Economic value of podiatry service in limb salvage alliance (2022)

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Journal of Vascular Surgery

Volume 75, Issue 1,

January 2022

, Pages 296-300

(Video) Avoiding Amputation - Temple Limb Salvage Center - Eric T. Choi, MD

Presented at the Thirty-fifth Annual Meeting of the Western Vascular Society, Santa Monica, Calif, September 26-29,2020.

Abstract

Objective/Background

Over the past decade, multidisciplinary “toe and flow” programs have gained great popularity, with proven benefits in limb salvage. Many vascular surgeons have incorporated podiatrists into their practices. The viability of this practice model requires close partnership, hospital support, and financial sustainability. We intend to examine the economic values of podiatrists in a busy safety-net hospital in the Southwest United States.

Methods

An administrative database that captured monthly operating room (OR) cases, clinic encounters, in-patient volume, and total work relative value units (wRVUs) in an established limb salvage program in a tertiary referral center were examined. The practice has a diverse patient population with >30% of minority patients. During a period of 3years, there was a significant change in the number of podiatrists (from 1 to 4) within the program, whereas the clinical full-time employees for vascular surgeons remained relatively stable.

Results

The limb salvage program experienced >100% of growth in total OR volumes, clinic encounters, and total wRVUs over a period of 4years. A total of 35,591 patients were evaluated in a multidisciplinary limb salvage clinic, and 5535 procedures were performed. The initial growth of clinic volume and operative volume (P< .01) were attributed by the addition of vascular surgeons in year one. However, recruitment of podiatrists to the program significantly increased clinic and OR volume by an additional 60% and >40%, respectively (P< .01) in the past 3years. With equal number of surgeons, podiatry contributed 40% of total wRVUs generated by the entire program in 2019. Despite the fact that that most of the foot and ankle procedures that were regularly performed by vascular surgeons were shifted to the podiatrists, vascular surgeons continued to experience an incremental increase in operative volume and >10% of increase in wRVUs.

Conclusions

This study shows that the value of close collaboration between podiatry and vascular in a limb salvage program extends beyond a patient's clinical outcome. A financial advantage of including podiatrists in a vascular surgery practice is clearly demonstrated.

Section snippets

Methods

During a period of 5years, there was a significant fluctuation in the composition of the Southern Arizona Limb Salvage Alliance (SALSA), an established integrated “toe and flow” team. Although there was an incremental increase in the number of vascular surgeons from 2 in 2015 and 2016 to a full complement of 4 in 2018, the clinical full-time employee (cFTE) remained relatively stable. The podiatry cFTE, however, changed from 1 in 2017 to 4 in 2019, and 50% of podiatric surgeons have advanced

Results

A total of 35,591 patient encounters in the SALSA clinic and 5535 operative procedures were performed during the period of 5years. The entire department experienced >100% of growth in clinic visits, operative cases, and total wRVU by 2019 compared with 2015 (P< .01; Table). With the equal number of podiatric and vascular surgeons in 2019, podiatry contributes to 40% of total OR cases andin-patient encounters, as well as 70% of clinic encounters.

The initial significant growth of clinic volume

Discussion

Podiatry plays a central role in DFU prevention and limb preservation.7 Many systematic reviews have shown that multidisciplinary teams have lower major amputation rates10, 11, 12 as well as the clinical benefits of a podiatrist in a diabetic limb salvage team.13, 14, 15, 16 In our SALSA “toe and flow” model, podiatric surgeons are recruited into a vascular surgery division. We have previously showed that this alliance has improved clinical outcomes and decreased lower extremity amputations.17

Conclusions

In conclusion, DFUs and PAD are complex pathologies that require a team approach to achieve optimal outcomes. This study shows that the value of close collaboration between podiatry and vascular in a limb salvage program extends beyond a patient's clinical outcome and that a “toe and flow” model is financially viable for a hospital system. This study contributes to the paucity of literature that helps to justify podiatric recruitment in a health care system.

Author contributions

Conception and design: NP, WZ

Analysis and interpretation: WZ

Data collection: NP, TT, CW, AHR, AR, JP, KG, WZ

(Video) Lower extremity limb salvage 3

Writing the article: NP, WZ

Critical revision of the article: NP, TT, CW, AHR, AR, JP, KG, WZ

Final approval of the article: NP, TT, CW, AHR, AR, JP, KG, WZ

Statistical analysis: WZ

Obtained funding: Not applicable

Overall responsibility: WZ

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    (Video) Limb salvage vs Amputation and Prosthesis in Limb Injures

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© 2021 by the Society for Vascular Surgery. Published by Elsevier Inc.

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