April 2014

Extended analysis confirms ironic effect of diabetic foot cost cutting

In the moment: Diabetes

By Jordana Bieze foster

An Arizona state Medicaid policy change designed to cut costs by eliminating podiatry services for diabetic foot infection had the opposite effect, according to a March presentation that included an extended analysis of previously reported data.

The new policy was announced in October 2009. Through the end of 2011, inpatient admissions had increased 35%, inpatient charges had increased 40%, hospital days per month had increased 24%, and severe aggregate outcomes (including amputation) had increased 47% compared with the 3.75-year period preceding the announcement.

For every dollar “saved,” $48 more was actually spent, according to study coauthor Grant H. Skrepnek, PhD, a health economist and an associate professor in the College of Pharmacy at the University of Oklahoma in Oklahoma City, who presented the results at the Diabetic Foot Global Conference in Los Angeles.

The findings are consistent with data from the same research group presented at the 2013 meeting of the American Diabetes Association, which included analysis through December 2010.


Skrepnek GH, Mills JL, Armstrong DG. Foot-in-wallet disease: Tripped up by ‘cost saving’ reduction. Presented at 73rd Scientific Sessions of the American Diabetes Association, Chicago, June 2013.

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