podiatry service wound care clinic 160527
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PODIATRY SERVICE PROPOSAL INPATIENT / OUTPATIENT SERVICES
WHAT CAN PODIATRY SERVICE OFFER?
A Holistic Approach to the Multidisciplinary Care of the Diabetic Patient. - Joslin Diabetes Center
“There is a person connected to that foot.”
FPMC PATIENT POPULATION
Obesity – Pain – Disability Vicious Cycle
DIABETIC FOOT MORBIDITY & MORTALITY o Diabetes affects 26 million people in the US; and more than 250 million people
worldwide. Diabetesatlas.org / ADA o 6-70% of those with diabetes will develop peripheral neuropathy, and lose
sensation in their feet. Dyck et al. Diabetic Neuropathy 1999. o Up to 25% of those with diabetes will develop a chronic foot ulcer. Singh,
Armstrong, Lipsky, JAMA 2005. o More than half of all foot ulcers will become infected, requiring hospitalization
and 1 in 5 will require an amputation. Lavery, Armstrong, et al. Diabetes Care 2006.
o Diabetes contributes to 80% of the 120,000 non-traumatic amputations performed annually in the US. Armstrong, et al., Amer Fam Physician, 1998.
o After a major amputation , 50 % of patients will have an amputation of the other limb within 2 years. Goldner, Diabetes, 1960., Armstrong, et al., JAPMA 1997.
o The relative 5-year mortality rate after limb amputation is 68%, second only to lung cancer (86%). When compared to colorectal cancer 39%, Breast Cancer 23%, Hodgkins 18%, Prostate 8%. Singh, Armstrong, Lipsky, et al. JAMA 2005.
o Having a wound immediately doubles ones chances of dying at 10 years compared to those without a diabetes. Iversen, et al., Diabetes Care 2000
CLINICAL REFERRAL GUIDELINES
Joslin Diabetes Center : HMS 2012
PODIATRY SCOPE OF SERVICES OFFERED:
o Diabetic Foot Evaluation Consult : per ADA Guidelines
o Minor Soft Tissue Procedures : Ingrown Toenails
o Chronic Wound Care : Ulcer Debridement
o Sports Foot Injuries / Biomechanical Treatment : Refer to Ortho, Phys Med, PT, Orthotics & Bracing
o Diabetic Shoe Referral / Foot Care Education
o Diabetes Center of Excellence
Neuro/ Vasc/ Pain
-Sx consults -Vasc studies
-Neuro:EMG/NCV -Pain Consults
Ortho : Multi-
articular sx Consult Physical Therapy
Vasc Surgery:
Sx & Study Consults
Podiatry screens for referrals: •Foot pain •Vascular studies & intervention •Ortho Consult: Knee, Hip, Back Pain •Referred Pain •Neurologic studies & intervention
Patient Referral Streams
PODIATRY SERVICES REFERRAL STREAM
o Podiatry Consult: o Multidisciplinary Treatment of the Patient
o MRI / Diagnostic Imaging: Indications o Diabetic Foot Ulcer Infection
o Infection Complicated Skin Soft Tissue Infections
o Osteomyelitis : MRI Standard of Care Diagnostic o Sensitivity & Specificity for Diagnosis
o Soft tissue disorder : Torn connective tissue, ex: PTTD
o Non-Invasive Vascular Studies o History of Risk Factors: DM, PAD, Intermittent Claudication
o Lab: All – inclusive – Multiple diagnostics
OUTPATIENT SPIN OFF PATIENT CARE
o Wound Care Clinic : Hyperbaric Oxygen Therapy
o Durable Medical Equipment / Dressings :
o Home Health Services : post-op, physical therapy, wound care.
o ICD-10 Codes
o CPT Codes
o HCPCS Codes
EFFICIENT GROWTH OF FOREST PARK MEDICAL CENTER PATIENT CARE
o Additional services – inpatient & outpatient
o Treat the patient for long-term complication prevention
o “Low-hanging fruit”: Outside advertising costs unnecessary, and hospital revenue generation from existing patient population.
o Good Patient Care!
QUESTIONS?
Stride Podiatry David M. Schwartz, DPM, MBA, RPh
http: //www.stridepodiatrytexas.com
Office: (214)997-FOOT(3668)
Cell: (972)345-5296
E-mail: [email protected]