A major new study commissioned by the Amputee Coalition and conducted by Dr. Allen Dobson, health economist and former director of the Office of Research at CMS (then the Health Care Financing Administration) shows that the Medicare program pays more over the long-term in most cases when Medicare patients are not provided with replacement lower limbs, spinal orthotics, and hip/knee/ankle orthotics.
Lower extremity and spinal orthotic and prosthetic devices and related clinical services are designed to provide stability and mobility to patients with lower limb loss or impairment and spinal injury. Supplying bracing or support (an orthosis) where needed or a new artificial limb (prosthesis) when necessary saves our healthcare system significant future costs. Medicare’s own data shows this to be the case. Timely treatment that preserves or helps regain mobility not only makes sense; it also saves dollars.
The study’s authors used the Medicare Claims database to review all Medicare claims data for patients with conditions that justified the provision of lower limb orthoses, spinal orthoses, and lower limb prostheses.The unprecedented study looked at nearly 42,000 paired sets of Medicare beneficiaries with claims from 2007-2010. The paired patients either received orthotic and prosthetic care or they did not get such care.
The study’s key finding was that Medicare costs are lower or similar for patients who received orthotic or prosthetic services, compared to patients who need, but do not receive, these services. According to the study, Medicare could save 10 percent ($2,920 on average) for those receiving lower extremity orthoses, and there also are modest savings for patients receiving spinal orthoses and lower extremity prostheses.
“Looking at full costs and other outcomes (including use of out-patient therapy, number of falls, ER admissions, and acute hospitalizations) over a 12-18 month period, our study concludes that patients who received the orthotic and prosthetic services experienced greater independence than patients who do not, with better or comparable health outcomes and generally lower Medicare payments.”
Dr. Allen Dobson
With respect to the prosthetic intervention, the cumulative cost comparison demonstrated that the cohort that received the prosthesis had about 1% higher costs compared to the population that did not receive the device. The slope of the cumulative cost curve indicates that had the period of evaluation been longer the break- even would have been reached.
“Everyone’s experience with limb loss and limb difference is unique. However, access to medically appropriate devices can dramatically change that experience, providing an avenue for a more active, engaged life in the community and the workplace. This study offers national data that provides support for the need for access to care — as well as pointing out the opportunity to further explore the impact prosthetic devices can have, both financially and personally.”
President & CEO, Amputee Coalition