I am deeply troubled by the proposal to eliminate podiatry from MaineCare, as this will not decrease costs to the system but likely increase them, as well as put patients with deep need in jeopardy of limb loss and other complications.
For diabetic patients alone, the risk is tremendous. It is well documented that if every American at risk for developing a diabetic foot ulcer visited a podiatrist once before complications set in, the U.S. health care system could save $3.5 billion annually. This estimation is a projection based on findings from the Thomson Reuters study published in the March-April issue of the Journal of the American Podiatric Medical Association.
As president-elect of the Maine Podiatric Medical Association and a practicing podiatrist, I am proud of the positive contribution podiatrists make to our health care delivery and financing systems. As a state leader who develops policies that affect the delivery of care, I thought it was imperative that readers have this information.
The study focused on identifying individuals with diabetes who developed a foot ulcer, and of those who developed a foot ulcer, examining whether they received any care from a podiatrist in the year prior to development of the ulcer. The study, sponsored by APMA and independently conducted by Thomson Reuters Healthcare, utilized Thomson Reuters Market Scan Data Base to examine claims from 316,527 patients with commercial insurance (64 years old and younger) and 157,529 patients with Medicare and an employer-sponsored secondary insurance.
The study’s findings are astounding. After comparing health and risk factors for those who had seen a podiatrist to those who had not, the commercial insurance group saved $19,686 per patient over a three-year period. The Medicare group saved $4,271 per patient over the same three years. Conservatively projected, these per-patient numbers support an estimated $10.5 billion in savings over three years ($3.5 billion a year).
Moreover, among patients with commercial insurance, each $1 invested in care by a podiatrist results in $27 to $51 of savings for the health care delivery system. Among Medicare-eligible patients, each $1 invested in care by a podiatrist results in $9 to $13 of savings. These savings are a result of effective evaluation, prevention and treatment of foot complications related to diabetes by podiatrists.
The Thomson Reuters Study is not alone in demonstrating the value of care by podiatrists for patients with diabetes. In fact, an unrelated, independent study conducted by Duke University researchers found that Medicare-eligible patients with diabetes were less likely to experience lower-extremity amputations if a podiatrist was a member of the patient care team.
Podiatrists receive the education, training and experience necessary to provide quality foot and ankle care to patients, and at the same time present cost-containment solutions to our health care delivery and financing systems. Access to podiatrists is an important component of ensuring quality of care and at the same time providing cost savings. The growing epidemics of diabetes and obesity and their concurrent complications, along with the aging of the population, are among the many reasons podiatrists are necessary and important members of the physician community providing health care.
Adam W. Darcy, DPM, FACFAS, is president-elect of the Maine Podiatric Medical Association and is based in Bangor.