Podiatrists in Medicaid Create $44:1 Cost Savings

An APMA podiatrist presented a first-of-its-kind study as a late-breaking research abstract at the 73rd Scientific Sessions of the American Diabetes Association (ADA) Symposium in Chicago last week. The study’s findings support the need to include podiatrists in Medicaid.

In 2009, the Arizona legislature voted to eliminate podiatric care reimbursement, deeming it an optional service. In the years following the announcement, what researchers at the University of Arizona College of Medicine found surprised them.

“What we found in a very short period of time,” said co-author of the study David G. Armstrong, DPM, MD, PhD, “was that compared to the previous five years, there was a 50-percent increase in severe aggregate outcomes, or SAOs—the technical term for death, amputation, sepsis, and surgical complications.”

They also saw a 38-percent increase in hospital admissions for diabetic foot infections; a 45-percent increase in charges for those admissions; and a 29-percent increase in length of hospital stay.

In a nutshell, for every $1 removed from the Arizona Medicaid budget, there was actually a remarkable $44 increase in costs of care.

These findings suggest a marked worsening of patient care in terms of increased inpatient admissions, lengths of stay, charges, and severe clinical outcomes. Restricting preventive care among patients with diabetes may have resulted in unintended consequences, particularly among the poor and underserved.

Dr. Armstrong is professor of Surgery and director of the Southern Arizona Limb Salvage Alliance (SALSA) at the University of Arizona College of Medicine. Professor and Chief of Vascular Surgery Joseph L. Mills Sr., MD, and Grant H. Skrepnek, PhD, RPh, of the University’s Center for Health Outcomes and PharmacoEconomic Research, co-authored the study.


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