I believe with the increase in diabetes and decrease in funded programs and personal income, fewer people will have adequate insurance to continue good diabetes management. As a result, we'll continue to see poor compliance with diet and medications, and a lack of timely doctor visits. Patients will choose priority medical care based on their perceived importance and because of their limited income. Podiatry will be looked at as an option, not a priority.
I concur. Patient non-adherence, restricted access to proper and timely care along with increased patient out of pocket costs and increased life expectancy will likely cause the amputation rate to rise.
ACOs (accountable care organizations) that we are told will improve patient outcomes will have the opposite effect. ACOs are a brilliant way the government/insurance carriers/ politicians/lawyers will ration care but keep the liability on the physician and hospitals so their hands are clean.
I believe that with the inevitable rationing of healthcare dollars to trim the rise in expenditures by the government on Medicare recipients and providers that less and less money will go toward the things we rely upon every day to heal wounds.
We’ve already seen the drastic reduction in reimbursement for biologics and the effect that has started to have in wound care centers. This will continue and be expanded to reduce payments for EM visits, débridements and care. The only possible expansion of reimbursement may be in education, but the reduction in reimbursement in almost all the other aspects of wound care will reduce the number of tools in our armamentarium and, in turn, increase the number of amputations in a burgeoning field of individuals with diabetes. Wound care centers will close, fewer people will participate in a loss-leader aspect of medicine and we will see the results in higher amputation rates.
The era we live in will be remembered as the "salad days" of diabetic care and will be celebrated and reflected upon as an opportunity lost to cost containment.
I feel we should continue the shoe program as a cash event even if the government drops the coverage. Yes, only those that can afford it will have the service. But two things will happen. (1) Those that can afford it will have better results and (2) the government will return to coverage because they hate seeing "those that have" getting something that the "have nots" are not getting! If it would turn out that those people with the shoes do not have better results, well, I guess we 66% thinking shoes help are proven wrong and it turns out to be a bad program in the first place.
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