BOSTON — The Local Coverage Determination draft proposal could create significant limitations to care for individuals who use lower limb prostheses, according to data presented at the American Orthotic and Prosthetic Association National Assembly, here.
According to Brian Kaluf, BSE, CP, APO, the overhauled K-level descriptors – as part of the Local Coverage Determination (LCD) draft – could significantly limit reimbursements.
In response to the proposed changes, Ability Prosthetics and Orthotics performed an internal quality assessment project to simulate the effects of the new K-level descriptors. De-identified data, including current K-level, AMPRO scores and ambulatory aid used, were identified. The draft LCD defined anyone using a walker or crutches as K-1, those with the ability or potential to use a prosthesis for transfer or ambulation on level surfaces at fixed cadence; and anyone using a cane as K2, those with the ability or potential to traverse low-level environmental barriers.
Occurrences were identified where patients would be classified at a lower K-level under the draft LCD based on ambulatory aid used, and therefore lose access to current prosthetic technology, according to the data. It was determined that if the proposed LCD policy change were enacted, 44% of all Ability P&O patients would lose access to the prosthetic technology they currently use, including those patients at higher mobility levels.
“When patients are examined based on their current K-level, as well as their functional mobility, it becomes apparent just how damaging the proposed LCD policy change would be for amputees of all functional activity levels,” the data noted.
Ability Prosthetics and Orthotics has submitted evidence to Medicare representatives showing that patients at all levels of functional mobility could lose access to their current prosthetic technology. – by Shawn M. Carter
Kaluf B. Impact of proposed draft/LCD policy change on access to care for persons with lower limb amputation. Presented at: American Orthotic and Prosthetic Association National Assembly; Sept. 8-11, 2016; Boston.
Disclosure: Kaluf reports the research was supported by Ability Prosthetics and Orthotics.