Practitioner to Potential Medicare Patient Ratio: A Preliminary Report

John W. Michael, CPO/L
CPO Services, Inc.
Portage, Indiana

Douglas G. Smith, MD
Prosthetic Research Study
Seattle, Washington

Sharon Hubbard, MS
Prosthetic Research Study
Seattle, Washington

This research was supported by a grant from the United States Department of Education to the Academy in an effort to better understand patient access to qualified prosthetic and orthotic care. Prior work by Nielsen¹ has suggested that there is a current shortage of American Board for Certification qualified practitioners compared to patients needing prosthetic and orthotic services and that the burgeoning numbers of aged citizens as the "baby boomers" retire will worsen this situation.

Related grant projects have focused on increasing the number of qualified applicants to existing prosthetic and orthotic practitioner programs, as well as fostering creation of the academic infrastructure necessary to develop future scientists, educators, and researchers in the field. This research attempts to document and understand the distribution of ABC Certifees nationwide and to compare the number of qualified practitioners to the number of potential patients requiring services in differing geographic locales. Identifying areas where the shortage of caregivers is more acute could help the field target efforts to increase the number of qualified practitioners more effectively.

Because most United States data regarding prosthetic and orthotic services is proprietary and held by diverse sources who do not share such information, there is no source for authoritative figures about services being delivered or about underserved populations. This research was undertaken to begin to fill this information void by examining national Medicare data, which is the largest database of P&O related services.

Although it would be straightforward to simply compare the number of ABC Certifees to the number of patients fitted with P&O devices in a given year, this would only provide insight into those patients who are receiving care during the study period. Patients who did not receive P&O care in another year would have been omitted, as would potential patients who may not have access to qualified providers. Therefore, the authors had to develop a methodology to estimate the total number of potential Medicare patients likely to need P&O services. This permits calculation of a practitioner to potential patient ratio that should be sufficient to identify areas where the shortage of prosthetist-orthotists appears to be greatest. The first step was to investigate the ratios by state, to determine if more detailed research would be warranted.

The preliminary report from this research was recently posted online². Key aspects of the methodology, results, and unanswered questions arising from this study will be discussed during this presentation to elicit comments and suggestions from the body of expert clinicians present that will be used to refine subsequent efforts to build upon this foundation. Limitations of this preliminary work will also be made explicit.

Figure 1: Logic used to estimate potential patients based on Medicare data

Future research plans include calculation of the practitioner-patient ratios for smaller geographic regions, analysis of metropolitan regions versus rural settings, and updating the practitioner data to reflect changes in the number and distribution of ABC Certifees in recent years. The investigators will also develop hypotheses that may explain the apparently non-uniform distribution of practitioners to patients and look for evidence that supports or contradicts these potential explanations.

Having such information, based on specific Medicare data, could enable the field to better address the projected shortage of qualified practitioners in the future. Businesses may want to locate new offices in areas where there is less competition, training programs may want to recruit students from underserved regions more aggressively, and existing practices may want to hire residents from such areas in anticipation of opening new clinics once the individual has become ABC Certified.

References

Caroline C. Nielsen. "Issues Affecting the Future demand for Orthotists and Prosthetists: Update 2002". National Commission on Orthotic and Prosthetic Education May 2002.
www.oandp.org/pql/