Allowing podiatrists to give diabetic patients regular foot health screenings — which are usually done by primary care doctors — could save limbs, lives and money, according to a new policy brief from the UCLA Center for Health Policy Research.
As many as 1 in 4 diabetic Californians develop damaging toe, foot and leg ulcers which could lead to amputation and elevated risk of death, according to the study. The cost of treatment statewide reached $565 million in 2014.
Using admissions data from the California Office of Statewide Health Planning and Development, authors of the study found that podiatry services provided to diabetic patients could have saved between $29 million and $97 million in 2014, even given the limited number of diabetics who received foot screenings — between 11 percent and 30 percent of patients, depending on age.
Role of podiatrist
A medical doctor who provides podiatric services to a Medi-Cal patient is reimbursed for treatments, which could include screening for foot health or treating wounds that could lead to infection. But a podiatrist who performs the same services in his or her office to that patient is typically denied reimbursement because his or her services are considered "optional."
"Foot screening should not be optional, unless you consider lower limbs optional," said Jonathan Labovitz, Medical Director of the Foot & Ankle Center at Western University of Health Sciences and lead author of the report. "An amputation does not just result in a reduced quality of life but in a significantly increased risk of death."
Foot ulcers are one of the most common complications of diabetes. Treatment for advanced cases involves hospitalization and amputation, making management of foot ulcers extremely expensive — about $17 billion a year nationwide, according to figures cited in the report. More than 80 percent of toe, foot or leg amputations among diabetic patients are preceded by foot ulcers, and as many as three-quarters of those amputees die within five years, according to the report.
It costs between $7,500 and $20,600 each time a diabetic foot ulcer is treated, according to the American Podiatric Medical Association (APMA). In comparison, the APMA says a limb amputation resulting from a foot ulcer costs $70,400 and as much as a half-million dollars over a patient's lifetime. The study's authors estimate that California would save between $7.5 and $16.9 million for Medi-Cal patients alone by providing foot screening and preventing amputation.
California Health Interview Survey data cited in the study estimates diabetes rates among California residents rose from 8.4 percent in 2011 to 8.9 percent in 2014. Among seniors, the rates were even higher: from 18.6 percent to 20.6 percent, possibly presaging a rise in diabetes-related complications — and costs.
"Getting diabetic patients checked regularly before foot problems escalate significantly brings down health care costs," said Gerald Kominski, Center director and co-author of the report. "Diabetes is not going away and California is aging. From a policy perspective, podiatric foot screenings are key to combatting the economic toll of this disease."
Read the policy brief: Podiatric Services Could Reduce the Cost of Treating Diabetes Complications in California by up to $97 Million
About the UCLA Center for Health Policy Research
The UCLA Center for Health Policy Research (CHPR) is one of the nation’s leading health policy research centers and the premier source of health policy information for California. UCLA CHPR improves the public’s health through high quality, objective, and evidence-based research and data that informs effective policymaking. UCLA CHPR is the home of the California Health Interview Survey (CHIS) and is part of the UCLA Fielding School of Public Health. For more information, visit healthpolicy.ucla.edu.