Researchers from the University of Iowa, Iowa City, have analyzed data from the Medicare Part B claims database for the years 2000-2010 to examine the impact of recent advances in orthopedic interventions to diabetic foot ulcers on the use and anatomic level of lower-limb amputations. Their analysis shows that rates of lower-limb amputation in the Medicare population declined over that time period, despite unfavorable demographic changes, and that when lower-limb amputation was performed, it was more likely to occur at distal, limb-conserving locations.
The researchers used the Medicare Part B claims database to compile data on the volume and reimbursement of all codes relating to lower-limb amputation (hip and below) as well as a selection of codes representing orthopedic treatments for diabetic foot ulcers. They then grouped the codes by utilization rates per 100,000 Medicare enrollees and calculated the compound annual growth rates (CAGRs) of payments.
The results of the analysis showed:
- Lower-limb amputation rates declined from 282.5 to 201 per 100,000 enrollees, a 28.8 percent decrease, over the decade.
- In general, declines were greatest for the most proximal levels and smallest for the most distal sites.
- Use of orthopedic treatments for diabetic foot ulcers, including Achilles tendon release and total contact casting; rose from 26 to 63.3 per 100,000 enrollees, a 143.3 percent increase.
Payment trends mirrored utilization data. During this period, total healthcare spending in the United States increased at a CAGR of 6.5 percent, whereas total Medicare payments rose at a CAGR of 8.9 percent.
The researchers said that despite the favorable information they presented, the burdens of diabetes-related complications are still tremendous for patients and society. They concluded that future work is needed to demonstrate best practices in preventing lower-limb amputations and to identify definitively the causes behind recent declines.
The data was reported in the February edition of the journal Foot & Ankle International.
