Navigating the Journey of Amputation Cases

Amputations are among the most challenging cases in workers' compensation. In this Expert Insights episode, MEC’s Senior National Catastrophic Medical Consultant Phyllis Ramondetta provides excellent insights into this complex topic that affects thousands of workers annually.
Phyllis shares expert commentary based on over 20 years of experience as a catastrophic nurse case manager. This includes:

• How trauma accounts for 44% of all work-related amputations, typically in high-risk environments.
• How prosthetists collaborate with medical teams to find the right solution. 
• The multi-faceted recovery process following an amputation.
• The psychological impact of an amputation. 

Whether you are managing amputation claims, supporting an injured worker through recovery, or trying to understand prosthetic technology better, this episode provides essential insights to navigate these life-altering injuries. 

Chapters

• 0:00 Introduction to Amputation Expert Insights
• 0:52 Causes and Types of Amputations
• 2:04 Recovery Process and Prosthetic Fitting
• 3:39 Complications and Psychological Impact
• 4:25 Prosthetic Costs and Considerations
• 7:15 Maintenance and Episode Closing

Transcript

Sara Hance: 0:02

Hello, this is MEC Connect Expert Insights, a companion series to our main MEC Connect podcast for Midwest Employers, Casualty. I'm Sara Hance and in these Expert Insights episodes, you'll hear from subject matter experts as they share practical tips and strategies on a variety of topics related to workers' comp and claims management. Today, Phyllis Ramondetta, Senior National Catastrophic Medical Consultant, will discuss amputations. Now let's hear from Phyllis.

Phyllis Ramondetta: 0:32

Thank you, Sara. As a catastrophic nurse case manager for over 20 years in the workers' compensation arena, I've had significant experience managing both upper and lower extremity amputations. So today I'd like to share some general information about amputations and share some insights on the type of prosthetics that are available, along with their associated costs. One of the main causes for amputation or loss of a limb is trauma. Approximately 44% of all amputations involving work-related injury are caused by trauma. Examples can include factory or construction accidents, crush injuries, traffic and agricultural accidents, as well as electrocution. Amputation is a last resort when the body part can just not be saved and it's either dead or dying, or it's going to be threatening a patient's life. The most common amputation is the below the knee amputation. A partial hand or finger amputation is the most common upper extremity amputation. Upper extremity amputation sites can vary in degrees, to include a finger, a partial hand, a wrist below the elbow, above the elbow and a complete shoulder disarticulation. That is where the whole arm up to the shoulder is removed. Lower extremity amputations can include a toe, a partial foot below the knee, above the knee and hip disarticulation, which means the whole leg up to the hip is removed and, as you can imagine, the higher the amputation, the more loss of function occurs. An amputation is a very traumatic event for the patient and the initial steps in physical recovery start with physical therapy. This will keep blood clots from forming and will improve blood supply to that area. The initial therapy goals will be to maintain and build muscle strength and increase mobility.

Phyllis Ramondetta: 2:23

In preparation for a prosthetic. Once the amputation site is healed, a prosthetist will work with the patient, along with the therapist and the physician, to determine the best type of prosthetic option they have. Consideration is given to the type of amputation, the remaining muscle mass, the strength of the muscle of the residual limb and the anticipated function. Priority Prosthetic fitting can be a very lengthy process and it can be very confusing and frustrating for the injured patient. Once the prosthetic is molded and fitted to the limb, significant physical therapy will be required. In a leg amputation, a temporary prosthetic leg can be used and this is to get the patient up and moving with therapy. But once the limb is completely healed and the swelling is down, the patient will then be fitted with a permanent prosthetic.

Phyllis Ramondetta: 3:13

Loss of a limb can produce a permanent disability that's going to affect mobility, self-care and can also affect self-esteem. There are varying degrees of success with therapy and it will depend on the level and the type of amputation and overall health and motivation of the patient. The general goal of therapy is for the patient to return to the highest level of function and to improve the overall quality of life, and this will require not only physical therapy to strengthen but education on the fitting and the use of the prosthetic and again, this is a very long, detailed process. The prosthetist and the patient must work together in order to get the best result. Amputations can produce multiple complications that can delay recovery and adversely affect the prosthetic fit. Common issues can include infection of the residual limb, skin breakdown from where the prosthetic is rubbing against the residual limb. It can also invoke depression and post-traumatic stress disorder, as well as poor self-esteem and phantom limb pain. It can be beneficial to consider early intervention with a mental health professional if depressive symptoms can occur. Doctors and prosthetists will work closely to manage all the complications. Amputations are not a common injury seen in workers' compensation, and claim handlers may not be experienced with managing the care and costs associated with that amputation. There are hundreds of billing codes for prosthetics that can be very confusing. A nurse case manager can be beneficial to help coordinate the treatment plan. One recommendation to the workers' compensation insurance carrier is to obtain the services of a prosthetic reviewer. This reviewer is going to ensure that the patient is getting the most appropriate prosthetic for the injury, analyze the estimates and invoices to make sure that there are no duplicative codes and assist in price negotiation.

Phyllis Ramondetta: 5:05

When dealing with a below-the-knee amputation, the prosthetic costs are going to vary greatly depending on the brand and features of the prosthetic. The approximate cost is between $15,000 and $20,000. Above-the-knee amputations are more difficult to fit and, depending on the age and the mobility of the patient, will determine if they need a standard or microprocessor knee joint. The costs vary significantly. A prosthetic with a standard knee component will run about $20,000 to $35,000, and a prosthetic with a microprocessor knee can run between $50,000 and $100,000,. Microprocessor knee can run between $50,000 and $100,000, and I've seen some go up to $150,000. It's very important that the prosthetist determine the activity level of the patient. If they are young, fit and mobile, then a microprocessor knee can be more appropriate. If you've got an older client that is not that functional, then a microprocessor knee would not be appropriate.

Phyllis Ramondetta: 6:02

Upper limb prosthetics can vary depending if you want a body-powered arm, limb or a myoelectric arm or hand. The costs fluctuate depending on the features of the prosthetic. The body-powered prosthetic is more durable, it requires less intensive training and it is preferred for heavy activity. The myoelectric prosthetic is very heavy and it's very difficult to learn to use, but it offers more functionality. The cost of a body-powered prosthetic is around $30,000, and the cost of a myoelectric prosthetic can cost up to $100,000 to $150,000, and up to $70,000 for a single finger that you can move normally. So a quick rule of thumb is to have the patient work with a body-powered prosthetic initially and see how they do, then consider a myoelectric hand or arm if they're interested. They do. Then consider a myoelectric hand or arm if they're interested. A lot of people work very well with their body-powered prosthetics and don't have any desire to go to a myoelectric hand or arm.

Phyllis Ramondetta: 7:02

Keep in mind that there will be expenses for maintenance. There will be socket replacements and supplies and generally they will cost up to about 10% of the total cost of the prosthetic on an annual basis. Once the amputated limb has stabilized and healed, the general replacement schedule for prosthetics are about every five years. Now, below the knee prosthetics can wear out. The foot component can wear out and may need to be replaced between three and four years, depending on the use. So, in closing, amputation care and prosthetic technology certainly continues to evolve, offering new possibilities for those who have lost limbs. This overview covers the range of challenges in amputation care, from recovery to long-term prosthetic use. Advances in prosthetics are expanding options for amputees, potentially improving their quality of life. With better knowledge of these issues, we can certainly provide more effective support to individuals adapting to life after limb loss. Thank you so much for listening.

Sara Hance: 8:02

Thank you for tuning in to MEC Connect Expert Insights. I'm Sara Hance from Midwest Employers Casualty. We hope you found Phyllis's insights on amputations valuable. Stay tuned for more from MEC Connect and more expert insights. Thank you for listening.