Journal of NeuroEngineering and Rehabilitation

Table 3 presents the ten most common etiological diagnoses for each type of O&P service, representing over 95% of beneficiaries in each service type. Be- cause all matched pairs were required to have the same etiological diagnoses, the percentages are identical among the study and comparison groups, and Table 3 therefore presents the percent of matched pairs with each diagnosis. The most com- mon etiological diagnosis for beneficiaries in the lower extremity orthotic analysis was other connective tissue disease, followed by spondylosis. These were also the top two diagnoses for beneficiaries in the spinal orthotic analysis, although the hierarchy was reversed. The most common diagnosis for beneficiar- ies in the lower extremity prosthetic analysis was dia- betes mellitus with complications, followed by chronic ulcer of skin. Outcomes analysis: lower extremity orthoses Table 4 presents the health care utilization and pay- ments by care setting for those who received lower extremity orthotic services (study group) compared to those who did not (comparison group). It presents the results of the updated 2011 – 2014 analysis as well as the results of the initial 2007 – 2010 analysis for comparison. Across the 18-month episode, in this updated ana- lysis the study group patients had a total Medicare payment of $22,734 compared to $24,673 for the comparison group, so the episode payment was $1939 lower for the study group ( p < 0.05). A main cause for this difference was significantly fewer admissions to acute care hospitals, as the study group patients were admitted 0.52 times during the episode, compared to 0.87 times for the comparison group ( p < 0.05). This lower rate of utilization lowered the total episode payments by $572 for patients receiving orthoses. In addition, similar to the 2007 – 2010 analysis, we again found that the lower extremity orthotic study group had significantly lower payments to physicians and outpatient hospitals. Study group beneficiaries also had lower overall Part D drug spending, a signifi- cant difference of $1044 ( p < 0.05). Despite having lower total episode payments, bene- ficiaries receiving the lower extremity orthoses dem- onstrated significantly higher expenditures in most post-acute care settings, including inpatient rehabili- tation facilities ($641 vs $378), skilled nursing facil- ities ($1619 vs $1504), and home health ($1187 vs $908) ( p < 0.05). These results are similar to those of the 2007 – 2010 analysis, with the exception of skilled nursing facilities. In the earlier analysis, expenditures in this care setting were $765 less than the compari- son group across the 18-month episode. In addition, patients who received lower extremity orthoses re- ceived significantly more outpatient therapy than those who did not receive the orthotic (12.53 vs 4.93 visits, p < 0.05). As shown in Table 4 , analysis of other outcomes revealed that study group patients Table 3 Etiological Diagnoses across Matched Pairs (2011 – 2014) Etiological diagnosis Percent of matched pairs with diagnosis Lower extremity orthoses Other connective tissue disease 32.4% Spondylosis; intervertebral disc disorders; other back problems 17.9% Other nervous system disorders 16.7% Osteoarthritis 11.3% Acute cerebrovascular disease 5.6% Acquired foot deformities 3.8% Fracture of lower limb 2.1% Sprains and strains 2.1% Multiple sclerosis 1.8% Joint disorders and dislocations; trauma-related 1.5% Spinal orthoses Spondylosis; intervertebral disc disorders; other back problems 40.1% Other connective tissue disease 25.7% Other nervous system disorders 15.6% Osteoarthritis 7.7% Other bone disease and musculoskeletal deformities 6.1% Sprains and strains 2.0% Other fractures 1.2% Joint disorders and dislocations; trauma-related 0.7% Other acquired deformities 0.4% Other congenital anomalies 0.3% Lower extremity prostheses Diabetes mellitus with complications 30.6% Chronic ulcer of skin 18.0% Peripheral and visceral atherosclerosis 17.8% Other non-traumatic joint disorders 8.5% Skin and subcutaneous tissue infections 7.9% Other circulatory disease 4.9% Complication of device; implant or graft 3.8% Complications of surgical procedures or medical care 2.8% Open wounds of extremities 2.7% Infective arthritis and osteomyelitis 2.1% Source: Dobson | DaVanzo analysis of custom cohort Standard Analytic Files (2011 – 2014) for Medicare beneficiaries who received O&P services from January 1, 2012 through June 30, 2013 (and matched comparisons), according to custom cohort database definition Dobson et al. Journal of NeuroEngineering and Rehabilitation 2018, 15 (Suppl 1):55 Page 65 of 72