Economic Value of Prosthetic Services Among Medicare Beneficiaries

Economic Value of Prosthetic Services Among Medicare PatientsCurrently, there are approximately 2 million individuals in the United States who are living with limb loss. The total number of individuals with an amputation, and those using prostheses, is expected to reach 2.4 million in the year 2020.

Although lower extremity prostheses are often provided to younger (non Medicare eligible) beneficiaries because of trauma or disease progression, the study focused on the impact of prostheses on Medicare beneficiaries with a recent amputation. On average, patients in the study who received lower extremity prostheses were 72.9 years of age.

Results of the Study

The study revealed that the receipt of a prosthetic device improves patient outcomes on a variety of functional and psychological measures. These services can reduce health care spending for some patients by preventing downstream clinical complications and reducing other types of health care utilization.

Evidence Regarding Patient Outcomes – Functional Ability and Psychosocial Issues

A number of studies have shown that the provision of a prosthetic device led to measurable improvements in the quality of patient care and functional and psychosocial outcomes. Beyond physical health, receipt of prosthetics is associated with improved mental health status and social functioning, and reduced role limitation because of emotional problems. Social gains included returning to work and reduced reliance on social services.

Evidence Concerning Cost – Benefit and Economic Value

Long-term savings and economic value are thought to result when patients receive appropriate prosthetic care. Without prosthetic care, individuals live more sedentary lifestyles, which research has shown to lead to secondary complications, including diabetes and other related issues.

Evidence Concerning the Benefits of Therapy

The study determined that both inpatient and outpatient therapy sessions are critical for patients with the prosthesis to help teach them balance and mobility with their new device.

Evidence Regarding Patient Outcomes – Increased Mobility

The study also revealed that the receipt of prosthetic services could increase a patient’s mobility, ultimately reducing their health care utilization and increasing their quality of life.

Conclusion

During the study over a 12 month period, patients who received lower extremity prosthetics had reduced Medicare payments such that the cost of the prosthetic was essentially ‘covered’. Through a reduction in acute care hospitalizations, physician visits, and facility-based care, patients experienced better quality of life at a comparable Medicare episode payment. Despite a comparable number of fractures and falls among lower extremity prosthetic users, the rate of emergency room admissions was lower than for those who did not receive the service. Part of the savings as a result of reduced facility-based care was offset by extensive physical therapy and rehabilitation to teach patients how to properly use their prostheses.

If used properly, lower extremity prostheses have the potential to increase quality of life and reduce facility-based care for newly amputated Medicare beneficiaries. Across all analyses presented above, the results suggest that prosthetic services provide value to the Medicare program, as well as a value to the patient. The cost of the services are nearly, if not completely, amortized through reduced acute care hospitalizations and facility-based care.

Economic Value of Prosthetic Services Among Medicare Beneficiaries