Death Panels for Diabetic Feet? Why we have been blown off course

“Surgeons Rebuke Obama’s $50k Per Amputation Claim, Media Mum”

This topic has been simmering for the last week or so and is still rather fresh, but I think it has been completely taken in the wrong direction by our colleagues at the AMA/American College of Surgeons and American Academy of Orthopaedic Surgeons– all who have rather inexplicably harshly countered it (rather than taking the time to educate). In fact, amputations do cost at least $30-50k per episode– it is just that the doctor is only reimbursed about $800. There are good data to support that teams put together focusing on prevention save legs, prolong life, and save money– but prevention doesn’t yet seem to pay. Perhaps this is something that might be explored by the media in a more thoughtful manner? The concept of procedure-based vs. prevention based systems is really at the heart of this healthcare debate. It is remarkable and, we believe, unfortunate that opportunities like this last one may have (very much like the “death panels” issue) blown us collectively off course.

One thought on “Death Panels for Diabetic Feet? Why we have been blown off course

  1. David, I appreciate your comments and I hope that the press release from APMA is consistent with your idea to educate. We are looking at other options to help educate the public.

    Ronald D. Jensen,DPM
    President, APMA


    Price of Diabetes Prevention Far Less Expensive than Billions Spent in Complication Treatment

    Bethesda, MD – The cost of doctors performing lower-limb amputations for people with diabetes has been misconstrued during recent health care reform discussions, according to the American Podiatric Medical Association (APMA), the nation's leading professional organization of doctors of podiatric medicine (DPMs), also known as podiatrists.

    According to a study published in 2007 in the Journal of the American Podiatric Medical Association (JAPMA), the overall estimated cost of a lower-leg amputation can range from $30,000 to $40,000, which includes fees for hospital stays, medical specialists, post operative care and physician reimbursement. While making a case for health care reform last week, President Barack Obama inaccurately attributed that cost solely to physician reimbursement. The actual physician reimbursement fee for a leg or foot amputation on average is far less, and according to Medicare ranges from nearly $750 to close to $1,000. The JAPMA article cites the actual physician reimbursement for the amputation is a small fraction of the projected $12 billion price tag paid by the nation’s health care system to cover overall costs of treating lower-leg amputations annually.

    “When a patient’s foot or leg has to be amputated, it usually means all other treatment options have been exhausted,” said APMA President Ronald D. Jensen, DPM. “Nothing is more devastating than performing an amputation, knowing that perhaps it could have been prevented.”

    Studies have shown that as many as 85 percent of non-traumatic, diabetic leg and foot amputations could have been prevented with early detection and treatment. Podiatrists are an integral part of a diabetes management team, and regular preventive foot and ankle care by podiatrists for people with and at risk for the disease translates into fewer amputations.

    APMA has been an active partner in the health reform process, seeking to safeguard the critical role of podiatrists in the prevention of such complications as foot amputations. It is important that beneficiaries of any health plan – including Medicaid and any new health plan – have access to the medical care provided by its members who so effectively keep Americans walking.

    For more information about diabetic amputation prevention or to find a podiatrist in your area, visit

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