Prosthetics Lower Healthcare Costs

The results of a recently released study build a strong case for amputees to receive proper orthotic and prosthetic services, which is good news for clients of Teter’s Grand Rapids prosthetics division. Amputees that have proper fitting lower prosthetics are less likely to be injured and hospitalized and have lower overall medical bills.

Researchers found that when Medicare and private insurance companies deny people prosthetic limbs or orthotics for the spine, hip, knee and ankle they typically end up paying higher costs for care for those patients who end up with new injuries or admitted to hospital.

The study, commissioned by a non-profit Amputee Coalition and released in August 2013, is probably no surprise to patients requiring prosthetics. Anyone who needs them knows that properly fitted prosthetics offer improved mobility and lower the risk of injury and hospitalization as well as encourage an active lifestyle, which improves circulation and overall health.

Dr. Allen Dobson, a health economist who was previously director of the Office of Research at the Centers for Medicare and Medicaid Services, conducted the nationwide survey. Data was examined from almost 42,000 Medicare claims submitted from 2007 to 2010.

Perhaps the fact that Medicare saved roughly 10 percent in overall costs for each patient who was approved to receive a lower leg prosthetic device will be an incentive for insurance companies to approve rather than deny artificial limbs and orthotics.

Dobson said that while devices might seem expensive, they pay off in the long run. His study found:

  • Patients who receive prosthetics and orthotics participated more in physical therapy and rehabilitative efforts
  • Those who had devices were not admitted to hospital or injured as much as those whose devices were denied
  • The majority of patients fitted with orthotics and prosthetics had better health outcomes and lower Medicare payments than those who did without
  • The average cost of care over the 12- to 18-month period studied showed those who got orthotic and prosthetic services tallied $27,007 versus $29,927 for those who did not get the same support

The full results of the study are available to read online here.

The Amputee Coalition sponsored the study after Medicare was criticized in a 2011 report by the Office of the Inspector General for paying $43 million for lower-limb prosthetic claims that didn’t meet payment requirements and another $61 million to patients who had no record of seeing a referring physician in the previous five-year period. The result from this, according to advocates, is that legitimate claims have been delayed or denied. Additionally, some doctors do not want to take the time to meet Medicare’s requirements for thorough documentation.

The American Orthotic & Prosthetic Association (AOPA) filed a lawsuit last spring against the U.S. Department of Health and Human Services because patients who need devices are being denied as a result of these changes arising from the 2011 report.

Advocates, and those of us involved in Grand Rapids prosthetics care like Teter Orthotics & Prosthetics hope the results of this study by Dobson will satisfy Medicare officials and private insurers that approving these devices improves quality of life for amputees and makes long-term fiscal sense. We sincerely hope the data helps end the need for patients to battle with insurance companies to get appropriate prosthetics and orthotics approved.

The professionals at Teter Orthotics & Prosthetics, veterans of Grand Rapids prosthetics care, know that the right devices will:

  • Smooth the gait
  • Increase stability
  • Boost confidence
  • Allow patients to be fully active, including on stairs or up and down inclines
  • Encourage patients to continue with therapy and strive for improving mobility

Looking for expert assistance from people who understand? We invite you to come and see the certified prosthetists at Teter Orthotics & Prosthetics. We are the premier providers of Grand Rapids prosthetics and orthotics, with more than 20 locations in Northern Michigan. We accept a wide variety of health insurance plans and the additional flexibility to negotiate an extended payment plan to cover care

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