Payors less inclined to cover high-tech prosthetics for amputees

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Payors less inclined to cover high-tech prosthetics for amputees

by John R. Fischer, Senior Reporter | October 30, 2017
Business Affairs Insurance Medical Devices

Hangsheng Liu, a policy researcher for RAND Corporation and the lead author of the study, says the value of health care should be defined based on the benefits that MPKs provide for amputees.

“There are two major sources of benefits," he told HCB News. "One is the reduction in the number of injuries. The second is the reduction in incidents of osteoarthritis. These two are the drivers of cost-savings. If you just look at the dollar amount, you probably won’t get a net savings per se. The quality of life of MPK users is much higher. That’s how we define the value. This is a very standard way of defining value in health care. How much money do you have to spend in order to gain a quality-adjusted life year?”

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Fise agrees with Liu’s assessment and says that payors should take into consideration the clinical and financial benefits of MPKs when deciding whether to cover the use of one for an amputee.

“I think that with the kind of data that we now have, such as the greater safety, savings of lives and the expense, we have to be looking for all payors to take that information into account and make it a smaller allocation of resources,” he said. “Yes, there might be a slightly [higher] upfront in costs for the MPK, but in the long-run, it saves them money.”

The authors do not address exact MPK and NMPK criteria of payors.

Research was sponsored by AOPA and conducted by RAND Health.

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