GAO releases study of assistive technologies for amputees
The Government Accountability Office (GAO) has released its study on Limb Loss: Rehabilitation Services and Outcomes for Medicare Beneficiaries. The report describes the characteristics of traditional Medicare beneficiaries who lost a limb in 2016 including the percentage who received rehabilitative services and the challenges that these individuals face.
GAO reported that there are an estimated 2 million individuals in the United States (about the population of Nebraska) living with limb loss and that this number is projected to increase to 3.6 million by 2050 driven by an aging population and high rates of vascular disease. The report also states that almost 200,000 individuals are estimated to experience limb loss each year and that most individuals experience limb loss due to either the effects of disease or after sustaining a traumatic injury.
The GAO report also noted that “nearly all 50,202 beneficiaries who lost a limb received at least one rehabilitative service” based on an analysis of CMS fee-for-service claims data from 2016 through 2019. GAO stated that 89 percent of limb loss patients received occupational therapy, 41 percent received PMR physician services, and 96 percent received physical therapy. AOTA emphasizes that this does not provide information on how many specific OT or other services were provided.
GAO interviewed AOTA and 9 other stakeholders when developing the report which was initiated after legislation was introduced by Senators Marsha Blackburn (R-TN) and Tammy Duckworth (D-IL) and Reps Brett Guthrie (R-KY) and G.K. Butterfield (D-NC). Earlier versions of the legislation had omitted occupational therapy practitioners and the role they play in this area; however, AOTA lobbied successfully to be sure the role of OT was not overlooked.
The GAO study reported on the challenges beneficiaries with limb loss face that could affect their ability to access care. AOTA emphasized issues with care coordination between healthcare providers which can result in amputee patients not receiving access to occupational therapy or other essential services. AOTA appreciates that the contributions of occupational therapy practitioners (OTPs) to the physical and mental health of those who have experienced limb loss are recognized by GAO; however, an example in the report suggests that only basic activities of daily living (ADLs) are medically necessary. AOTA emphasizes that OTPs address other critical areas such as instrumental ADLs (driving and community mobility, home management, meal preparation and cleanup, etc..) and health management that may be medically necessary depending on a client's needs.
The Amputee Coalition which advocates for people impacted by limb loss and limb difference reports that “it is grateful that GAO looked at and highlighted the importance of the care provided to this population.” They noted however, that “in our initial review of the report, we noticed a lack of cohesive connection for the services provided from amputation through rehabilitation.” The Coalition also noted that although it is “excited to see such high numbers of Medicare beneficiaries receiving an initial rehabilitation service, it is unclear in the report if individuals are, in fact, receiving the necessary occupational therapy and/or physical therapy services needed along the continuum of care.” The Coalition “attributes this to a lack of care coordination, which is also mentioned in the report.”
AOTA will work with the Amputee Coalition and others as Congress, CMS and others review this report and work to improve care for people with limb loss.