Economic value of orthotic and prosthetic services among medicare beneficiaries: a claims-based retrospective cohort study, 2011–2014

Abstract

BackgroundThere are few studies of the economic value of orthotic and prosthetic services. A prior cohort study of orthotic and prosthetic Medicare beneficiaries based on Medicare Parts A and B claims from 2007 to 2010 concluded that patients who received timely orthotic or prosthetic care had comparable or lower total health care costs than a comparison group of untreated patients. This follow-up study reports on a parallel analysis based on Medicare claims from 2011 to 2014 and includes Part D in addition to Parts A and B services and expenditures. Its purpose is to validate earlier findings on the extent to which Medicare patients who received select orthotic and prosthetic services had less health care utilization, lower Medicare payments, and potentially fewer negative outcomes compared to matched patients not receiving these services.MethodsThis is a retrospective cohort analysis of 78,707 matched pairs of Medicare beneficiaries with clinical need for orthotic and prosthetic services (N = 157,414) using 2011–2014 Medicare claims data. It uses propensity score matching techniques to control for observable selection bias. Economically, a cost-consequence evaluation over a four-year time horizon was performed.ResultsPatients who received lower extremity orthotics had 18-month episode costs that were $1939 lower than comparable patients who did not receive orthotic treatment ($22,734 vs $24,673). Patients who received spinal orthotic treatment had 18-month episode costs that were $2094 lower than comparable non-treated patients ($23,560 vs $25,655). Study group beneficiaries receiving both types of orthotics had significantly lower Part D spending than those not receiving treatment (p < 0.05). Patients who received lower extremity prostheses had comparable 15-month episode payments to matched beneficiaries not receiving prostheses ($68,877 vs $68,893) despite the relatively high cost of the prosthesis.ConclusionsThese results were consistent with those found in the prior study and suggest that orthotic and prosthetic services provide value to the Medicare program and to the patient.

How Well Do All Patient Refined–Diagnosis-Related Groups Explain Costs of Pediatric Cancer Chemotherapy Admissions in the United States?

“…Finally, KID only provides a total charge for the admission, a markup of costs determined by each hospital. 40 We used cost-to-charge ratios that represented markup practices aggregated across the entire hospital; this may not accurately reflect the costs of individual departments. However, past studies have suggested that the difference is generally less than 10% 41 and that similar admissions, such as those within a DRG group, are likely to use similar resources across organizations, further decreasing between-hospital variation.…”

Obstacles to Prosthetic Care—Legal and Ethical Aspects of Access to Upper and Lower Limb Prosthetics in Germany and the Improvement of Prosthetic Care from a Social Perspective

“…We will argue that prosthetic care is so important for the overall health of users that it is economically beneficial for health insurances to deliver the best possible care. This has already been pointed out in some studies [8,9], but is still not widely acknowledged by insurances, in Germany also due to the short-term budget allocation scheme in the health care system [10] (p. 61). We posit that there are ways to efficiently improve prosthetic care, minimising the burden on the health care budget, in particular social aspects of acceptance are taken more systematically into account.…”

“…By doing so, probably not only quality of life may improve but also resources may be allocated more efficiently by reducing long-term negative side effects of failed prosthetic care such as a lack of acceptance of and adaptation problems with prostheses as well as by reducing costs in its research and development phase. It has already been shown, for example, that prosthetic care for high-cost knee prostheses is beneficial for the insurance budget in the long term, if compared to the use of such prostheses without care [8,9]. Biddiss et al point out that there are possibilities to reduce costs of prosthetic limbs by technical means like computer-aided design and manufacturing, and due to new market opportunities [1].…”

“…The costs of a more fairly distributed prosthetic care in Germany (where everyone would get the same chance to get an optimal prosthesis according to his/her needs) may be higher or lower than current costs for prosthetic care (where some insured don't get the prosthesis they want) is a fairly open question. There are only few studies regarding this question for the US, suggesting that in the long term, prosthesis prescription even could save money [9]. While Section 2 of this paper dealt with the question of how prosthetic care could be made better by social innovation and changes, but possibly at the same time more efficient in order to circumvent this problem to a certain extent, we will now turn to the more complex question or an alternative solution.…”

Economic Value of Orthotic and Prosthetic Services Among Medicare Beneficiaries: A Claims-Based Retrospective Cohort Study, 2011–2014

“…Additionally, O&P services can reduce health care spending via better patient outcomes, which in turn reduce other types of health care utilization [10,11]. Long-term savings are thought to result when patients receive appropriate orthotic and prosthetic care.…”