Q&A with Jan Saunders, CPO, LPO, Paradigm’s Clinical Director of Prosthetics

April is Limb Loss and Limb Difference Awareness Month. Sponsored by the Amputee Coalition, this event recognizes the limb loss and limb difference community and provides education around the importance of equitable medical access, care, and coverage. The 2024 theme, We Thrive, celebrates the many ways this community thrives and how anyone can help and participate.

Limb loss and limb difference deserve attention, as they often result from a serious injury. And they affect people from all walks of life. In 2021, there were more than two million people living with limb loss in the United States alone.¹ Additionally, there were more than 2,000 amputations resulting from work-related injuries in 2019,² highlighting the critical need for high-quality and appropriate injury management.

As the leader in achieving life-changing outcomes for catastrophically injured workers, Paradigm has extensive care management experience, proprietary data, and clinical expertise in amputations and limb loss. To support the high level of catastrophic care management required for these cases, we are committed to working with best-in-class providers and have built clinical partnerships with leading research organizations in this field. In fact, in honor of Limb Loss and Limb Difference Awareness Month, Paradigm’s Chief Medical Officer, Workers’ Compensation, Dr. Michael Choo, recently shared his insights as a founding member of the panel formed to support and guide the Mayo Clinic’s Limb Loss and Preservation Registry (LLPR).

Why experienced, focused prosthetic care matters for limb loss cases
To learn more about the importance of expert-driven, human-centered care for injured workers with limb loss, we spoke to Jan A. Saunders, CPO, LPO, Clinical Director of Prosthetics for Paradigm’s Care at Home. With more than 40 years of experience as a nationally certified prosthetist and orthotist, he has spent his career helping injured workers adjust and adapt to limb loss in order to gain function and enjoy an active life.

According to Jan, the best prosthesis for an injured worker may not always be the newest device with the most advanced technology or highest price tag. Instead, the job of a prosthetist should be to help select the most appropriate prosthesis that will have the best impact on that person’s functional activity. Doing this successfully requires a combination of focused expertise and collaboration with the injured amputee, the medical team, and care managers to create an individualized treatment plan.

Why is early intervention so important for limb loss cases?

Jan Saunders: When an injured worker loses a limb, there are so many sources of fear, including the ability to provide for their family, concerns about appearance, and how relationships will be affected. Intervening early can play a key role in relieving these fears and anxiety, by giving injured patients clear and functional recovery goals. A team-driven approach from the beginning with the injured worker, their families, the physician, claims professionals, and case managers working together can help foster a sense that this person is going to come out of this okay.

How early should a prosthetist be involved and what role do they play in device selection?

Jan Saunders: Along with physical medicine and rehabilitation specialists and occupational therapists, the prosthetist should be involved from the very beginning to ensure the recommended device is truly appropriate for the injured worker and his/her functional needs. The surgeon performing the amputation will generally rely on the specialized expertise of a prosthetist to determine the proper codes and specific components needed for that case and to help identify the requirements for the prescription. However, it is just as important to have qualified oversight, both to prevent unnecessary cost overruns and to guarantee that the prosthetic device serves the functional needs of the patient. Achieving a good result has a lot to do with selecting the right prosthetist with the right area of expertise.

Why is specialization important for prosthetists?

Jan Saunders: Specialization is as important in prosthetics as it is for other medical fields. In the same way a podiatrist should not be performing spine surgery, a prosthetist specializing in lower extremities should not be the prosthetist providing the myoelectric prosthetics for upper limbs, as they can be very technical and expensive. Working with dedicated specialists who have relevant backgrounds is a big key to successful outcomes.

What are some of the factors that can lead to inappropriate prosthetic selection and how can this lead to excessive costs and suboptimal outcomes for injured workers? 

Jan Saunders: Even though an expensive device may seem like the best, it may not be the most appropriate. I’ve always made the analogy of not buying a Ferrari when a nice Escalade would be the appropriate prosthesis to do the job. Often in workers’ compensation, higher-technology prosthetics end up being assigned to injured workers who may not be able to use all of the technology, and therefore will not benefit from them. Not only does this increase costs substantially, but more importantly, it can lead to poor functional outcomes for injured workers.

Among the primary drivers of this problem are the selection criteria for a patient’s rehabilitation potential, including the K-level system used by Centers for Medicare and Medicaid Services and the U.S. Department of Veterans Affairs. This rating system was designed to help patients with limb loss receive appropriate prosthetic devices based on their ability and potential for ambulation. But because the levels are set largely by surgeons without specific prosthetic experience, many injured workers may not receive the correct rating and end up with a device that is inconsistent with their true rating. For years, I have been part of efforts to reform this system so that physical medicine and rehabilitation physicians, along with therapists with more relevant expertise, will be the ones to conduct the testing and assign the K-levels.

In the meantime, it is critical to provide oversight during the recovery process to ensure that qualified specialists are guiding the process. Paradigm’s Care at Home Prosthetics and Orthotics Program utilizes functional assessment tests, including the Amputee Mobility Predictor Assessment Tool, administered by an occupational/physical therapist to ensure appropriate rating of K-levels and training for injured workers. Matching injured patients affected by limb loss with the best device for their needs is only the first step in a very long rehabilitation journey toward their return to their families, communities, and activity.

Support Limb Loss Awareness Month
Help Paradigm continue to help people living with limb loss and limb difference thrive. All month, the Amputee Coalition wants you to share inspiring stories around limb loss and limb difference by using the #WeTHRIVE and #LLLDAM2024 hashtags. You can also support Paradigm by liking and sharing our posts focusing on this important area of injured worker care.

Learn how Paradigm achieves the best outcomes for our injured workers with complex limb loss by delivering solutions based on an individualized, clinical approach to recovery that promotes maximum well-being.

Sources

1. 2019 Annual Report – Amputee Coalition (amputee-coalition.org)
2. Severe Injury Reports | Occupational Safety and Health Administration (osha.gov)