Economic Value of Orthotic and Prosthetic Services Among Medicare Beneficiaries: A Claims-Based Retrospective Cohort Study, 2011–2014

Allen Dobson,Kennan Murray,Nikolay Manolov,Joan E Davanzo

doi:10.1097/jpo.0000000000000238

Abstract

ABSTRACT Background There are few studies of the economic value of orthotic and prosthetic services. A prior cohort study of orthotic and prosthetic Medicare beneficiaries based on Medicare Parts A and B claims from 2007–2010 concluded that patients who received timely orthotic or prosthetic care had comparable or lower total health care costs than a comparison group of untreated patients. This follow-up study reports on a parallel analysis based on Medicare claims from 2011–2014 and includes Part D in addition to Parts A and B services and expenditures. Its purpose is to validate earlier findings on the extent to which Medicare patients who received select orthotic and prosthetic services had less health care utilization, lower Medicare payments, and potentially fewer negative outcomes compared to matched patients not receiving these services. Methods This is a retrospective cohort analysis of 78,707 matched pairs of Medicare beneficiaries with clinical need for orthotic and prosthetic services (N = 157,414) using 2011–2014 Medicare claims data. It uses propensity score matching techniques to control for observable selection bias. Economically, a cost-consequence evaluation over a four-year time horizon was performed. Results Patients who received lower extremity orthotics had 18-month episode costs that were $1,939 lower than comparable patients who did not receive orthotic treatment ($22,734 vs $24,673). Patients who received spinal orthotic treatment had 18-month episode costs that were $2,094 lower than comparable non-treated patients ($23,560 vs $25,655). Study group beneficiaries receiving both types of orthotics had significantly lower Part D spending than those not receiving treatment (p<0.05). Patients who received lower extremity prostheses had comparable 15-month episode payments to matched beneficiaries not receiving prostheses ($68,877 vs $68,893) despite the relatively high cost of the prosthesis. Conclusions These results were consistent with those found in the prior study and suggest that orthotic and prosthetic services provide value to the Medicare program and to the patient.

Highlights

There are few studies of the economic value of orthotic and prosthetic services
This study focuses on three types of orthotic and prosthetic (O&P) services – lower extremity orthoses, spinal orthoses, and lower extremity prostheses
The analytic methodology consisted of three key activities, including: 1) developing patient cohorts of orthotic and prosthetic users and matched comparison groups using a propensity score approach; 2) developing clinical episodes of care for each individual beneficiary; and 3) calculating descriptive statistics and analyzing the impact associated with each O&P service on Medicare episode utilization and payments

Summary

Introduction

A prior cohort study of orthotic and prosthetic Medicare beneficiaries based on Medicare Parts A and B claims from 2007 to 2010 concluded that patients who received timely orthotic or prosthetic care had comparable or lower total health care costs than a comparison group of untreated patients. Long-term savings are thought to result when patients receive appropriate orthotic and prosthetic care Without such care, individuals may live more sedentary lifestyles, which research has shown leads to secondary complications, such as diabetes and related comorbidities, as well as increases in health care utilization and spending [12]. The beneficiary’s quality of life may very well be improved as well through increased mobility [14]

Methods

Results

Conclusion