SLR - March 2022 - Joseph R. Brown
Reference: Patel N, Tan TW, Weinkauf C, Rice AH, Rottman AM, Pappalardo J, Goshima K, Zhou W. Economic Value of Podiatry Service in Limb Salvage Alliance. J Vasc Surg. 2022 Jan;75(1):296-300.Level of Evidence: Level IV Retrospective Observational study
Scientific Literature Review
Reviewed By: Joseph R. Brown, DPM
Residency Program: Grant Medical Center – Columbus, OH
Podiatric Relevance: A multidisciplinary team approach is critical to the success of limb salvage efforts. Podiatrists and vascular surgeons often work closely together in the treatment of patients with diabetic foot ulcers (DFU) with concomitant peripheral artery disease (PAD). This team approach is common knowledge from a clinical perspective; however it is less-understood the monetary and practice volume gains that can be made with the addition of foot and ankle surgeons within a vascular surgery practice.
Methods: This was a retrospective review of an administrative database over a five-year period. The total clinical and surgical volume was evaluated within an integrated practice of vascular surgeons and podiatrists. Specifically, the total number of yearly operating room (OR) cases, clinical encounters, in-patient volume, and total work relative value units (wRVUs) were evaluated. The yearly data was compared as the number of podiatrists within the practice increased from one to four, while the total number of vascular surgeons remained relatively constant.
Results: There was a total of over 35,000 patient encounters and 5,000 operative procedures performed over a five-year period. The limb salvage program experienced a >100 percent increase in clinic visits, operative cases, and total wRVUs within that time period. When the total number of podiatrists and vascular surgeons were equal, foot and ankle surgeons contributed to 40% of the total OR cases and in-patient encounters, and 70% of clinical encounters.
Conclusions: Treatment of DFUs in combination with PAD is complex and requires a team approach to provide the appropriate care. Podiatrists play a central role in the care of patients with DFUs in an effort to prevent major amputations. The value of foot and ankle surgeons within a “toe and flow” model, where podiatrists work in a vascular surgery division, extends beyond providing optimal care to patients. Podiatrists can also contribute a significant increase in the total patient volume, as well as a substantial financial benefit, to the limb salvage team. Not only does the total number of clinical patient encounters and OR cases increase with this model, but the number of vascular specific procedures increases as well due to the fact that podiatrists contribute to an increase in screening of patients for PAD. Understanding the true value of foot and ankle surgeons within a limb salvage program is beneficial in marketing and justifying the recruitment of podiatric surgeons within the healthcare system.