VA Provides Broader Variety of Assistive Technologies for Veterans with Stroke at Lower Cost
Assistive technology devices (ATDs), also known as durable medical equipment, allow individuals to live more independently, avoid institutionalization, and can improve outcomes. Further, ATDs make care easier and improve overall quality of life. Recent increases in the cost for and use of ATDs have resulted in a controversy surrounding the Medicare policy of covering devices for "in-home only" use. VA policy does not include this limitation. Using VA and Medicare data, investigators in this study sought to compare policy, utilization, and costs for providing ATDs related to both mobility and activities of daily living (ADL) across both systems between FY 01 and FY 03 among 12,046 post-stroke Veterans.
Findings suggest that VA provides a broader variety of ATDs at a lower cost than Medicare. In specific ATD comparisons, VA costs were substantially lower than Medicare for purchased items, and slightly lower than Medicare for capped rental payments. More than half of the ATDs provided by VA were ADL-related compared to only 11% provided by Medicare. Findings also showed that 39% of the cohort had not received an ATD of any kind, while 56% received ATDs from VA only, 3% received ATDs from both systems, and 1% received an ATD from Medicare only. Analyses suggest that VA policy in providing ATDs is driven by Veterans' needs, whereas Medicare policy may be driven, in part, by cost-containment needs associated with increases in fraudulent claims.
Winkler S, Vogel B, Hoenig H, Cowper Ripley D, Wu S, Fitzgerald S, Mann W, Reker D. Cost, Utilization, and Policy of Provision of Assistive Technology Devices to Veterans Poststroke by Medicare and VA. Medical Care February 1, 2010, e-pub ahead of print.
This study was VA-funded. Drs. Winkler, Cowper Ripley, and Mann are with the HSR&D/RR&D Rehabilitation Outcomes Research Center for Veterans with Neurological Impairment in Gainesville, FL; Dr. Hoenig is with HSR&D's Center for Health Services Research in Primary Care in Durham, NC; and Dr. Reker is with HSR&D's Center for Management of Complex Chronic Care in Hines, IL.