Journal of NeuroEngineering and Rehabilitation

and expenditures are significantly lower in the study group. That is, the higher use of post-acute care may eliminate the need for additional or subsequent admission to acute care hospitals, ultimately lowering total episode cost. The increased rate of outpatient therapy seen in the study group is consistent with Medicare ’ s emphasis on restorative care for beneficiar- ies, when possible. It may be related to the lower rate of negative outcomes for patients who received O&P services, including fewer fractures and falls and emer- gency room visits. The results of this analysis suggest that with the receipt of the lower extremity orthotic, study group patients could withstand more intensive therapy that led to in increased standing stability, resulting in fewer emergency room admissions, hospi- talizations, and lower Medicare payments. In the spinal orthotic model, the lower payments for Part D drugs seen among study group beneficiar- ies could indicate lower prevalence of comorbid conditions and generally better health status among beneficiaries receiving spinal orthoses, compared to those who do not. Differences between this updated analysis and the previous one suggest that there may have been a different standard of care for patients receiving spinal orthotics in 2011 – 2014 than there was in 2007 – 2010. This updated analysis found higher payments for rehabilitation facilities among study group participants, which could indicate a shift toward more intensive facility-based rehabilitative care for beneficiaries receiving orthoses. This analysis of lower extremity prosthetic services demonstrated that the cost of the prosthetic device and clinical prosthetic care was amortized within the 15-month follow-up period, offset by higher total costs for the untreated comparison group patients. Compara- tive efficacy trials and systematic reviews of components have found similar value concluding that some pros- thetic components may be initially costlier but are ultim- ately worth funding due to lower fall risk, less work missed and improved quality of life [ 4 , 14 , 21 ] . In this study, through a reduction in acute care hospitalizations, physician visits, and facility-based care, patients experi- enced improved quality of life at a comparable Medicare episode payment. Study and comparison group beneficiaries in this lower extremity prosthetic analysis had roughly a comparable number of fractures and falls, as well as comparable emergency room admission among lower extremity prosthetic users, compared to those who did not receive the service. Part of the savings due to reduced facility-based care was offset by more extensive physical therapy and rehabilitation presum- ably to teach patients how to properly use their prostheses, as amputees must learn balance and mobility with their new device. Additionally, the high use of therapy among beneficiaries in the study group may be associated with increased ambulation, which suggests that the study group patients with prostheses were less homebound than the compari- son group. This increased level of independence among beneficiaries receiving prostheses may explain the similarity in the rate of falls and fractures and emergency room admissions among the study and comparison groups. Much has changed in health care, and in orthotic and prosthetic care, since 2010. Despite research that suggests Fig. 2 Cumulative Spinal Orthotic Episode Payment by Cohort Dobson et al. Journal of NeuroEngineering and Rehabilitation 2018, 15 (Suppl 1):55 Page 69 of 72