Can The Medical Home Model Reinvent Outpatient Diabetic Foot Care?

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By Thomas Belken, DPM

   In a recent article in USA Today, the CEO of Kaiser Permanente discusses the current state of healthcare and how his system has already adopted practices and principles that patient-centered medical homes and other accountable care organizations are structured around.6 By adopting protocols on prevention, Kaiser Permanente has reduced the rate of serious complications (stroke, sepsis, etc.) and improved patient care and satisfaction. In doing so, the company is on average 15 percent more cost-effective than all of its competitors.

Key Insights On Complication Prevention

Every patient with diabetes should have a comprehensive foot exam at least once per year (this is one of the requirements for a PCP’s meaningful use). It is our responsibility to provide the primary care docs with a diabetes risk grading score. Patients deemed as higher risk (score) — patients who have peripheral arterial disease, neuropathy, foot deformities, history of ulcers, pre-ulcerative lesions or amputations — should get screenings at more frequent intervals. Researchers have documented that when podiatry is involved in patient care, there is a significant decrease in limb loss and a substantial cost savings.4,5

   As the cost of healthcare continues to skyrocket, physicians regardless of specialty have to take measures to keep these costs down. Insurance companies are constantly auditing charts and billing, looking for the slightest reason to reject a claim. Developing healthcare that is more efficient and cost-effective will ease the scrutiny placed on healthcare costs. The sooner we can assimilate ourselves into the system, the sooner we can reap the rewards and utilize these models to better manage and care for our patients with diabetes. Most importantly, we need to continue to demonstrate the important and often limb saving and life enhancing nature of our services.

   Dr. Belken is in private practice at Foot Healthcare Associates in Michigan.

1. Gandhi TK, Burstin HR, Cook EF, et al. Drug complications in outpatients. J Gen Int Med. 2000;15(3):149-54.
2. American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, and the American Osteopathetic Association. Joint Principles of the Patient-Centered Medical Home, March 2007.
3. BCBSM Physician Group Incentive Program Patient-Centered Medical Home and Patient-Centered Medical Home-Neighbor Domains of Function Interpretive Guidelines, V4.2 2012-2013. Available at .
4. Carls GS, Gibson TB, Driver VR, et al. The economic value of specialized lower-extremity medical care by podiatric physicians in the treatment of diabetic foot ulcers. J Am Podiatr Med Assoc. 2011; 101(2):93-115.
5. Sloan FA, Feinglos MN, Grossman DS. Receipt of care and reduction of lower extremity amputations in a nationally representative sample of U.S. elderly. Health Serv Res. 2010; 45(6 Pt 1):1740-1762.
6. O’Donnell J. Kaiser Permanente CEO on Saving Lives and Money. USA Today. Published October 23, 2012. Accessed December 3, 2012.

   For further reading, see “When Diabetic Foot Ulcers Can Be Managed At Home” in the October 2004 issue of Podiatry Today. To access the archives, visit

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