At the request of the US Congress, the Government Accountability Office (GAO) conducted research about Medicare beneficiaries and the services and outcomes they experience following limb loss. The resulting report described characteristics of traditional Medicare beneficiaries who lost a limb in 2016, the percent of those who received rehabilitative services or prosthetic limbs, the percent of those who experienced selected health outcomes, and challenges to obtaining rehabilitative services and prosthetic limbs. The report includes information about care for veterans with limb loss received from the Veterans Health Administration (VHA).
The GAO researchers also interviewed officials from the Centers for Medicare & Medicaid Services (CMS) and VHA and representatives from ten stakeholder groups representing healthcare providers, patients, and prosthetics and rehabilitation facility industry groups.
The data collected and described in the report showed that 50,202 beneficiaries enrolled in traditional Medicare lost a limb in 2016. Of these, most lost a lower limb (96 percent) and were White (66 percent). Black, Hispanic, and dual-eligible for Medicare and Medicaid beneficiaries were disproportionately affected by limb loss. For example, 21 percent of beneficiaries who lost a limb in 2016 were Black, while 8 percent of beneficiaries in traditional Medicare that year were Black. 2016 was the first full year of claims data available using current medical coding, and 2019 was the last full year of claims data prior to the start of the COVID-19 pandemic.
Of beneficiaries in traditional Medicare who lost a limb in 2016, nearly all received at least one selected rehabilitative service, and 30 percent received a prosthetic limb from 2016 through 2019.
It is estimated that over 2 million individuals in the United States live with limb loss, and is expected to almost double by 2050, according to researchers. Individuals 65 and older are at the greatest risk of having amputation surgery.
To read the report, “Limb loss: Rehabilitation services and outcomes for Medicare beneficiaries report to congressional requesters,” visit the GAO website.
