GAO Publishes Limb Loss Report

What You Need to Know

The majority of Medicare beneficiaries (a) who lose a limb do not get a prosthesis, and (b) die within 3 years of their amputation.

The GAO report examined (1) the characteristics of beneficiaries who lost a limb in 2016, (2) the percentage of beneficiaries who lost a limb in 2016 and received rehabilitative services or prosthetic limbs from 2016 through 2019, (3) the percentage of beneficiaries who lost a limb in 2016 who experienced selected health outcomes from 2016 through 2019; and (4) challenges beneficiaries with limb loss face in obtaining rehabilitative services and prosthetic limbs.

Key statistics from the GAO report include:

• Just over 50,000 Medicare beneficiaries underwent an amputation in 2016, 96% of which were lower limb and 4% of which were upper limb;

• Only 30% of beneficiaries who experienced limb loss in 2016 received a prosthetic limb between 2016 and 2019;

• The prosthetic limb fitting rate was 37.4% for individuals experiencing major lower limb amputation and 22.7% for individuals who underwent major upper limb amputation;

• Age appears to play a role in access to prosthetic limbs, with the GAO reporting that Medicare beneficiaries with limb loss who are under the age of 65 get a prosthesis 39% of the time, while those over 65 receive a prosthesis only 26% of the time.

• More than half - 61% - of Medicare beneficiaries who lost a limb in 2016 died by the end of 2019.

What this Means for You

Understanding your patient demographics and their health risk factors can help you provide better care and offer better services to your patients. Using some of the GAO data as benchmarks, you may be able to establish the value of your clinical and other services if your Medicare patients outperform those benchmarks (e.g., mortality rate). Finally, while some Medicare beneficiaries who experience limb loss will never be appropriate candidates for prosthetic limbs, it is likely that some percentage of the 70% of people who don't get a prosthesis would benefit from one. Determining how to identify and connect to this underserved population is therefore an opportunity.

To see the complete GAO report - which contains far more data than that summarized in this article - click here.