Many individuals in the United Sates have limb loss. While advancements in technology have made it possible to live a normal life after amputation, the lack of adequate funding has made that difficult to achieve.
George Gondo, MA, director of research and grants for the Amputee Coalition and co-author of Impact of Limb Loss in the United States, is looking to communicate the full impact of limb loss within the United States health care system and improve the economics and quality of life for amputees.
Impact of limb loss
In the United States, more than 500 amputations occur each day, and nearly 2 million people currently live with limb loss. According to the study findings, that number is expected to double by 2050. Limb loss can occur for a number of reasons including trauma, peripheral arterial disease, diabetes and obesity.
Individuals who experience amputation often face an elevated risk for developing chronic health conditions such as cardiovascular disease, depression, joint and bone issues. Amputees also face mortality rates higher than many common chronic diseases.
Lack of funding
While many amputees exist on a global scale, amputations are typically infrequent in a given individual acute care hospital. Because of this, the amputee community is not well represented throughout the health care system and no funding is typically provided for a designated limb loss team or standardized treatment protocols, Gondo said.
“Compared to other disease or disability patient populations, the instance of amputation is relatively small. Consequently, it is a patient population that does not have quite the focus in the U.S. health care system as other disease or disability populations,” Gondo told O&P Business News. “It is also a fragmented population with diverse etiologies that can impact the most appropriate treatment options for the patient.”
The immediate costs associated with amputation total nearly $8 billion annually, according to data from the Healthcare Cost and Utilization Project. This does not include prosthetic care or rehabilitation costs. When prosthetic care and rehabilitation are accounted for, costs increase significantly.
According to researchers at Johns Hopkins University, the lifetime health care and prosthetic costs associated with limb loss total more than $500,000 per person, almost double the lifetime health care costs of an average individual. If infection, obesity, joint or bone issues become present, the health care costs are even further compounded.
Coverage for prosthetic devices varies considerably according to individual policies, Gondo said. Often the prosthetic benefits included in a person’s insurance policy is severely inadequate, he added.
The most notable example of this is the insurance cap, a yearly or lifetime benefit maximum. The cap is a common method used to limit coverage and reduce the financial obligation of the company, while still allowing it to claim to offer coverage.
It can offer as little as $5,000 in compensation, or one prosthetic device during an amputee’s lifetime. This will not provide the most basic prosthetic components.
Younger amputees typically outgrow their first prosthesis and require an updated or replacement device. Study findings show that the cost of one upper extremity device can reach $30,000, and a lower extremity prosthesis can reach $50,000.
The number of insurers with financial caps to prosthetic coverage, exclusions or high deductibles increased 100% during a 6-year period from 2000 to 2006, according to the study.
Gondo said one method of reducing health care-related limb loss fees is eliminating the need for amputation where possible. While all cases of limb loss are not preventable, some can be avoided through patient education, disease management and regular screening for at-risk individuals.
As an extension of the Limb Loss Task Force meetings, which are panels of experts on limb loss care research and rehabilitation, the Amputee Coalition has been researching prevention methods.
“The Coalition has been working on the issue of preventing limb loss for many years…we have convened panels on what needs to be improved and what can be done to prevent instances of limb loss that are preventable,” Gondo said. “The best example is how to prevent the amputation of a limb due to complications related to diabetes.”
However, the current health care system does not reimburse care to protect at-risk individuals, Gondo added. There is no standard for coordinating preventive measures such as vascular evaluation, wound care, podiatry or pedorthotist intervention.
Gondo said establishing standardized programs for at-risk patients could help reduce overall costs. Rehabilitation programs for those with limb loss could also aid in post-amputation costs.
“Establishing specialized rehabilitation programs for persons with limb loss and developing programs that address their psychological and emotional needs could positively impact the care and quality of life of those with limb loss while reducing health care costs through hospital readmissions.”
“Ideally, we would like to create a model system for amputee care and rehabilitation in order to create a longitudinal database on amputation. This would enable researchers to have data on best practices and what is most likely to impact the care and long term,” Gondo said. “The model systems program has been truly beneficial for other disability populations, like patients with traumatic brain injury, burn, or spinal cord injury.”
Amputation of a limb represents a significant burden on the U.S. health care system, according to study findings. Yet, no active surveillance efforts, such as registry, currently exist. A registry would offer better insight into the landscape of limb loss, provide research for evidence-based amputee interventions and offer a standardized guideline for care.
However, the process of forming a registry can be difficult, Gondo said. A line item must be approved by the U.S. congressional appropriations committee, which could take an extended period of time.
The Amputee Coalition
It has become increasingly apparent that legislation is necessary to ensure fairness in prosthetic coverage, Gondo said. The Amputee Coalition, the only national nonprofit advocacy group in the United States, introduced federal legislation in the form of their “arms and legs are not a luxury campaign.”
The Coalition has been successful in 21 states that have passed prosthetic parity legislation during the past 10 years. This legislation seeks to ensure adequate and affordable access to prosthetic devices without arbitrary caps and restrictions. It also aims to treat external prosthetic devices similar to internal devices, such as heart stents and pacemakers.
The Coalition has been monitoring the implementation of the Affordable Care Act and offering input to the Department of Health and Human Services regarding the importance of including prosthetic coverage in the essential health benefits of amputees.
The Coalition represents the more than 2 million people living with limb loss. It provides national resources and programs for these individuals, as well as their health care providers. Their government activities include efforts to ensure insurance fairness for prosthetic coverage, and to advocate for the amputee community.
“The Coalition will continue to work on these important issues through our limb loss task force,” Gondo said. “We want to continue to…ensure funding opportunities exist to support research on amputee care and rehabilitation and amputation prevention and that those who lose a limb are successfully reintegrated into the community.” — by Shawn M. Carter
Disclosure: Gondo has no relevant financial disclosures.