AAPM&R was contacted by the U.S. Government Accountability
Office (GAO) earlier this year with the opportunity to provide expert
input for a study on the quality-of-care currently available for patients
with limb loss and limb difference, as well as ways that our national
healthcare system can be improved for this patient population.
Marlis Gonzalez-Fernandez, MD, FAAPMR and Prateek Grover, MD,
FAAPMR answered the call and met with senior staff from the GAO’s
Health Care Team to provide PM&R’s perspective on the level of care
available to patients dealing with limb loss and limb difference, and
how the quality-of-care for this population can be elevated by more
fully incorporating PM&R into health systems and increasing access
to physiatrists throughout the care continuum.
The main themes covered by Drs. Gonzalez-Fernandez and Grover
for the GAO were the challenges faced by this patient population,
for access to both services and devices, and the need for gathering
more substantive evidence on the current level and availability
of care for this patient population. Finally, they emphasized the
point that the quality-of-care available to these patients can
be improved by PM&R leading the field of limb loss and limb
difference rehabilitation. AAPM&R also provided recommendations
for undertaking additional research into coordinated healthcare
systems, interprofessional education and fellowships, and creating
model systems of limb loss rehabilitation.
This study was requested by Senators Tammy Duckworth (D-IL) and
Marsha Blackburn (R-TN) and Representative Brett Guthrie (R-KY-02),
the current chair of the House Energy and Commerce Subcommittee
on Health and the now-retired Representative G.K. Butterfield
(D-NC-01). These are all senior members of Congress who have
demonstrated an interest in the quality-of-care and level of resources
available to patients with limb loss and limb difference. The hope is
that the report produced by GAO (expected in late 2023/early 2024)
will serve to inform these federal policymakers as they craft federal
legislation to improve the quality-of-care available to this patient
Dr. Gonzalez-Fernandez currently serves as the Associate Professor
of PM&R and Orthopaedic Surgery, and the Vice Chair for Clinical
Affairs in the Department of PM&R, at the John Hopkins University
School of Medicine. Dr. Grover currently serves as an Associate
Professor of Physical Medicine and Rehabilitation at Penn State
Center of Medicine, as well as the PM&R Vice Chair of Quality &
Safety and Director of Resident Research at Penn State Health.
Dr. Grover also serves as an at-large member of AAPM&R’s Quality,
Practice, Policy & Research (QPPR) Committee, a Strategic Coordinating Committee for the Academy. QPPR is responsible for developing and managing an integrated and strategic plan and resource allocation to advance the practice, policy and research priorities of the Academy. As such, engaging with the GAO on this study was a perfect fit with Dr. Grover’s volunteer work for the Academy, as well as his professional expertise in providing care to patients with limb loss and limb difference.
“The opportunity to meet with staff from the GAO to discuss limb loss and limb difference rehabilitation challenges, inequities and responsive strategies was incredibly rewarding. The conversation focused on the non-uniform quality-of-care and resources available for post-limb loss rehabilitation and prosthetics, how physiatrists are truly uniquely qualified to lead team-based care in this space, and that funding further research, education and systems development is vital for both patient care and healthcare utilization. I look forward to seeing the results of this study and the recommendations that GAO will send to Congress. I hope that our participation will lead to improved policy and resources for people with limb loss and limb difference to receive comprehensive rehabilitation and appropriate prosthetic devices in a timely manner,” said Dr. Grover.