Toes. Feet. Legs. Diabetics in Chicago's impoverished neighborhoods are hospitalized for amputation at five times the rate of chronic disease sufferers in more affluent areas.
In fact, University of Chicago Medicine amputates an estimated four limbs a week—nearly 200 procedures last year alone. It's a stubborn and steady trend the Hyde Park-based academic medical center aims to quell with a proposed limb salvage center that was greenlighted in February.
The center, which does not yet have an official launch date, is estimated to cost more than $2 million and employ about a dozen specialists, from vascular surgeons to podiatrists and endocrinologists. The estimated cost, to be spread out over five years, would include hiring four additional employees, including a program coordinator. The bulk of the team already works at U of C Medicine.
“We try to work closely with clinicians in the communities,” says Dr. Christopher Skelly, chief of the section of vascular surgery and endovascular therapy at U of C Medicine. “But at the end of the day, we tend to see a lot of patients who walk into the ER and it's too late.”
In the era of federal health care reform, where prevention is heralded as key to reining in costs and improving patient health, U of C Medicine's center highlights an effort to fix an expensive gap in care, experts say. The estimated sticker price for an amputation-related hospital stay at U of C Medicine can reach $80,000. That doesn't include months of potential rehab or an artificial limb.
The center's goal: to reduce the number of amputations by half through preventive care. And if U of C Medicine figures out how, the three-hospital system could save millions of dollars. Based on a rough estimate of 200 amputations performed in 2014, such a drastic reduction would have saved $8 million.
It might not sound like much for a health system with $1.45 billion in 2014 operating revenue. But every little bit counts for hospitals these days as insurers look to decrease costs, experts say.
“That goal won't be met immediately,” says Dr. Trissa Babrowski, a vascular surgeon spearheading the reduction campaign with Skelly and podiatrist Dr. Ann Zmuda. “A lot of this is long-term preventative strategy.”
A UNIQUE PROPOSITION
Coordinating care is a catch phrase these days as hospitals and health systems, in an effort to cut costs and reap rewards from insurers, scramble to prevent pricy hospital stays and unnecessary testing. Those that don't “are going to be left behind” when it comes to insurers deciding which doctors and hospitals to keep in-network, says Dr. Edward Winslow, an associate vice president at Skokie-based Sg2, a health care consultancy and analytics firm.
Saving limbs is a time-consuming task that involves several specialists, and across the country, only a few organized programs or centers exist. Many hospitals have doctors who play a part in wound care or improving poor blood circulation, which often leads to amputations. But they don't typically function as teams.
The care is “absolutely” fragmented, says Dr. Sean Roddy, a vascular surgeon in Albany, N.Y., who is chief of a committee for the Chicago-based Society for Vascular Surgery. His group is drafting a potentially new payment model for Medicare, the federal health insurance program for the elderly. The idea is that Medicare would financially reward medical teams that work together to prevent amputations.
TAKING A TEAM APPROACH
A limb salvage center at U of C Medicine had been on the mind of Skelly, the chief vascular surgeon, for years but gained momentum courtesy of a health care analytics lab at the university's Booth School of Business. In search of ways to make his department more financially efficient, Skelly asked the lab to examine various programs. They homed in on limb salvage.
Advocate Trinity Hospital, about 6 miles southeast of Hyde Park, also treats a large portion of residents with poor circulation due to diabetes, smoking or obesity. The hospital, which is part of Advocate Health Care, the largest hospital network in the state, saw a “significant” decrease in amputations after launching a limb salvage program four years ago, says Dr. Jaafer Golzar, an interventional cardiologist and one of the program's leaders.
The team typically is activated when a patient shows up in the emergency room and shows signs of potentially losing a limb, such as a dark and dry foot (dead tissue).
“You have to have these dedicated groups of physicians, everybody working together to help and save these limbs,” Golzar says. “We know it's a problem.”
For amputees, the survival rates are grim, Golzar says. Patients have up to a 20 percent chance of dying in the hospital after an above-the-knee amputation.