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Obama Missteps on Foot Amputation Pay to Surgeons

Cheryl Clark, for HealthLeaders Media, August 14, 2009

At least three large physicians' groups, and many physician bloggers yesterday blasted President Obama for saying that a surgeon makes $30,000 to $50,000 to amputate the foot of a diabetic, while receiving a pittance to prevent the diabetes that necessitated the procedure in the first place.

That is wrong, said members of the American Academy of Orthopaedic Surgeons, the American College of Surgeons, and the California Medical Association. Numerous bloggers and pundits promptly pounced on his statements, some calling him "idiot-in-chief."

"The CMA wholeheartedly agrees with the President on the importance of prevention, but the examples he used were inaccurate and offensive and could undermine the trust central to the physician-patient relationship," said the California group, which represents about one-fourth of the state's 125,000 licensed doctors.

"President Obama got his facts completely wrong," according to a statement from the ACS, whose 74,000 members make it the largest organization of surgeons in the world.

"In fact, Medicare pays a surgeon between $740 and $1,140 for a leg amputation," sais ACS, which is care that includes evaluation of the patient the day of the operation and follow-up care that is provided for 90 days after the operation.

Private insurers pay a variation of the same amount, said the group, adding that it is "deeply disturbed" over the President's "uninformed public comments."

In fact, the cost of a foot amputation includes payment to the hospital for several days' stay, to an anesthesiologist and rehabilitation specialists, and for wound care after the surgery is over. But the surgeon doesn't charge those amounts. A 2007 article in the Journal of the American Podiatric Medical Association estimates the cost of a lower extremity amputation at $30,000 to $60,000, with an additional $43,000 to $60,000 for subsequent care for 3 years.

At a Town Hall meeting, in Portsmouth, N.H., on Wednesday, Obama said: "Let's take the example of something like diabetes . . . a disease that's skyrocketing, partly because of obesity, partly because it's not treated as effectively as it could be.

"Right now . . . if a family care physician works with his or her patient to help them lose weight, modify diet, monitors whether they're taking their medications in a timely fashion, they might get reimbursed a pittance. But if that same diabetic ends up getting their foot amputated, that's 30,000, 40, 50,000 dollars immediately the surgeon is reimbursed.

"Well, why not make sure that we're also reimbursing the care that prevents the amputation. Right? That will save us money," said Obama.

Orthopedic physicians said they are "profoundly disappointed" with his comments, which had the effect of "blurring the realities of physician reimbursements."

"Surgeons are neither reimbursed by Medicare, nor any provider for that matter, for foot amputations at rates anywhere close to $50,000, $40,000 or even $30,000. Medicare reimbursements to physicians for foot amputations range from approximately $700 to $1,200."

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