Diabetes Self-Management Blog

A couple of weeks ago, President Barack Obama was speaking at a town hall meeting on health care when he mentioned the idea of increasing reimbursement rates for doctors who provide preventive care. As an example of how reimbursement rates can affect medical expenses and outcomes, he brought up diabetic amputations. While doctors who work with patients to manage their diabetes “might be reimbursed a pittance,” he said, if a patient needs a foot amputated, “that’s thirty thousand, forty, fifty thousand dollars immediately the surgeon is reimbursed.”

Obama was quickly attacked by doctor organizations for getting his numbers wrong. According to an article from HealthLeaders Media, the American College of Surgeons noted in a statement that Medicare actually reimburses surgeons between $740 and $1,140 for a leg amputation — and private insurers tend to have similar rates. But Obama’s numbers were not made up: According to the Journal of the American Podiatric Medical Association, a foot or leg amputation costs between $30,000 and $60,000 in initial hospital costs, plus between $43,000 and $60,000 in costs for follow-up care over the next three years. So even though individual doctors may not have a large financial incentive to perform them, amputations are costly to the health insurance system.

But can amputations be reduced through an emphasis on preventive care, as Obama suggests? A recent Associated Press article concludes that they can at least be prevented in many cases, although it’s difficult to prove that this saves money. Foot and leg ulcers — which can eventually lead to amputations if they get infected — can cost thousands of dollars to treat effectively. It is possible, of course, that greater spending on diabetes education and doctor or nurse visits could reduce the incidence of ulcers in the first place; many studies have confirmed that blood glucose control has a large effect on the incidence of diabetic complications.

How often do you — and how often does your doctor — examine your feet? If you’ve ever had a foot ulcer, were you, in your view, given the support needed to help it heal as quickly as possible? Do you think elected officials like President Obama should be more careful about suggesting that doctors decide what they do based on reimbursement rates, or is this a fair charge? Should the government reimburse primary and preventive care at a higher rate through Medicare? Should it force private insurers to do the same? Finally, is there too much emphasis in this discussion on saving money within the health-care system, rather than on improving lives and preventing suffering? Leave a comment below!

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Comments
  1. I don’t believe that there are many doctors who will consciously choose to operate because this pays more than prevention. I do believe that clinics and individual physicians are pressured by the economics of health care into putting less resources (particularly face time with patients) into preventative care.

    Posted by Bob |
  2. I do not believe my doctors and support system at U of M push amputation as a quick fix for diabetes patients and more money for themselves. These people are more interested in education of the patient in the care and understanding of their patient so we do not have to go through amputation. Should doctors be reimbursed by Medicare? Yes, their face time with the patient helps tremendously in having a quality life. Medicare should not be dictating what or how a patient should be treated. This should be between the patient and the doctor.

    Posted by Paula Kilburn |
  3. I don’t feel I would get quality care with government intervention. It is bad enough now with insurance restrictions and mandates. Just when did insurance companies aquire so much power and money to dictate to doctors and patients what can and cannot be done in treating patients? AND, pharmacutical companies need to be investigated and controls need to be implemented on the cost of medications. We know that it costs so little to make some of our drugs but the mark-ups are at 1000%. Put an end the pharmacutical companies spending outragious sums of money on ‘courting’ doctors with fancy lunches, dinners, and other gratuities to push their companies drugs.

    Posted by Diane Rheaume |
  4. I was shocked by Pres. Obama’s statements. My father had to have both his legs amputated below the knees due to diabetes. All the doctors he had were caring people who tried to save the leg. To suggest they would amputate too make a few dollars is the disrespect the entire medical community.

    Posted by Eileen Ferro |
  5. I hate that medical offices have to charge about sixtyeight dollars in order to collect $5.40 - five dollars forty cents - to run a common series of blood tests! $68 may be too high but how can you possibly expect good, accurate results for $5.40 for several test items?!

    Posted by Abe Cox |
  6. Since having initial ulcers on my toes 3 yrs. ago I have had a standing appoinment (every 3-4 weeks) with my Podiatrist. I have had AT LEAST 3 hospital stays per yr. for Sepsis, and/or foot infections. I have just come home from the hospital after a 3 week stay for Antibiotic IV therapy. I salute my Podiatrist & my Primary Care Physician for their dedication in treating my infections from my foot ulcers. The Infectious Disease Specialist at the hospital told me that I was most likely going to have my big toe amputated
    but another course of inpatient IV antibiotic therapy & follow-up care by my doctors & there is no trace of those ulcers. I inspect my feet nightly & I run to my podiatrist at the first sign of a problem. I cannot stress the importance of prevention and early intervention of any foot or leg injury where the skin has been broken. Also, checking the temperture of lower extremities is another important indication od possible infection.
    I believe it is the doctor’s & nurse’s responsibility to remind diabetic patients & their families to do a daily foot inspection.

    Posted by Vicky Foppiano |
  7. I don’t believe, in any way, that a doctor would
    decide to amputate a leg to get more money.

    Obama, in my estimation, does not always have his facts right. I don’t think Medicare, which I have, pays the doctor enough and certainly not in
    fast payment. I see the Medicare statements come and they are always several months after an office visit or a procedure.

    Posted by Charlotte |
  8. I am an american who has lived for a about 6 years outside of the US in a country with socialized medicine. At first, I thought it would be great- but it is far worse than the US system, expecially for diabetes. The cost to go to an endocrinologist (because it is a specialist rather than a GP) is about 3 times the cost of what it is to go to an Endo in the US. I was told repeatedly that having an A1C at 8.0 - 8.4 was just fine- and in fact, it is better to keep my A1C OVER 6.8, because less than that would cause too many hypos. Although the cost for insulin is a little cheaper, there are far fewer insulins types available- and when I first moved, I changed insulin 3 times in the first 6 months and gained about 20 pounds. Also because I am type 1 and the majority of diabetics are type 2, GP’s are only instructed to treat for Type 2. One of the first doctors I went to told me that he would only treat me for type 2, because ‘it’s all the same as far as the government is concerned’. Being back in the US system, my body is healing for the time I had socialized medicine. I really and scared that the US will go the way of Europe- and because of it, the US will have more diabetics on permanent disability. I don’t think Obama has thought this health care plan through at all for people with chronic conditions.

    Posted by Sher |
  9. My wife is a Type 1.
    We work together to keep tight and accurate control over her blood sugar and to prevent complications.
    One thing we have found for sure, it is not the doctor who makes the difference. The patient must aggresively take responsibility for their disease, its treatment, locating new treatments and the eventual outcomes and progression of the disease.
    If the patient does not do the work, then the patient should not complain about sad outcomes.
    There are great doctors out there, there are frustrated doctors out there, just as there are sorry doctors around as well. We cannot depend on doctors to do the magic necessary for great outcomes. don’t even think about the insurance company staff taking real responsibility for the patient - they normally don’t. Only the patient can see that they have great outcomes.

    Posted by Freeloader |
  10. Check this article in the Washington Post regarding the ROI on preventative and protective care for Type 2 diabetes. (You can link to the original study from there.) Quality of life, social value of life, aside — it is cheaper for them to treat the complications (and allow us to die earlier) than to prevent them.

    Posted by tmana |
  11. “improving lives…” means more people need better coverage who can not afford it. That would mean, in turn, more government-sustained health services, perhaps requiring higher taxes. Helping those who can’t afford good care is a very tough problem but should be one objective of an advanced civilizationl.

    Posted by Lawrence Wackterman |
  12. I am a retired nurse,I’ve worked as an Army Nurse, at VA hospital, priviate hospital, and as a Public Health Nurse. First of all I take issue with those who say the US government cannot produce and or manage a public health care program. They already have several simular programs in progress. These same people who say this also say the US is the greatest country in the world. I believe that the US is the greatest country in the world and that when focused on any task will find a solution. Right now, the task is to develop a program that will provide the best health care for every one who needs it. This includes the rich to the poor. I also believe that President Obama wants that too. So, he may have gotten a few figures incorrect, it seems that we shouold be happy that the cost may not be as much. I don’t think he ment to imply that doctors choose to amputate rather than prevent. I have seen that sometimes doctors are too busy to give the time they should to preventive health and that could and probably did result in an unfortunate outcome. We need to include in the program more help to those people who want to enter the field and serve without ending up with thousands of dollars in debt. Allow medicine to go back to providing health care, not just a financial stress machine for those who enter the profession. Lets think of solutions, not pickey criticism. Thanks for your reading time.

    Posted by joyce rogers |
  13. I have Type 2 diabetes and am very proactive in my own care I do my labs every 3 months and try to keep my A1C below 7 my Dr tells that for being a diabetic I am very healthy I don’t always watch what I eat but I really try to eat mt favorite foods in moderation I believe in order for your Dr to treat you correctly you have to be proactive in your own health care…I teat my sugars 4-5 times a day sometimes more I also walk 2 miles a day and it really helps to keep my sugars down….If you have diabetes be proactive in your health care it is very important as it is a very costly disease as you all know your Dr can only be part of the prevention you have to take control after all it is your life…

    Posted by Linda Reyes |
  14. The health care reform has become a political issue, and thats hurting the whole purpose. It is inconcievable, to imagine that approximately 46 million people in America are uninsured,and have no hopes of health insurrance in the foreseeable future. We are currently involved in two wars that have no end in sight. The only viable option now for major players in this sector is to leave the issue as it is.This will be a great disservice to most affected Americans. Obama’s reform will only re-evaluate the healthcare system, to ensure that money wasted on preventable surgrey and other medical procedures could be made available to cover the numerous uninsured Americans.The ‘big boys ‘ in this power-play should know that it is no longer bussiness as usual. There is the inevitable hand of destiny at work. only history will tell the last tale

    Posted by Wesley David |
  15. I have been a Registered Nurse for 38 years, the last 15 in the Home Health setting. I was also diagnosed with Type II Diabetes a year ago. The first thing my doctor did was refer me to a diabetic nurse educator. I am managing my diabetes with a support group at my local hospital. I also have good family support. I don’t expect my doctor to hold my hand or micro-manage my care. In my home health practice, I have noticed that many chronic diseases are self-inflicted. One of the goals of home care is to teach self-care management. I have found that many people don’t care to be responsible for themselves. They don’t want to control their diet or exercise, learn about their diseases or medicines, or give up their bad habits. Preventive care is a great idea. I believe if people took care of themselves they could avoid many of the chronic illnesses that cost so much, not only in health care costs, but also in human suffering.

    Posted by E S Conrace |

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