What Studies Reveal About The Preventive Value Of Podiatric Care For Patients With Diabetes

Paul J. Liswood, DPM, FACFAS

Study Shows Significant Cost Savings With Podiatric Care

But is there a cost savings realized if podiatrists are involved in the care of patients with diabetes? Yes, according to the study by Carls and co-workers.1 In the commercial insurance group, researchers saw an average savings of $19,686 per patient and an average savings of $4,271 per patient in the Medicare group when podiatrists were involved as part of the health care team. If you extrapolate this information out to populations who are at risk for a foot ulceration, the healthcare system could save $1.97 billion in the commercial insurance group and $1.53 billion in the Medicare group each year if these patients saw podiatrists. That would be a total savings to the U.S. healthcare system of $3.5 billion annually.1

   The study also showed that an investment in podiatry care yielded an exceptional cost savings. Every dollar invested in care by a podiatrist resulted in $27 to $51 of savings in the commercial insurance group and $9 to $13 of savings in the Medicare group.1 This is important information for healthcare policy makers.

Reducing The Risk Of Lower Extremity Amputations

A second study out of Duke University sought to determine the effectiveness of care from podiatrists and lower extremity clinician specialists in regard to diabetes-related lower extremity amputation.2 The researchers looked at Medicare 5 percent sample claims from 1991 to 2007, and stratified individuals based on disease severity.

   They found that patients visiting a podiatrist and a lower extremity clinician specialist within a year before developing all stage complications were between 31 and 77 percent as likely to undergo amputation in comparison to individuals visiting other health professionals.2 They concluded that visiting a podiatrist reduced the risk of lower extremity amputation in patients with diabetes. Once again, researchers demonstrated the value of care by podiatrists.2

   However, the true value of podiatry may be in preventing ulcerations and amputations in the first place. In 2008, Rogers, Lavery and Armstrong looked at the incidence of ulcers and amputations, and extrapolated that info out to the diabetic population in the U.S.6 They calculated cost per episode and created a model that showed U.S. lower extremity disease cost exposure of about $30.6 billion annually. Then they looked at practical reductions that clinicians could achieve with amputation prevention strategies. They reported that practical reductions of 48 to 73 percent for ulcers and 50 to 69 percent for amputations are possible. If this occurred, the savings could be $14.9 to $21.8 billion annually.6

Emphasizing The Importance Of Risk Classification

Although the above data is impressive, we should look to improve on these results. Podiatrists are uniquely trained and educated in providing diabetic foot examinations and risk assessments. Following a patient risk evaluation, podiatrists should assign a risk classification to the patient as outlined by the American Diabetes Association Foot Care Interest Group Task Force.8

   In the risk classification recommendations from Boulton and colleagues, risk category 0 is normal sensation and circulation with no deformity.8 Patient education would be appropriate and there should be annual visits. Risk category 1 is a loss of protective sensation. With these patients, podiatrists should consider prescription footwear, prophylactic surgery and patient education. Patient follow-up would be every three to six months.

   Risk category 2 is arterial disease with or without neuropathy. Podiatrists should obtain vascular consultation for these patients and schedule follow-up visits every two to three months. Risk category 3 would be a history of ulcer or amputation. These patients require follow-up every one to two months.8

   A qualified podiatrist should assign every patient with diabetes a risk classification. Individual podiatrists must take it upon themselves to perform the evaluations.

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