Study: It pays to spend on O&P

Tuesday, September 24, 2013

WASHINGTON – If you ask a person with a prosthetic limb whether it’s a good value, they are likely to laugh at you.

“It’s the difference between being up and walking, and living life in a wheelchair,” said Susan Stout, interim president and CEO of the Amputee Coalition, during an Aug. 27 press conference to announce the results of a new study.

Proving that value to payers has been a tougher sell, so the coalition, which advocates for people with limb loss, commissioned a study compare the costs of providing vs. not providing O&P care.

The study, conducted by Dobson DaVanzo & Associates, looked at the claims of more than 42,000 paired sets of Medicare beneficiaries—who either received full O&P care or not—from 2007-2010. The following info was compared: Medicare payments per month and overall; number of fractures and falls; use of physical therapy; and emergency room and hospital admissions.

The main finding: Patients who receive O&P services have lower or comparable Medicare costs than those who don’t. Of three groups, studied according to device, only those with lower limb prosthetics had slightly higher Medicare costs ($68,040 compared to $67,312, on average). Those patients were also healthier and enjoyed a higher quality of life, according to the study.

“When the government, or any payer, invests money to provide O&P services, in the longer term, they will save money,” said Thomas Kirk, president of the American Orthotics and Prosthetics Association (AOPA). “For the patients, they are doing normal activities, becoming a member of the workforce and ambulating (without) assistance.”

The Amputee Coalition, AOPA and other stakeholders have long sought better insurance coverage for O&P care. While most payers do provide some coverage, they often have lifetime caps and other limits that put the devices out of reach for some patients. The study should help payers look at the bigger picture, say stakeholders.

“Many payers have seen the cost of prosthetics in a vacuum rather than actually contributing to the overall health improvement of the patient,” said Tom Fise, executive director of AOPA, during the call.  “Insurers typically won’t say a patient shouldn’t have a prosthetic, but they’ll try to pay for the least expensive, which may not necessarily maximize the patient’s ability to attain independence.”