title: Cost, utilization, and policy of provision of assistive technology devices to veterans poststroke by Medicare and VA.
abstract: BACKGROUND
  The increase in provision of assistive technology devices (ATDs) has spurred controversy over Medicare policy aimed at reducing cost-policy that forces social isolation and conflicts with legislation, facilitating participation for individuals with disabilities. In contrast, Department of Veterans Affairs (VA) policy does not limit provision of AT to "in home" use only but rather, states "all enrolled and some non-enrolled veterans are eligible for all needed prosthetics."
  
  
  OBJECTIVE
  Examine ATD provision policy by comparing 2 systems, Medicare and VA. Empirically analyze differences in ATDs provided, cost, and duplication in provision.
  
  
  METHODS
  Retrospective study of VA databases, including VA Medicare data.
  
  
  METHODS
  A population based study of 12,0461 veterans post-stroke.
  
  
  METHODS
  Frequency of provision of ATDs by Health Care Common Procedural Code, purchase price, and capped rental payments.
  
  
  RESULTS
  Of the poststroke veteran cohort, 39% received no AT, 56% received AT from the VA only, 1% received AT from Medicare only, and 3% received AT from both the VA and Medicare. Most ATDs were for activities of daily living, followed by walkers/canes/crutches. In specific ATD comparisons, VA costs were substantially lower than Medicare for purchased items and slightly lower than Medicare for capped rental payments.
  
  
  CONCLUSIONS
  VA provides a broader variety of ATDs at a lesser cost than Medicare. Analyses of policy differences between VA and Medicare suggest VA policy is driven by veteran need whereas Medicare policy is driven at least in part, by containing costs that have skyrocketed as a result of fraudulent claims.
authors.affiliation: Rehabilitation Outcomes Research Center, Research Enhancement Award Program, North Florida/South Georgia Veterans Health System, 1601 SW Archer Road, Gainesville, FL 32608, USA. Sandra.Winkler@va.gov
authors.forename: Sandra L Hubbard
authors.initials: SL
authors.lastname: Winkler
authors.forename: Bruce
authors.initials: B
authors.lastname: Vogel
authors.forename: Helen
authors.initials: H
authors.lastname: Hoenig
authors.forename: Diane C Cowper
authors.initials: DC
authors.lastname: Ripley
authors.forename: Samuel
authors.initials: S
authors.lastname: Wu
authors.forename: Shirley G
authors.initials: SG
authors.lastname: Fitzgerald
authors.forename: William C
authors.initials: WC
authors.lastname: Mann
authors.forename: Dean M
authors.initials: DM
authors.lastname: Reker
mesh_terms: D000328:Adult; D000368:Aged; D004864:Equipment and Supplies / Q000191:economics; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006787:Hospitals, Veterans / Q000191:economics; D006801:Humans; D008297:Male; D006278:Medicare / Q000191:economics* / Q000706:statistics & numerical data; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D017149:Private Sector / Q000191:economics; D012189:Retrospective Studies; D012656:Self-Help Devices / Q000191:economics* / Q000706:statistics & numerical data; D020521:Stroke / Q000191:economics*; D000071939:Stroke Rehabilitation; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000191:economics; D014728:Veterans / Q000706:statistics & numerical data*