Wolff J, Agree E, Kasper J; AcademyHealth. Meeting (2005 : Boston, Mass.).
Abstr AcademyHealth Meet. 2005; 22: abstract no. 3543.
Johns Hopkins University, Health Policy & Management, 624 North Broadway, Room 692, Baltimore, MD 21205-1996 Tel. 410-502-0458 Fax 410-955-0470
RESEARCH OBJECTIVE: Assistive technology (AT) is widely used by individuals with disabilities. While most health insurers include AT as a benefit, stringent and ambiguous policies make coverage disputes common; more than half of older adults pay for AT privately. The goal of this research was to describe use of the Medicare durable medical equipment (DME) benefit for the acquisition of mobility-related AT, including: (1) characteristics of beneficiaries who obtained devices and (2) the magnitude of devices acquired and related spending by type of AT. STUDY DESIGN: Cross-sectional observational study using the 2001 Medicare Current Beneficiary Survey and linked DME claims. Individuals who obtained mobility AT were identified based on Health Care Procedure Coding System (HCPCS) and related modifier codes listed in DME claims data. Survey data were used to examine study participant health and socio-demographic characteristics by type of device (canes, crutches, walkers, manual and power wheelchairs). Logistic regression models were estimated to examine the strength of the association between individual characteristics and the use of the DME benefit for mobility AT. POPULATION STUDIED: A nationally representative sample of community-dwelling Medicare beneficiaries (n=12,691). PRINCIPAL FINDINGS: A total of 6.2% of Medicare beneficiaries obtained mobility devices under the Medicare DME benefit during 2001. These beneficiaries were disproportionately poor, disabled, and users of acute and post-acute services. For example, beneficiaries who acquired wheelchairs reported difficulty with 3 or more activities of daily living, more than one third were dually enrolled in both Medicare and Medicaid, and more than one-quarter lived alone in the community. Average per-item spending varied from $52 for a cane to $6,208 for a power wheelchair. Spending was highly concentrated: canes, crutches, and walkers accounted for 53% of all devices and 8% of Medicare spending whereas power wheelchairs comprised 8% of devices and 66% of spending. Among beneficiaries who acquired mobility AT, related spending comprised 2% of overall Medicare expenditures, ranging from a low of 0.2% among individuals who used the DME benefit for a cane, to a high of 16.1% among beneficiaries who acquired a power wheelchair. Mobility impairment was strongly related to acquisition of mobility AT, and particularly wheelchairs. Use of acute and post-acute services was the strongest predictor of acquiring a cane, crutch, or walker. CONCLUSIONS: Mobility AT comprised only a modest proportion of overall annual Medicare expenditures among beneficiaries who obtained such devices in 2001. Aside from mobility difficulty, use of acute and post-acute services was the strongest predictor of acquiring mobility AT under the Medicare DME benefit. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: Our findings imply that use of the Medicare DME benefit is concentrated at the point of acute and post-acute medical service delivery, and that individuals with mobility problems who do not use such services may have less access to the benefit. These findings also have implications for the current debate over program costs related to changing in the home coverage criteria for mobility AT. Further research is needed to elucidate the circumstances surrounding use of the Medicare DME benefit for AT.
Publication Types:
Keywords:
- Adult
- Canes
- Cross-Sectional Studies
- Crutches
- Disabled Persons
- Durable Medical Equipment
- Health Expenditures
- Humans
- Medicaid
- Medicare
- Self-Help Devices
- Walkers
- Wheelchairs
- economics
- hsrmtgs
UI: 103623006
From Meeting Abstracts