Journal of NeuroEngineering and Rehabilitation

experienced significantly fewer falls and fractures (0.38 compared to 0.48, p < 0.05) and significantly fewer emergency room (ER) admissions (0.83 vs 1.22, p < 0.05). Figure 1 presents the cumulative episode payment for those who received the lower extremity orthoses compared to those who did not by episode month. Despite a period of higher spending in Months 7 to 12, the study group patients had lower Medicare episode payments than the comparison group. Thus, over the entire 18-month episode the cost of the orthotic was fully amortized through reduced utilization in other settings. These findings are consistent with those of the 2007 – 2010 analysis. Outcomes analysis: spinal orthoses Table 5 presents the health care utilization and pay- ments by care setting for those patients who received spinal orthoses (study group) compared to those who did not (comparison group). Across the 18-month episode, the study group patients had significantly lower total episode payments across all care settings ($23,560 vs $25,655, p < 0.05). This result is different than that found in the 2007 – 2010 analysis, which found a nonsignificant difference in total episode spending between the study and comparison groups. In this updated analysis, a major contributor to the difference in total episode payments between the study and comparison groups was significantly lower payments for Part D drugs in the study group ($840 lower among Part D users only, p < 0.05). Study group patients had higher payments for DME services, in- patient rehabilitation facilities, and home health, but lower payments to acute care hospitals, long-term care hospitals and physician offices ( p < 0.05). This is somewhat different than our earlier analysis, which found higher payments to physician offices and lower payments to inpatient rehabilitation facilities. Despite higher payments for inpatient rehabilitation care in the study group, the average length of stay in inpatient rehabilitation facilities was significantly lower in this group (0.24 vs 0.32, p < 0.05). These pa- tients appear more likely to return home faster and to receive follow up care in the home, as evidenced by higher payments to home health among the study group ($1100 vs $901, p < 0.05). Table 4 Spending and Utilization for 18-Month Lower Extremity Orthotic Episode (2007 – 2010 and 2011 – 2014) Care setting 2007 – 2010 analysis 2011 – 2014 analysis n = 34,864 Matched pairs n = 43,487 Matched pairs Study Comparison Difference Study Comparison Difference Physician $6482 $7171 -$688 * $5629 $6078 -$449 * DME $2002 $966 $1036 * $763 $602 $162 * Acute Care Hospital / Other inpatient $8392 $10,828 -$2436 * $5640 $6212 -$572 * Long Term Care Hospital $366 $639 -$273 * $239 $294 -$55 Inpatient Rehabilitation Facility (IRF) $1178 $924 $255 * $641 $378 $262 * Outpatient $3552 $3752 -$199 * $2778 $3127 -$349 * Skilled Nursing Facility $2415 $3180 -$765 * $1619 $1504 $115 * Home health $2231 $1912 $320 * $1187 $908 $279 * Hospice $388 $556 -$168 * $319 $607 -$288 * Total Part D Drug Spending – – – $3920 $4964 -$1044 * Total $27,007 $29,927 -$2920 * $22,734 $24,673 -$1939 * Number of therapy visits 17.36 12.10 5.26 * 12.53 4.93 7.60 * Number of fractures and falls 1.45 1.52 − 0.07 0.38 0.48 − 0.10 * Number of inpatient admissions – – – 0.52 0.87 − 0.35 * Length of stay for inpatient admissions (days) – – – 2.64 4.77 − 2.14 * Number of emergency room admissions 1.08 1.20 − 0.12 * 0.83 1.22 − 0.39 * Number of IRF admissions – – – 0.03 0.04 0.00 * Length of stay for IRF admissions (days) 0.72 0.52 0.20 * 0.42 0.47 − 0.05 * 12-Month mortality rate – – – 0.00 0.01 − 0.01 * * Difference is significant at α = 0.05 Source: Dobson | DaVanzo analysis of custom cohort Standard Analytic Files (2007 – 2010 and 2011 – 2014) for Medicare beneficiaries who received O&P services from January 1, 2008 through June 30, 2009 or 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 66 of 72