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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