The Challenge of Justification

As chief executive officer of a prosthesis manufacturer in today's market, I could say that we live in interesting times. Since Touch Bionics' i-limb prosthetic hand first became available in 2007, the prosthetics landscape has changed considerably. Advanced prosthetic limbs are now part of the fabric of society. Whether it is Oscar Pistorius competing against able-bodied athletes in the Olympic Games, or the appearance of the i-limb ultra in a recent Will.i.am and Britney Spears music video, high-tech prostheses are no longer the stuff of science fiction but are now widely accepted as the new standard in limb care. But while the public may view these technology developments as the natural next step in the provision of modern patient care for individuals with amputations, private payers are increasingly demanding justification when considering claims for such devices. The payer position is understandable. The cost of fitting high-tech devices can be substantially higher than lower-tech options, and payers need to be able to understand why this cost difference is warranted. The solution to claims approval is payer education and the provision of data that demonstrates the ability of the device to deliver meaningful benefits to the user. Payers face considerable challenges when it comes to understanding the complexity of new prosthetic devices. As these devices become more advanced and complex, the manufacturer has an increasing responsibility to provide the product support packages and training O&P providers need to deliver successful patient outcomes. Myoelectric upper-limb devices, for example, can offer improved functional levels, decreased overall impairment, a broader range of occupational options, and increased work capacity, as well as aesthetic and social benefits. But when comparing fitting such prostheses to less sophisticated upper-limb technologies, there is much more clinician time required to ensure the patient is able to get full use of a high-tech prosthetic device and to allow the patient to be successful in his or her activities of daily living (ADL) using the device. Due to the extra time and expertise applied to fitting complex devices, patients who are fit with high-tech devices are able to have significantly improved quality of life and better perform everyday activities in both work and home environments. This has resulted in a higher level of reimbursement from some providers, which is an encouraging sign. But to ensure that this standpoint is taken across the broader private payer market, advanced technologies must also be supported with real data. At Touch Bionics, we are fully committed to ensuring that our products' ability to deliver improved patient outcomes is supported with validated data. We have developed an online tool that monitors a patient's experience with his or her prosthesis, starting prior to fitting and continuing at regular intervals thereafter. This tool utilizes internationally recognized outcome measures to generate patient scores to be included in a database we are building of evidence-based practice to show payers the impact our prosthetic devices have on patients' lives and their ability to complete ADLs. This evidence helps to provide payers with the insight they need regarding the value of this advanced technology. Other ways manufactures can help justify the cost to payers are to provide patients with reimbursement support teams and help achieve good patient outcomes via clinical support services. So although we may live in interesting times for high-tech prostheses, the future looks bright if we as an industry are prepared to stand by our products and support them with the data that proves the benefits we know they provide. Ian Stevens is the chief executive officer of the prosthetic technologies company Touch Bionics, headquartered in Livingston, Scotland.

The Challenge of Justification

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Bio-Mechanical Composites Relocates

IPC Announces the Paralympics Grand Prix Series

IPC Announces the Paralympics Grand Prix Series

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