Thousands of amputees in the United States who would benefit from microprocessor-controlled devices are denied access to the technology by Medicare and private payers, according to researchers who addressed a National Press Club event Thursday in Washington, D.C.
Speakers at the event, sponsored by the American Orthotic and Prosthetic Association, highlighted several recently released studies, including a RAND Corporation report that concluded microprocessor-controlled knees (MPKs) were associated with improved physical function and reduction in falls and osteoarthritis, and met standard criteria in value for money compared with non-MPKs. The event also included testimonials from lower limb amputees who agreed that microprocessor-controlled prostheses greatly improved their quality of life compared to their previous devices.
“I’ve been on every type of leg you can think of,” Christopher Allen, a tax attorney and above-knee amputee of 23 years, told attendees. “I have a microprocessor motorized knee now, but I started out on just a normal swing knee and that thing was terrible.”
Allen, who lost his leg in a car accident when he was 19 years old, said he often experienced up to four falls every month with the swing knee.
“That kept up for 10 years, until I got on a microprocessor knee, which significantly reduced that,” he said. “Now, I rarely fall — maybe once a year — and when I do, it is usually my own fault because I’m not paying attention.”
According to the researchers, U.S. amputees are facing a “tech gap.” Private health insurers deny access to new MPKs, which are slightly more expensive over a lifetime and considerably safer in terms of preventable injuries and deaths than “1970s-style” prostheses, they said.
According to the RAND study, Medicare total payments for prostheses declined 15% from 2010 to 2014, despite advances in technology. In addition, of the 185,000 new amputees each year, 25% to 30% receive a prosthetic leg and knee, the researchers said.
“The prevalence of amputees is about the equivalent of people with breast cancer, autoimmune-deficiency syndrome, schizophrenia or Parkinson’s disease,” Kenton R. Kaufman, PhD, PE, of the Mayo Clinic in Rochester, Minnesota, told the National Press Club. “The hospitalization costs for amputees was more than $8 billion in 2009.”
Kaufman discussed three studies, including one he presented at the AOPA 2017 World Congress, which found transfemoral amputees who can walk independently prior to amputation are more likely to receive prostheses after amputation. Another study he discussed focused on the high cost of falls among transfemoral amputees. According to that study, which was published in Prosthetics and Orthotics International, the additional cost for falls among transfemoral amputees who required a visit to the emergency department was $18,000. For those who required hospitalization, the additional cost was more than $25,000.
The third study, presented by Dobson DaVanzo Associates at the AOPA 2017 World Congress, found patients who received O&P services generally had fewer acute care hospital admissions, more outpatient rehabilitative therapy visits, lower or comparable Medicare Part D drug spending and lower or comparable Medicare episode payments compared to those who did not receive O&P care.
“If we can start to look at the needs of mobility of the amputee, then we can provide the care that they need and hopefully change the quality of their life,” Kaufman said. – by Jason Laday