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When USA Medicare expanded coverage for microprocessor knees to include some K2 amputees last September, its stated objective was to cut costs. By decreasing fall risk in K2 ambulators, the argument went, MPKs would reduce expenditures for ER visits, hospitalizations, and other healthcare to treat fall-related injuries.
That theory is now backed by hard data. According to a new paper in Prosthetics and Orthotics International, the average MPK pays for itself in just 19 months—an extremely rapid turnaround.
Commissioned by Ottobock in conjunction with Dobson|Davanzo & Associates (a healthcare finance consultancy), the study examines retrospective Medicare claims data for about 18,000 prosthesis recipients between October 2016 and December 2020. The analysts compared the costs of post-fall claims for both MPK and non-MPK amputees, with adjustments to account for variation in patients’ age, comorbidities, and other risk factors.
According to the paper’s cost analysis, an MPK adds about $25,000 to the up-front expense of a prosthesis. The claims data show, however, that an MPK reduces fall-related healthcare expenditures by an average of $1,351 per month per person. Over 19 months, those savings exceed the up-front investment, and the dividends continue to roll in over the ensuing months and years.
This finding rests on the assumption that MPKs reduce actual falls by just 18 percent, a conservative figure (other studies have claimed MPKs decrease falls by as much as 80 percent). Over ten years, the paper concludes, Medicare would save $410.3 million if the entire population of K2 amputees were fitted with MPK prostheses.
Of course, the entire K2 population is not eligible for MPKs—not yet, anyway. Medicare’s coverage expansion only applies to a subset of the K2 population. Applicants must provide extensive documentation about their mobility and underlying health, an inventory of daily activities, and an explanation for why a non-MPK knee fails to meet the applicant’s needs. If the savings match the estimates published in the Ottobock study, perhaps Medicare will relax its criteria.
