Surge in Artificial Feet Medicare Spending

Medicare’s cost for artificial feet rose nearly 60 percent in recent years, even though last month the government reported that rates of foot and leg amputations due to diabetes have continued to drop dramatically. 

The government reportedly paid $94 million for artificial feet in 2010, and according to AP research that figure was nearly $35 million more than in 2005, even though Medicare covered about 1,900 less of these prostheses in 2010.

The cost of artificial feet is just a miniscule proportion of the $550 billion Medicare program that covers health care for 9 million older and disabled people, and the surge in spending underlines the fundamental questions about the affordability, technology and appropriate care that the billion dollar health program faces as the government finds ways to solve country’s current economic predicament.    

Dramatic Drop in Non-Traumatic Lower-Limb Amputations

Medical Daily had previously reported that the U.S. Centers for Disease Control and Prevention had released an analysis last month that found the rate of non-traumatic lower-limb amputations among diabetics had fell by 65 percent between 1996 and 2008.

According to the latest government reports released late last month, the rate of non-traumatic lower-limb amputations among diabetics was 3.9 per 1,000 in 2008 compared to 11.2 per 1,000 in 1996, and previous diabetes studies have also shown drops in toe, foot and leg amputations.

The analysis also showed that in 2008, the rate of non-traumatic lower-limb amputations was eight times higher in diabetics compared to those without the disease.

If amputations have and are continuing to decline among diabetes patients that make up the significant majority of non-traumatic lower-limb amputations, it would be rational to think that spending on artificial limbs would decline because of less demand.

Where is Taxpayer Money Going?

However, the prosthetics and orthotics industry says that the spike in Medicare’s bill for artificial feet is expected because patients are benefiting from newer technology in artificial limbs designed for wounded soldiers back from Iraq and Afghanistan.

"We have had a huge improvement in the quality of devices that we can provide, thanks to all the knowledge that has flowed from providing care to soldiers," Thomas Fise, executive director of the American Orthotic & Prosthetic Association, a trade group, told AP. "That technology has now become available, and patients believe they should be entitled to it, and who is going to tell those Medicare beneficiaries they are not entitled?"

"What the government got for their money was value-added, "said Tom DiBello, president of the group, which represents professionals who fit artificial limbs as well as manufacturer, according to AP.

However some experts question the industry answer because they say there is no evidence to support the surge in prosthetic spending.

Justified? High-Tech Limbs Are Given to All

Dr. Howard Gilmer of National Rehabilitation Hospital in Washington told AP he questioned whether a high-tech foot designed for an active person, like returning wounded servicemen, would be appropriate and used for diabetic and older patients.

"A lot of our patients are just trying to transfer from the wheelchair to the toilet," Gilmer said.

A Health and Human Services inspector general had found prevalent questionable billing for lower-limb prostheses, which included artificial feet in 2011, and two years before investigators said Medicare had inappropriately paid $43 million for lower-limb prostheses that failed basic requirements for accurate claims.

Investigators questioned an additional $61 million in billing cases where the Medicare beneficiary had not seen the referring doctor in the previous five years, prompting researchers to wonder if the prosthesis was even medically necessary.

According to AP analysis the sharp rise in spending is largely driven by a shift in the types of prosthetics being given to Medicare beneficiaries, from cheaper hundred dollar artificial limbs to more sophisticated types that that cost thousands.

The news outlet noted that Medicare had recently begun covering computer-controlled ankle/foot that is priced at $15,000 even though many major private insurers consider it experimental and do not cover it.

AP analysis also showed almost a 300 percent increase in Medicare coverage for a model of shock absorber foot prosthesis that costs about $6,500, which some doctors said is unnecessary and excessive for older people under Medicare who aren’t physically active.

"Most of our Medicare patients are not going out playing hoops every day," said Gilmer said to AP, and fitting a patient is a customized process that is determined by many factors, not just physical activity.

Government Cracks Down?

Medicare "is aware of and shares the concerns this research raises about lower limb prosthetics," said Medicare spokesman Brian Cook.

Cook told the news outlet that the government has been cracking down on fraud involving artificial limbs, and the investigations saved $867,000 of taxpayer money in 2011, but he was unable to provide the ages of beneficiaries who received artificial feet or the states where they lived.

Government officials acknowledge the widespread deficits in documentation for many Medicare cases, but they are worried that heightened regulation could restrict come beneficiaries from getting needed care.

"We are committed to reducing improper payments and fraud, while ensuring that Medicare beneficiaries have access to the care and services that they need," said Cook.

The 2011 inspector general's report calls for Medicare to revise a scale health providers use to measure patients’ functional activity which determines what kind of artificial limb is appropriate for a particular patient.

"These changes would help ensure that prostheses are matched to beneficiaries' needs and that (Medicare billing contractors) can assess the medical necessity of these devices," the report said.

Similar Trend in Knee Replacements

Medical Daily had also reported in December there has also been a surge in knee replacement surgeries in recent years and reports of knee pain among older adults, even though there is no evidence that knee arthritis is on the rise.     

Last year investigators who noticed a spike in knee replacements found that complaints of knee pain increased by about 65 percent from 1974 to 1994 among white and Hispanic men and women and among African American women, according to data collected from six National Health and Nutrition Examination Surveys. 

Researchers said X-ray results even showed a slight decrease in arthritis rates from 42 percent in 1974 to 35 percent in 1994, but people with knee pain and symptomatic knee osteoarthritis doubled in women and tripled in men over two decades.

Study authors had concluded that Americans could be undergoing replacements at an earlier age or at lesser severity than in the past.