Page 9 - Amputation Prevention Centers - A White Paper

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