Dr. David Armstrong is a professor of surgery at the University of Arizona and director of the UA-based Southern Arizona Limb Salvage Alliance
The most common reason for hospitalization in diabetes is not for a heart attack or a stroke, but rather for a foot infection. This often forgotten problem leads to more than a million amputations worldwide per year-- one every 30 seconds. After an amputation, work by our team and others has suggested that 5 year survival is often worse than a bad form of cancer.
There is a misconception that because amputations cost a great deal of money, somehow the doctor gets that money and is incentivized to cut things off instead of providing the preventative care to keep the foot on. In fact, amputations do cost a least $30-50k per episode—it is just that the doctor is only reimbursed about $800….But that’s not the real point—and I believe we’ve been sent slightly off course.
There are good data to support that teams put together focusing on prevention save legs, prolong life, and save money. Our Southern Arizona Limb Salvage Alliance (SALSA) service at the University of Arizona, has been held out as a model of care nationally and internationally. Unfortunately, in our current system prevention doesn't yet seem to pay. Hospitals, clinics and doctors are often reimbursed on a fee for service basis-- and this procedure-based system is a difficult one to sustain.
We had publicly lamented that the media had missed a chance to educate in this case-- just as a chance might that the concept of procedure-based vs. prevention based systems is really at the heart of this health care debate. It is remarkable and, we believe, unfortunate that opportunities like this last one may have blown us collectively off course. The exciting thing is that we know from our experiences right here at home that, in this specific area at least, we can right the ship and keep a few more legs on a few more bodies, because that's what we all deserve, whether we have diabetes or not. We think that this portends even greater things for the health care system in general.