Enterprise-Wide Initiative (EWI) - Specialty Care
Mobile Prosthetic and Orthotic Care (MoPOC)
Background
Problem
Veterans require Orthotic & Prosthetic (O&P) care to treat amputation and other mobility-disabilities. They often struggle to receive these services because traveling to an appointment is difficult. Rural Veterans have the most difficult time, given that these services are offered exclusively at Veterans Health Administration (VHA) Medical Centers in large cities. Rural Veterans can be seen by non-VHA providers closer to home, but this care costs more, is often lower quality,1 and is not the first choice for most Veterans.
O&P care requires special tools and equipment housed in a custom lab, as well a separate space to work with the patient. VHA has small clinics in rural communities called Community Based Outpatient Clinics (CBOC). These CBOCs have patient care rooms, but they do not have the custom labs and tools required to serve Veterans with amputations.
Solution
The VHA Office of Rural Health (ORH) established the Mobile Prosthetic and Orthotic Care (MoPOC) Enterprise-Wide Initiative (EWI) in 2021 to address these problems. Through MoPOC, VHA O&P providers travel to rural CBOCs on a regular weekly schedule and as needed, to Veterans homes. These providers travel in mobile O&P labs, eliminating the need for costly brick-and-mortar labs, giving VHA the flexibility to provide care wherever it is needed. MoPOC enhances access to care, achieves exceptional Veteran satisfaction, and costs less than community-based care.
Goals and Objectives
MoPOC ensures improved access to VHA O&P services for rural Veterans by reducing or eliminating the patient burden of travel, while maintaining world-class standards and saving money. MoPOC leadership and team members strive to provide Veterans with the best care experience.
Goals for Fiscal Year (FY) 2024 included
- Expand MoPOC to five new sites. This goal was exceeded through expansion to 10 sites, with half working on acquiring the mobile O&P lab, and the other half commencing patient care.
- Conduct 6,560 patient visits. The actual number of patient visits, 6,095, was lower than the goal due to understaffing in Memphis and program discontinuation in Guam.
- Increase the proportion of rural Veterans served to 72%. This goal was exceeded, with 77% of all patient visits taking place with Veterans classified as rural or highly rural.
- Increase Veteran reported Quality of Care score to an 87% rating of good or excellent. This goal was exceeded, with 98% of Veterans reporting that MoPOC care was good or excellent.
- Increase Veteran satisfaction with Ease of Travel to 91%. This goal was exceeded, with 95% of Veterans reporting that they were mostly or very satisfied with ease of traveling to their appointments.
- Save $582K in cost, by providing care with VHA-based O&P providers. MoPOC achieved $671K in cost avoidance in FY24.
Methodology
Since starting in 2021, MoPOC has been expanding at a rate of roughly five sites per year. Eligible sites are identified by the MoPOC Program Office based on VHA data for rurality, CBOC enrollment rates, travel distances, and site capabilities. Sites are selected to implement MoPOC on an annual basis. The Program Office works closely with local sites to assist in startup, optimize operations, and ensure program success.
MoPOC clinicians work four 10-days/week. On three of those days, they travel from their home stations to VHA CBOCs, keeping a consistent schedule to ensure continuity of care. On the fourth day, clinicians perform fabrication work, stock the mobile O&P lab, and conduct home visits as needed. 
The mobile O&P lab is equipped to allow MoPOC clinicians to perform most procedures done in a standard brick & mortar lab. For example, when fitting a prosthetic leg, the clinician can use specialty tools within the mobile O&P lab to grind away tight spots, adjust the alignment, or replace the foot. All the MoPOC mobile O&P labs have the same configuration and tools, with minor differences due to improvements made each year.
Impact on Rural Veteran Health
MoPOC greatly improves access to O&P care in the areas where it is implemented, it allows Veterans to receive their care in VHA, and results in outstanding Veteran satisfaction.
- MoPOC is currently providing care at 16 VHA sites, reaching 39 CBOCs across 14 states, and expanding access to 225,961 Veterans.
- In FY2024, MoPOC clinicians conducted 6,095 patient visits with 4,239 Veterans, 77% of whom live in rural or highly rural areas.
- 95% of Veterans were mostly or very satisfied with the ease of traveling to their MoPOC appointment.
- 75% of Veterans agreed or strongly agreed that MoPOC care was easier to get compared with other O&P care they have received.
- 20% of Veterans reported that they would not have received O&P care at all if MoPOC services were not available.
- 98% of Veterans rated the quality of MoPOC services as good or excellent.
Key Takeaways
Veterans with O&P needs that live in rural communities often struggle to access the care that will help them improve their mobility and quality of life. MoPOC enables VHA to bring critical O&P care closer to home. Reducing the travel burden has shown to improve outcomes among Veterans served by MoPOC.
- Veterans prefer to receive their O&P care in VHA, and MoPOC helps make this possible for those living in rural communities.
- Veterans are highly satisfied with the services they receive through MoPOC.
- MoPOC costs less than sending rural Veterans to community providers for the same care.
Download the Printable PDF for Healthcare Providers and Researchers.
References
- Mobile Prosthetic and Orthotic Care (MoPOC) - (PDF)
- O’Hanlon, C., Huang, C., Sloss, E. et al. (2017). Comparing VA and Non-VA Quality of Care: A Systematic Review. Journal of General Internal Medicine, 32, 105–121. https://doi.org/10.1007/s11606-016-3775-2
- Leonard, C., Young, J., Feser, W., Gylys Colwell, P., & Hebert, P. (2024). MoPOC Enterprise-Wide Initiative Annual Evaluation Report Fiscal Year 2024. VA Collaborative Evaluation Center (VACE) and Seattle-Denver Center of Innovation for Veteran-Centered & Value-Driven Care.
Contact
- Daniel Abrahamson, CPO, National Program Manager, Mobile Prosthetic and Orthotic Care, VISN 20 Prosthetics and Sensory Aids Services – Seattle, VA Puget Sound Healthcare System. daniel.abrahamson@va.gov
- Funding Acknowledgement: Department of Veterans Affairs, Veterans Health Administration, Office of Rural Health, NOMAD #PRFY-00539.
- Abrahamson, D.C., & Kaufman, G.E. (2024). Mobile Orthotic and Prosthetic Care [PRFY-00539]. Department of Veterans Affairs, Veterans Health Administration. Washington, DC: Office of Rural Health. Retrieved from https://www.ruralhealth.va.gov/enterprise-wide-initiatives/mobile-prosthetic-orthotic-care-mopoc.asp.
Rural Health - Navigation
- Office of Rural Health Home page: https://www.ruralhealth.va.gov/index.asp
- Enterprise-Wide Initiative (EWI) Home page: https://www.ruralhealth.va.gov/providers/Enterprise_Wide_Initiatives.asp
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