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-
1
Roby DH, Watson G, Jacobs K, et al: Modeling the impact of the Affordable Care Act and the individual mandate on Californians. J Fam Econ Issues 34: 16, 2013.
-
2
Stark Casagrande S, Fradkin JE, Saydah SH, et al: The prevalence of meeting A1C, blood pressure, and LDL goals among people with diabetes, 1998-2010. Diabetes Care 36: 2271, 2013.
-
3
Lavery LA, Wunderlich RP, Treadwell JL: Disease management for the diabetic foot: effectiveness of a diabetic foot prevention program to reduce amputations and hospitalizations. Diabetes Res Clin Pract 70: 31, 2005.
-
4
Driver VR, Goodman RA, Fabbi M, et al: The impact of a podiatric lead limb preservation team on disease outcomes and risk prediction in the diabetic lower extremity: a retrospective cohort study. JAPMA 100: 235, 2010.
-
5
Skrepnek GH, Mills JL, Armstrong DG: Foot-in-wallet disease: tripped up by “cost-saving” reductions? Diabetes Care 37: e196, 2014.
-
6
Sloan FA, Feinglos MN, Grossman DS: Receipt of care and reduction of lower extremity amputations in a nationally representative sample of U.S. elderly. Health Serv Res 45: 1740, 2010.
-
7
US Census Bureau: Profile of general population and housing characteristics: 2010. Available at: http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=DEC_10_DP_DPDP1. Accessed August 19, 2013.
-
8
University of California Los Angeles, Center for Health Policy: California Health Interview Survey. Available at: http://healthpolicy.ucla.edu/Pages/home.aspx. Accessed May 20, 2014.
-
9
Stevens CD, Schriger DL, Raffetto B, et al: Geographic clustering of diabetic lower-extremity amputations in low-income regions of California. Health Aff (Millwood) 33: 1383, 2014.
-
10
Lucia L, Jacobs K, Dietz M, et al: After Millions of Californians Gain Health Coverage Under the Affordable Care Act, Who Will Remain Uninsured? UCLA Center for Health Policy Research and UC Berkeley Labor Center , Los Angeles and Berkeley, CA, September 2012.
-
11
UC Berkeley Center for Labor Research and Education and UCLA Center for Health Policy Research: California Simulation of Insurance Markets (CalSIM) version 1.8: methodology & assumptions. Available at: http://healthpolicy.ucla.edu/publications/Documents/PDF/calsim_methods.pdf. Published March 1, 2013. Accessed May 5, 2014.
-
12
Mirmiran R, Page JC, Armstrong JR, et al: Barriers to podiatric care among diabetic patients in the San Francisco Bay area. J Foot Ankle Surg 39: 301, 2000.
-
13
Driver VR, Fabbi M, Lavery LA, et al: The costs of the diabetic foot: the economic case for the limb salvage team. J Vasc Surg 52: 17S, 2010.
-
14
American Diabetes Association: Economic costs of diabetes mellitus in the U.S. in 2012. Diabetes Care 36: 1033, 2013.
-
15
Center for Disease Control and Prevention: Crude and age-adjusted hospital discharge rates for nontraumatic lower extremity amputation per 1,000 diabetic population, United States, 1988-2009. Available at: http://www.cdc.gov/diabetes/statistics/lea/fig3.htm. Accessed June 3, 2014.
-
16
Carls GS, Gibson TB, Driver VR, et al: The economic value of specialized lower-extremity medical care by podiatric physicians in the treatment of diabetic foot ulcers. JAPMA 101: 93, 2011.
-
17
Driver VR, Madsen J, Goodman RA: Reducing amputation rates in patients with diabetes at a military medical center: the limb preservation service model. Diabetes Care 28: 248, 2005.
-
18
Van Gils CC, Wheeler LA, Mellstrom M, et al: Amputation prevention by vascular surgery and podiatry collaboration in high-risk diabetic and nondiabetic patients: the Operation Desert Foot experience. Diabetes Care 22: 678, 1999.
-
19
Hedetoft C, Rasmussen A, Fabrin J, et al: Four-fold increase in foot ulcers in type 2 diabetic subjects without an increase in major amputations by a multidisciplinary setting. Diabetes Res Clin Pract 83: 353, 2008.
-
20
Torio CM, Andrews RM: National inpatient hospital costs: the most expensive conditions by payer , 2011: HCUP Statistical Brief #160. Agency for Healthcare Research and Quality website . Available at: http://www.hcup-us.ahrq.gov/reports/statbriefs/sb160.pdf. Published August 2013. Accessed May 20, 2014.
-
21
Weiss AJ, Elixhauser A, Steiner C: Readmissions to U.S. hospitals by procedure, 2010: HCUP Statistical Brief #154. Agency for Healthcare Research and Quality website. Available at: http://www.hcup-us.ahrq.gov/reports/statbriefs/sb154.pdf. Published April 2013. Accessed May 20, 2014.
-
22
Elixhauser A, Steiner C: Readmissions to U.S. hospitals by diagnosis, 2010: HCUP Statistical Brief #153. Agency for Healthcare Research and Quality website. Available at: http://www.hcup-us.ahrq.gov/reports/statbriefs/sb153.pdf. Published April 2013. Accessed May 20, 2014.
-
23
Zhuo X, Zhang P, Kahn HS, et al: Change in medical spending attributable to diabetes: national data from 1987 to 2011. Diabetes Care 38: 581, 2015.
Forecasting the Value of Podiatric Medical Care in Newly Insured Diabetic Patients During Implementation of the Affordable Care Act in California
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Background: Because value-based care is critical to the Affordable Care Act success, we forecasted inpatient costs and the potential impact of podiatric medical care on savings in the diabetic population through improved care quality and decreased resource use during implementation of the health reform initiatives in California.
Methods: We forecasted enrollment of diabetic adults into Medicaid and subsidized health benefit exchange programs using the California Simulation of Insurance Markets (CalSIM) base model. Amputations and admissions per 1,000 diabetic patients and inpatient costs were based on the California Office of Statewide Health Planning and Development 2009-2011 inpatient discharge files. We evaluated cost in three categories: uncomplicated admissions, amputations during admissions, and discharges to a skilled nursing facility. Total costs and projected savings were calculated by applying the metrics and cost to the projected enrollment.
Results: Diabetic patients accounted for 6.6% of those newly eligible for Medicaid or health benefit exchange subsidies, with a 60.8% take-up rate. We project costs to be $24.2 million in the diabetic take-up population from 2014 to 2019. Inpatient costs were 94.3% higher when amputations occurred during the admission and 46.7% higher when discharged to a skilled nursing facility. Meanwhile, 61.0% of costs were attributed to uncomplicated admissions. Podiatric medical services saved 4.1% with a 10% reduction in admissions and amputations and an additional 1% for every 10% improvement in access to podiatric medical care.
Conclusions: When implementing the Affordable Care Act, inclusion of podiatric medical services on multidisciplinary teams and in chronic-care models featuring prevention helps shift care to ambulatory settings to realize the greatest cost savings.
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