A major new study commissioned by the Amputee Coalition and conducted by Dr. Allen Dobson, health economist and former director of the Office of Research at CMS shows that the Medicare program pays more over the long-term in most cases when Medicare patients are not provided with replacement lower limbs, spinal orthotics, and hip/knee/ankle orthotics.
The American Orthotic & Prosthetic Association (AOPA) provides members with resources that ensure high-quality patient care; promotes the education of public policy makers, influencers and third party payers about the critical role played by orthotic and prosthetic (O&P) professionals in delivering care; and protects patients and the profession from threats that would impair delivering quality care.
O&P Professionals serve prosthetic (artificial limbs), orthotic (orthopedic braces) and pedorthic (shoes and shoe inserts) patient needs.
Key Patient Facts
- In 2012, Medicare approved payment for nearly 2.4 million orthotic codes that accounted for more than $710 million in Medicare expenditures.
- The orthotic code with the highest Medicare expenditure in 2012 was for a prefabricated lumbar sacral orthosis (LSO) or back brace. Medicare approved payment for 135 thousand braces for over $127 million.
- In 2012, Medicare allowed nearly 2.2 million prosthetic services for $710 million in expenditures.
- Medicare approved nearly 5.9 million pedorthic codes for $255 million in payments in 2012
- The risk of losing a foot or leg is 15 – 40 times higher for people living with diabetes than for those without the disease, according to the American Diabetes Association (ADA). More than 80,000 diabetes-related lower limb amputations are performed every year in the U.S., the International Diabetes Federation reports. Another 30 thousand limb amputations result annually from Peripheral Vascular Disease.
- More than 3,000 patient care facilities provide orthotic and prosthetic services.
- More than 800 facilities provide pedorthic services.
- AOPA estimates that the O&P businesses provide patient services worth more than $3.45 billion annually.
- More than $60 million in government funds has been earmarked for research related to orthotic and prosthetic needs by veterans.
Founded in 1917, the American Orthotic & Prosthetic Association (AOPA), based in Alexandria, Virginia, is the largest non-profit organization dedicated to helping orthotic and prosthetic (O&P) businesses and professionals navigate the multitude of issues surrounding the delivery of quality patient care. With nearly 2,000 members, AOPA serves the O&P profession with advocacy on Capitol Hill, premier publications, high-quality coding products, expert reimbursement guidance and a full slate of education programming on O&P-specific issues.
ABOUT AMPUTEE COALITION
Today, almost 2 million Americans have experienced amputations or were born with limb difference. Another 28 million people in our country are at risk for amputation. The Amputee Coalition is the nation’s leading organization on limb loss, dedicated to enhancing the quality of life for amputees and their families, improving patient care and preventing limb loss. With the generous support of the public, we are helping amputees live well with limb loss, raising awareness about limb loss prevention and ensuring amputees have a voice in matters affecting their ability to live full, thriving lives.
ABOUT DOBSON DAVONZO
Dobson | DaVanzo & Associates, LLC is a health economics and policy consulting firm based in the Washington, D.C. metropolitan area. The work of our principals has influenced the design of demonstrations and many public policy decisions, and appears in numerous instances in legislation and regulation. Our litigation support efforts have helped courts, plaintiffs, and defendants understand the economic value of various health care issues.
Our research helps payers and providers develop, implement and evaluate equitable payment methodologies. We are at the forefront of using administrative data sets to explore payment bundling and other CMS initiatives. We apply decades of experience, access to a broad range of policymakers and subject matter experts, and innovative research techniques in order to best meet our clients’ needs. Our analyses are rigorous and objective, and make use of a variety of public and private-sector data sources.
We have provided testimony to the Centers for Medicare and Medicaid Services (CMS), the Medicare Payment Advisory Commission (MedPAC), U.S. Treasury, as well as members of Congress, State legislatures and numerous stakeholder groups. Dobson | DaVanzo also routinely facilitates group discussions concerning policy development with organizational leadership, and Boards of Directors. We also provide technical briefings on study results to a wide range of policymakers such as state legislators, congressional staff and members, MedPAC, CMS, and White House staff in the Executive Office of Management and Budget (EOMB). Dobson | DaVanzo is on the federal government’s GSA schedule.