People with amputations in the United States are facing a “tech gap” in which the Centers for Medicare & Medicaid Services (CMS) and private health insurers deny access to new microprocessor-controlled knees (MPKs), which are only slightly more expensive over a lifetime and safer in terms of preventable injuries and deaths than the older, less technologically advanced prostheses. Those are among the key findings of a new report issued by RAND, Santa Monica, California, and available online from the American Orthotics & Prosthetics Association (AOPA).
The study showed that fewer people with amputations are getting access to the new, safer technology. These patients are confined to older and more dangerous prostheses, according to the report. The RAND study noted that Medicare total payments for prosthetic devices declined 15 percent during the 2010-2014 period despite advances in technologies.
The study showed that 26 percent of patients who received more advanced prosthetic limbs with MPKs will fall per year as opposed to 82 percent of patients with the non-MPK limbs. There were 14 fall-related deaths per 10,000 patient years for non-MPK users, and three fall-related deaths per 10,000 patient years for those patients using an MPK. As a result, up to 11 lives per 10,000 patient years could be saved through wider MPK usage, the study suggested. The data also showed that 38 falls per 10,000 patient years resulted in injuries to users of MPKs versus 182 falls per 10,000 patient years for non-MPK users.
“Due to recent advances in technologies, prosthetic knees and feet allow for more dynamic movements and improve user quality of life, but payers have recently started questioning their value for money. The results suggest that the incremental cost of MPK is in line with commonly accepted criteria for good value for money and with the incremental cost of other medical devices that are currently covered by U.S. payers,” said Soeren Mattke, MD, managing partner, Health Care Practice, RAND, Boston.
New technology compared to older technology can be a “life-and-death issue for an amputee,” said Michael Oros, CPO, AOPA president, and CEO, Scheck & Siress, Chicago. “This is not a case of amputees wanting to have access to new technology just because it is new. And there is a quality of life issue here. Amputees who are stuck with the 1970s-style tech tend to be less mobile in addition to being more vulnerable to risk of injury or death.”
AOPA hosted a press event at the National Press Club, Washington DC, on October 19 to share the research.
AOPA led a national campaign in 2015 to oppose a Medicare rule that would have placed additional restrictions on access to MPK devices and reduced the quality of current technology care provided to people with amputations in the federal program.