Because of the increasing difficulties created by Medicare reimbursement and proving medical necessity for orthotic and prosthetic devices, the Amputee Coalition commissioned a study to determine the effects of orthotic and prosthetic care on patient outcomes and Medicare payments.

“In order to achieve the goal that those who lose a limb receive appropriate prosthetic devices, it is important to address the question of the value of this service to our health care system,” Sue Stout, interim president and chief executive officer of the Amputee Coalition, stated during an Aug. 27 webinar, in which the study results were disclosed. “Insurers want to see the data that proves the health care system is better off if the service is provided, so we commissioned the study to help provide the answers about the value of lower limb prostheses in our health care system.”

The study was conducted by Allen Dobson, PhD, a health economist and the president of Dodson/DaVanzo & Associates LLC, with funding from the American Orthotic & Prosthetic Association (AOPA).

“Our study had one main research objective, and that was to determine the financial benefits to the government and private payers when a person with limb impairment or limb loss obtains restored mobility and receipt of orthotic and prosthetic services,” Dobson said.

Cost savings

Dobson and his colleagues created a custom database containing Medicare claims filed between 2007 and 2010, totaling 2.4 million beneficiaries. Of these beneficiaries, they identified patients who filed claims for lower extremity orthoses, spinal orthoses or lower extremity prostheses and used propensity scoring to match them to patients who needed but did not receive those same orthotic and prosthetic services. The approximately 42,000 pairs were compared based on outcome measures over an 18-month period, including Medicare payments per member per month and overall, prevalence of fractures and falls, use of physical therapy and emergency room and hospital admissions.

They found that patients who received orthotic or prosthetic services had lower or comparable Medicare costs than patients who did not receive the same services. They also found that these patients had fewer hospital-based or facility-care admissions, received more outpatient rehabilitative therapy and experienced greater independence and ambulation.

“The results of our propensity score matching suggest that patients who receive O&P services generally had fewer hospital admissions and facility-based admissions, more outpatient rehabilitation therapy visits and comparable or lower Medicare episode payments,” Dobson said. “Across all O&P services, the cost of the device was nearly, if not completely, amortized over the study period. This study suggests that the reduction in health care expenditures exceeding the cost of O&P services increasing the quality of life for the patient and reducing the cost of the Medicare program.”

“The conclusions that Dr. Dobson shared are extraordinarily significant, because for the first time, we can actually use data that come directly from the Medicare database based upon two cohorts of patients that clearly demonstrate the efficiency and efficacy of the services we provide,” Thomas F. Kirk, PhD, president of AOPA, said during the webinar.

The speakers also asserted that they will be using these results to work with insurers and continue fighting for insurance fairness for orthotic and prosthetic devices.

“This study conclusively proves that from an economic perspective, as well as from a health and wellness perspective, an O&P intervention is efficient and helps the patient. I think the idea from a historical perspective was that this was just a cost,” Kirk said. “We’ve clearly shown in this study it is an investment that pays back, in addition to all the soft side benefits.”

“Now that the study is completed, we intend to use the information contained in the study to achieve fair insurance coverage for prosthetic devices,” Stout added. — by Megan Gilbride