The Amputee Coalition and the American Orthotic & Prosthetic Association (AOPA) have released a jointly commissioned, retrospective study that details the value of O&P services among Medicare beneficiaries. They also held a joint webcast on August 27 to discuss the report findings, which they say is actual data that proves the value of an O&P intervention based on economic criteria.
The report, “Retrospective Cohort Study of the Economic Value of Orthotic and Prosthetic Services among Medicare Beneficiaries,” was completed by Dobson DaVanzo & Associates, Vienna, Virginia. The study’s primary objective was “to determine the economic value of O&P services in terms of the totality of a beneficiary’s health care utilization and expenditures.” The customized cohort dataset, which was requested and received from the Centers for Medicare & Medicaid Services (CMS) for this analysis, focused on three cohorts of Medicare beneficiaries: those who received lower-limb orthoses, those who received spinal orthoses, and those who received lower-limb prostheses within 12 months of undergoing amputation. The dataset covered the years 2007-2010 and comprised claims across all settings.
A summary of the findings follows:
Lower-Limb Orthoses: Patients in the study cohort who received lower-limb orthoses were shown to have fewer falls and fractures, fewer emergency room admissions, and Medicare episode payments that were 10 percent less than the comparison group: $27,007 (including the cost of the orthosis) versus $29,927. This cohort was also able to sustain more rehabilitation and was able to remain at home instead of needing inpatient care.
Spinal Orthoses: Patients in the study cohort who received spinal orthoses had Medicare episode payments that were 0.3 percent less than the comparison group, $32,598 versus $32,691; had higher ambulatory and home-based care rates; and had a slightly higher prevalence of fractures and falls, which may be attributed to increased ambulation and mobility.
Lower-Limb Prostheses: Patients in the study cohort who received lower-limb prostheses were more likely to receive home health or extensive outpatient therapy than facility-based care; they had slightly higher rates of fractures and falls, likely due to increased ambulation; and they experienced fewer acute care hospitalizations and less facility-based care. The cohort who received prostheses had 1 percent higher total Medicare payments over the 12-month episode than the comparison group: $68,040 versus $67,312. The cohort who received prostheses experienced soft benefits at no additional cost to Medicare or the patient, such as better quality of life, increased independence, and the opportunity to more fully earn a living, compared to patients who did not receive prostheses.
Editor’s note: This story was adapted from materials provided by the Amputee Coalition and the American Orthotic & Prosthetic Association.