LAS VEGAS — Patients who received O&P services generally had fewer acute care hospital admissions and more outpatient rehabilitative therapy visits, as well as lower Medicare Part D drug costs and episode payments, according to research presented at the American Orthotic & Prosthetic Association World Congress.
Lower costs, increased QoL
The study, conducted by researchers at Dobson DaVanzo & Associates LLC, found the reduction in health care use exceeded the cost of O&P services, increasing the quality of life for the patient while reducing the cost to Medicare.
“We used Medicare claims data from the years 2011 to 2014. An earlier study we did had looked at data from the years 2007 to 2010,” Allen Dobson, PhD, president of Dobson DaVanzo & Associates LLC, told O&P News. “The purpose of [both studies] was to understand the extent to which the use of lower extremity orthoses, spinal orthoses and lower limb prostheses could reduce expenditures for payers. Prosthetics are expensive, and payers are somewhat reluctant to pay for them. They are a more willing to pay for orthoses, but still questions are asked.”
Study and methods
To determine if the use of O&P services reduced other expenditures, such as hospital stays, researchers examined administrative claims data from 2011 to 2014 for a custom cohort of orthotic and prosthetic users, as well as a control group of non-users.
The study and control group patients were matched 1:1 using propensity score techniques, based on demographic and clinical characteristics, including etiological diagnoses and comorbidities, as well as prior health care use and mortality.
“We built 18-month episodes for lower extremity orthoses and spinal orthoses, and 15-month episodes for prosthetics,” Dobson said. “We followed the patients through 18 months and 15 months, respectively, to see how much their total expenditures were. We then compared the study group, which had the orthoses and prostheses, to the comparison group, which did not, to see what the difference was and if the numbers favored the O&P group — and indeed they do.”
Findings and considerations
According to the researchers, patients who received lower extremity orthoses spent $1,939 less during the 18-month episode than those who did not receive O&P treatment. In addition, those who received spinal orthotic treatment had total 18-month episode costs that were $2,094 less than comparable patients who did not receive O&P care. Patients who received both types of orthoses had significantly lower Medicare Part D costs than those who did not receive O&P treatment. Patients who had lower extremity prostheses had comparable Medicare episode payments to those who did not, despite the relatively high cost of prostheses, as well as better outcomes on certain metrics. In addition, patients who received prosthetic care had significantly lower spending for most facility-based care, which offset the cost of the prosthesis in a 15-month period.
“The whole industry — the health care marketplace — is moving toward what they call ‘value-based purchasing,’ where payers are more insistent that they get value for their dollars and they are no longer, if they ever did, just going to pay for anything,” Dobson said. “The O&P field has always been challenged, as their care is expensive, particularly prostheses, and the payers need information with reasons why they should pay for this. The reason they should pay for this is that it pays for itself and that’s just part of the story. The other part is increased mobility, increased ability to engage in the community, to leave the house, improved lifestyle and quality of life.” – by Jason Laday
- Dobson A, et al. The economic value of orthotics and prosthetics care to the medicare program. 2011-2014 update: final report findings. Presented at: American Orthotic & Prosthetic Association World Congress; Sept. 6-9, 2017; Las Vegas.
Disclosures: The researchers report employment with Dobson DaVanzo and Associates LLC. This study was commissioned by the American Orthotic & Prosthetic Association.