A report commission by the American Orthotic & Prosthetic Association and conducted by Dobson DeVanzio & Associates has concluded that 19% of patients who have received a Medicare-reimbursed off-the-shelf device later receive a custom-fitted orthosis.
According to a summary of key findings from Dobson DeVanzio & Associates, the firm conducted two separate claims analyses to better understand “how the distribution of O&P services has changed over time across provider specialties” and “whether, and to what extent, Medicare beneficiaries receive multiple O&P services.”
The first claims analysis is based on the Medicare Physician/Supplier Procedure Summary Master file, which includes all Part B CMS claims for 2011 and 2012. The second analysis is based on information from the Standard Analytic File for Medicare claims, which includes patients who received O&P services from Jan. 1, 2008 to Dec. 31, 2008 and follows each patient for 18 months.
The analyses showed that the proportion of certified O&P personnel providing non-off-the-shelf (OTS) and custom-fitted or fabricated devices decreased between 2011 and 2012 while the proportion of medical supply companies rendering these services increased. Currently, 15 devices are classified as custom-fitted by AOPA but are classified as OTS by CMS. The proportion of services provided by certified O&P personnel for these devices varies.
The analyses also revealed that for Medicare beneficiaries who received O&P services in 2008, 16.1% of patients received an OTS orthosis as their first device. Of those, 19% of TLSO, LSO and AFO patients received a subsequent custom-fitted or custom fabricated device.
“While there may be clinical indications to occasionally use OTS devices as a transitional device, this large proportion of patients suggests that some beneficiaries are utilizing OTS services where custom-fitted or fabricated orthotic services may be more appropriate,” the firm states in the summary.
Overall, 90.2% of TLSO patients, 98% of LSO patients and 69.6% of AFO patients received custom fitted devices. The firm concluded in its summary that the analyses show “that medical supply companies and other uncertified providers bill a large proportion of O&P services” and indicate “that a sizeable portion of beneficiaries are not receiving the appropriate device initially.”
