Page 8 - Amputation Prevention Centers - A White Paper
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Specialty Service Contracting                                                                                             Clinical Outcomes






               n Amputation Prevention Center  service line                                                                              esearchers from around the world have             According to the Centers for Medicare and
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          Alends itself to the possibility of specialty-care                                                                        Rfound that diabetic foot teams, such as               Medicaid Services (CMS), the goal of coordinated
          contracts with payers. The highly specialized                                                                             those located in hospital-based limb salvage           care is “to ensure that patients, especially the
          approach to limb salvage is similar to a center of                                                                        centers that are structured to treat patients          chronically ill, get the right care at the right time,
          excellence for cardiac surgery or orthopedic                                                                              with limb-threatening conditions urgently and          while avoiding unnecessary duplication of services
          surgery. Just as these other service lines have                                                                           aggressively, see significant decreases in major       and preventing medical errors, thus improving
          gained acceptance by payers as highly specialized                                                                         amputation rates.                                      outcomes and reducing costs.” An Amputation
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          and coordinated delivery models, an Amputation                                                                                                                                   Prevention Center  delivers such coordinated
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                            ®
          Prevention Center  is proving to be a delivery                                                                            One author reporting from a U.S.-based hospital        care for patients with chronic foot ulcers, as a
          model where payers can proactively refer patients                                                                         found that an organized effort with written            result of diabetes or other disease, that puts
          with positive outcomes.                                                                                                   pathways and policies reduced amputations by 72        the patient at risk for a major amputation. Since
                                                                                                                                    percent over two years.  Limb-sparing procedures
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          Managed care payers have said that an Amputa-             “                                                               such as toe or transmetatarsal amputation rates        most patients with lower extremity wounds have
                                                                                                                                                                                           peripheral vascular disease and other co-mor-
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          tion Prevention Center  can help decrease                     “Up to 80% of                                               rose during the reporting period. The ratio of         bidities (such as coronary artery disease), it is
          the number of non-traumatic lower extremity                                                                               major limb loss to limb-sparing amputation can be      essential to coordinate care with other specialists.
          amputations, which reduces the overall cost of                  lower extremity                                           used as a marker of effectiveness in an Amputa-
          treating patients who would otherwise undergo                   amputations                                               tion Prevention Center . This is referred to as the
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          amputations. The comprehensive, collaborative                   are preventable.”                                         “hi-lo amputation ratio” — the number of “major”
          team approach also helps reduce length of stay                                                                            amputations (below or above-the-knee) vs. the
          and unnecessary hospitalizations and readmis-                   — The World Health Organization                           number of “minor” amputations (toe or mid-                                 72%
          sions. The benefits to payers are seen in increased               and International Diabetes Federation                   foot). This ratio decreased eight-fold over the
          savings, decreased lower extremity amputations                                                                            study period.                                                           REDUCED
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          and consistently high patient satisfaction.                                                                                                                                                  AMPUTATIONS
                                                                                                                                    A retrospective analysis of data of all diabetic
                                                                                                                                    patients with critical limb ischemia (CLI) present-
                                                                                                                                    ing to a one-stop multidisciplinary clinic over 2.5
                                                                                                                                    years also showed an impact. In 312 patients, only
                                                                                                                                    4.1 percent required major amputations.
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                                                                                                                                    Understanding the pathophysiology, promptly                                  APCs
                                                                                                                                    identifying risk factors and using a multidisci-                    ENSURE THAT
                                                                                                                                    plinary team is necessary to achieve optimal
                                                                                                                                    outcomes. Prompt recognition, classification and                PATIENTS GET THE
                                                                                                                                    treatment of diabetic foot infection is mandatory              RIGHT CARE AT THE
                                                                                                                                    to achieve a goal of limb salvage and preserve as
                                                                                                                                    much function as possible. 5                                           RIGHT TIME














     7 | Promoting Service Line Success by creating an Amputation Prevention Center ®                                                                                                                   Improving Patient Health, Reducing Costs and Increasing Margins   | 8
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