Why reimbursement is required for quality diabetic foot ulcer care

As a director and clinical instructor for a regional hospital-based wound clinic, I see patients from a large geographical area, many of whom make the trip to our clinic because their wounds have failed to resolve with care provided in their local area. A notable number of these patients present with plantar diabetic foot ulcers (DFUs), and based on my discussions with many of them, it is clear to me that the DFU care they receive varies widely.

There have been a number of studies and articles describing shortcomings in DFU care. A recent article in ProPublica asserted that African American patients with DFUs in southern states experience abnormally high rates of amputations, and focused on the under-utilisation of radiological studies to determine whether lower extremity limbs can be salvaged prior to amputation.¹ While that shortcoming in care is not directly related to ‘wound care’, it is symptomatic of a larger abdication of DFU care that seems to be an ongoing problem in the US healthcare system. A November 2018 article in Diabetes Care asserted that the rate of major lower extremity amputations in the US increased by 29% between 2009–2015, following a 43% decline from 2000–2009.²