Quality of Care Should Not Suffer in the Face of Component Denial

Andrew Sawers, MSPO, CPO, LP
Andrew Sawers

CHICAGO – As a patient care provider, consider the following scenario: You are treating a young man who has an active job that requires walking across varied terrain and hours on his feet. You think he is an appropriate candidate for a microprocessor knee (MPK); however, he has been denied for reimbursement. This scenario was presented at the American Academy of Orthotists and Prosthetists Annual Meeting and Scientific Symposium, here, during the Prosthetic Grand Rounds: Evidence Based Decisions about Lower Limb Prostheses.

“Part of it is getting the medical system to understand the categorization of our patients,” Douglas G. Smith, MD,said. “They get lumped in a group that is actually not an appropriate group for that individual.”

As a way to mount the appropriate argument, co-presenters, Brian Hafner, PhD, Andrew Sawers, MSPO, CPO, LP, and John W. Michael, Med, CPO/L, FISPO, FAAOP, discussed nine outcome areas to support that appeal.

“We can group these nine categories from strongest to weakest in terms of the validity of the evidence,” Sawers said. “It’s important to know that … the weakest evidence does not constitute that there’s no evidence.”

The strongest areas of evidence are negotiation of environmental obstacles and safety.

Sawers explained that activity, cognitive demand, quality of life and economics provide intermediate levels of evidence.

Those ranked weakest included metabolic energy expenditure, gait mechanics and preference/satisfaction.

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