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As we approach the November Podiatry Management issue dedicated to diabetes mellitus, the issue of not addressing preventative care for this patient segment comes to mind. Great strides have been made in wound care with cellular tissue products, bone grafting materials, non-invasive circulatory testing, microbiologic testing, etc. Yet the single largest segment of diabetic patients has largely not been addressed. That is the segment of patients without patient-recognized symptoms, those who require screening for diabetic foot complications.
Our colleague Paul Han, DPM, published a recent Health Affairs Scholar article called, “Underinvesting in prevention: the costly blind spot in US Diabetes Care”. (https://doi.org/10.1093/haschl/qxag190) Dr. Han will also have an article in the November PM issue on this same subject. In a personal communication with Dr. Han, he stated that 30 percent of the California Medicaid budget is spent on diabetic in-patient foot complications, yet only 1 percent total payment is spent on diabetic eye complications. This because there is an insufficient infrastructure for screening diabetic foot pathology and a robust structure for screening diabetic ophthalmological complications before requiring expense treatments, surgery, and/or hospitalization.
After reading this article, every podiatrist should be armed with sufficient facts to have an intelligent conversation with their federal and state representatives. We should be demanding responsible reimbursement by all insurance carriers for screening exams, equivalent to what ophthalmology is paid for retinopathy screenings. Podiatrists should be demanding these screenings be performed based on International Work Group on Diabetic Foot (IWGDF) guidelines and not the antiquated and insufficient Loss of Protective Sensation (LOPS) policy.
LOPS exams exclude many patients who may not qualify (non-neuropathic patients or those who have seen any health care provider for any foot issue within six months). The LOPS exam also has an insufficient reimbursement formula for any physician regardless of their degree to perform.
Reading Dr. Han’s two articles is a must for all DPMs.
—Paul Kesselman, DPM