witnesses today regarding the factors that led to this increase.  It is not clear to me whether the increase is primarily due to the practice of open market purchases, or to an increase in either the costs of surgical implants or an increase in their use. 

 Patient safety is our number one concern.  That is why I am concerned over allegations that surgical implant vendor representatives participated in direct patient care.  I want to ensure that VA policies are fully followed in this regard while also recognizing that at times vendor representatives can have an important role in providing technical assistance and education to VA care providers.

So let us begin the conversation on how best to fix the problems before us today and work to improve the VA health care system and the health care it provides to our veterans.  Spending taxpayer dollars wisely is essential, but providing the health care that veterans have earned and deserve is critical.

I look forward to hearing from our witnesses today, and I yield back the balance of my time.