IMPROVED QUALITY OF DIABETIC FOOT CARE, 1984 VS 1990 - REDUCED LENGTHOF STAY AND COSTS, INSUFFICIENT REIMBURSEMENT

Ischemic foot ulceration in the diabetic patient is a source of great physical and emotional strain for the patient and represents a signifi cant financial burden for the health care system responsible for the c ost of such care. Limb salvage remains the primary therapeutic goal; y et, fiscal constraints imposed by diagnosis related group-based reimbu rsement systems require maximal cost efficiency in the care process. B etween 1984 and 1990, the changes in our team management approach to t his problem, emphasizing aggressive surgical revascularization of thre atened limbs, have improved the quality of care and dramatically reduc ed the major and minor amputation rate. In the process, we have reduce d the length of hospital stay and the overall cost of care. Despite th is improvement in outcome and efficiency, Medicare reimbursement remai ns insufficient, with an average loss of $7480 per admission.