Friday, April 25, 2014

Make mine a peg leg, please.

Because so many of the Boston Marathon Bombing victims lost their lower limbs, there’s been a lot in the news over the past year about prosthetic devices that are straight out of Steve Austin’s Six Million Dollar Man or Jaime Summer’s Bionic Woman. 

And, of course, there are all the stories we’ve been seeing over the past decade talking about the Iraq vets who lost a leg and have been kitted out with bionic limbs.

I’ve seen a few people walking around on the  Oscar Pistorius-style blades – this was pre-Marathon Bombing, so Iraq vets, perhaps.

It is incredibly impressive to see how smoothly these folks can get around. A lot of this can be chalked up to the hard work that so many amputees do in physical therapy. It’s not like they strap on their new leg and get moving. It’s not like buying a new pair of shoes, good to go. But a lot of the credit has to go to the companies that are making these bionic limbs.

One of these companies, BiOM, is local.

They’re the ones that made the bionic limb for bombing survivor, and, not incidentally, professional dancer, Adrianne Haslet-Davis.

…who lost a foot in the Boston Marathon bombing last year, [and who] performed  for the first time since the terrorist attack as part of the 2014 TED conference last month. (Source: BetaBoston)

BiOM is all about what it calls “personal bionics”, using “bionic propulsion technology to replace lost muscles and tendons” and to make movement more comfortable, more natural, and far less taxing than the movement you get with old-style prosthetics. Here’s how BiOM founder and MIT prof Hugh Herr, himself a double amputee, having lost both legs in a mountaineering accident while still in his teens, explains what they do.

“Bionic integration and how electro-mechanics attach to the body and [are] implanted inside the body are beginning to bridge the gap between disability and ability, between human limitation and human potential.”

Bridging that gap is, of course, expensive. Many of BiOM’s customers are wounded vets, so the government picks up the tab for their personal bionics.

Civilians are on their – or their insurance company’s – own.

I have no idea whether Haslet-Davis’ insurance paid for her device, or whether she was able to pay for her prosthetic through the money she was allotted by the One Boston Fund or by using her own personal resources and fund-raising efforts. Personally, I’d be just delighted to learn that she didn’t have to go one dime out of pocket to get back on her feet and dancing. She’s young and certainly deserves to get back in her dancing shoes without having to figure out how to pay for the foot that goes in one of them.

But, as the BetaBoston article pointed out, if Haslet-Davis had been on Medicare, she wouldn’t have been reimbursed:

To win coverage under Medicare, BiOM must demonstrate the cost advantage of its prosthetics, something McCarthy says the worker’s compensation industry already recognizes. The BiOM device, for example, allows employees to return to work more quickly and reduces the need for treatment over the long term. Additionally, patients experience less pain and stress on their joints than with normal prosthetic limbs, [BiOM CEO Tim McCarthy] explained.

Even though I’ll be a Medicare-ier sooner rather than later, I’m actually okay with Medicare holding off until they figure out the cost-benefit analysis here.

Let’s face it, most of the folks on Medicare don’t work, so there’s no benefit to them being able to return to work more quickly. Yes, the reduction in treatment costs over the long term should be considered, but until that can be demonstrated…

It’s one thing for insurance to cover the costs for a young, fit, otherwise healthy person like Haslet-Davis. Quite another to pay for a 75 year old suffering from vascular disease – the reason for 2/3’s of all leg/foot amputations – who isn’t working, may not have the will and the way to go through the therapy required, and may end up riding around in his motorized chair even with his spiffy new personal bionic. Yes, there are plenty of active, fit, long life ahead of them 75 year olds. I hope to be one of them. But this can be decided on a case by case basis, no?

Ah, the horror.

Bad enough death panels, now we have leg and foot panels.

Sound harsh?


But we can’t keep on paying endless amounts of money on all the latest treatments for the village elders, who won’t have a somewhat limited shelf life, if it means we’ll be depriving younger folks of those resources. I’d like to think that if the choice was using tax money to provide a personal bionic to an 18 year old kid rather than an 81 year old geezer, we’d go with the kid. And I’d like to think that the 81 year old geezer would agree that this was the right thing to do.

Maybe Medicare could cover some of the costs – maybe the same amount they would for a traditional prosthetic – and let the rest come out of supplemental insurance or out of pocket. Sorry if that means that some people won’t be able to afford the latest, but that’s life. And it’s not exactly as if the alternative prosthetic is a wooden peg leg.

Unfortunately, this approach will not necessarily work:

BiOM is not the first company to confront Medicare with an expensive technology that radically re-thinks current standards of care for the disabled. The iBOT, a stair-climbing, gyroscope-based wheelchair invented by Dean Kamen’s DEKA Research & Development Corp. in Manchester, N.H., was shelved due to a lack of reimbursement money.

Developed with Johnson & Johnson subsidiary Independence Technology LLC, the iBOT carried a price tag in excess of $25,000, and was shut down after CMS made it eligible for only about $6,000 in reimbursement.

So why not encourage companies like BiOM, who stand to gain plenty if Medicare approves reimbursement for their products, subsidize those who can’t afford it. As they produce more, their costs will go down, etc. Maybe it would be worth it to them.

Maybe if the shoe were on the other foot, and I needed a personal bionic, and I was on Medicare – which I will be, this time next year – I’d be pounding on Medicare’s door to let BiOM in.

I may be kidding myself, but I’d like to think I’d ask whether it made financial sense to kit me out with the Cadillac of prosthetics.

I hope I never have to find out.

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