Journal of NeuroEngineering and Rehabilitation

Study group patients who received spinal orthoses experienced the same number of fractures and falls compared to those who did not receive the orthoses, but a significantly lower number of emergency room admissions (0.81 admissions for the study group com- pared to 1.03 for the comparison group, p < 0.05). Figure 2 presents the cumulative episode payment for those who received spinal orthoses compared to those who did not by episode month. Similar to the lower extremity orthotic analysis, this chart indicates that, despite a period of additional cost for the study group between months 7 to 12, the cost of the orth- otic was fully amortized over the episode. Outcomes analysis: lower extremity prostheses Table 6 presents the health care payments by care setting for those who received lower extremity pros- theses compared to those who did not. As discussed in the methodology, the results for lower extremity prostheses were compared across approximately 15 months post-service. Across the 15-month episode, the study group pa- tients had total Medicare payments that were slightly, but not significantly, lower than the comparison group ($68,877 for the study group compared to $68,893 for the comparison group). About 14% of the total episode payment for the study group patients is attributed to the prosthesis ($9694 of the total episode payment of $68,877). The prosthetic device represents an additional cost that was fully amortized within 15 months due to a reduction of care in other settings. This stands in contrast to the 2007 – 2010 analysis, which found higher total episode payments of $1015 among the study group. The largest difference in payments between the study and comparison groups was for acute care hospitals. The study group patients had a significantly lower rate of hospitalization than the comparison group patients (1.23 admissions for the study group compared to 1.54 admis- sions for the comparison group, p < 0.05), resulting in lower episode Medicare payments for acute care hospitali- zations ($15,529 for the study group compared to $19,851 for the comparison group, p < 0.05). These results are similar to those found in the 2007 – 2010 analysis. Study group patients had significantly lower expen- ditures for facility-based long-term care and in-home hospice services than the comparison group patients ( p < 0.05), but spending differences were not signifi- cantly different in other care settings. Expenditures were nominally lower among study group participants in physician offices, hospital outpatient departments, and skilled nursing facilities, but nominally higher among study group participants for inpatient rehabili- tation facilities and home health. In addition, expendi- tures were lower for Part D drugs among the study group, although this difference was not significant. Patients need to be trained and receive extensive ther- apy to properly use a prosthetic device, and study group patients had considerably higher utilization of outpatient therapy (26.86 visits vs 17.97 visits, p < 0.05). The num- ber of fractures and falls and emergency room admis- sions were not significantly different between the study and comparison groups. Figure 3 presents the cumulative episode payment for the study and comparison group by episode Fig. 1 Cumulative Lower Extremity Orthotic Episode Payment by Cohort Dobson et al. Journal of NeuroEngineering and Rehabilitation 2018, 15 (Suppl 1):55 Page 67 of 72