Response To The President on Surgical Costs of Foot Surgery
ACFAS Responds to President on Surgical Costs
The American College of Foot and Ankle Surgeons (ACFAS) has joined the American College of Surgeons by writing to President Obama about his recent comments on the appropriateness and cost of surgical procedures, particularly the cost of a foot amputation – a procedure ACFAS members know well.
At a town hall meeting on August 11, the President said, “Right now if we paid a family — if a family care physician works with his or her patient to help them lose weight, modify diet, monitors whether they’re taking their medications in a timely fashion, they might get reimbursed a pittance. But if that same diabetic ends up getting their foot amputated, that’s $30,000, $40,000, $50,000 — immediately the surgeon is reimbursed. Well, why not make sure that we’re also reimbursing the care that prevents the amputation, right? That will save us money. (Applause.) So changing reimbursement rates will help.”
In the College’s letter to the President, ACFAS President Mary E. Crawford, DPM, FACFAS said, “We agree with you that preventive and conservative care is always preferred to surgery, not only for the patient’s well-being, but to save medical costs. Unfortunately your comments painted an inaccurate picture to consumers that the surgeon is being paid up to $50,000, when, in fact, Medicare pays between $740 and $1,140 for a leg amputation, and foot amputations can often pay even less via Medicare.
“As you know, the vast majority of medical costs are not for the physician or surgeon, but for hospitals, supplies, and follow-up care. Since insurance companies pay close to Medicare’s reimbursement rates, the federal government is already the de facto single-determiner in what physicians and surgeons are paid – and the rates you believe should be changed have, in fact, already been cut or fallen far behind inflation every year for the past decade.”
APMA Corrects Obama’s Misstatement on Foot Amputation Costs
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 healthcare reform last week, President 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 that the actual physician reimbursement for the amputation is a small fraction of the projected $12 billion price tag paid by the nation’s healthcare 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.