Podiatric Research and Value-Based Care: Examining Next Steps

The evolution of health care continues towards value-based care, like a runaway train with policymakers and payors acting as the train engineers. Providers can either purchase an upgraded ticket at a discount or ignore the oncoming locomotive and get barreled over by it. The podiatric profession has taken some essential steps to prepare for the change, but work is still required. The profession must act quickly; otherwise, we will be left at the station platform, desperately running down the track to catch the train.

The American Podiatric Medical Association (APMA), with guidance from the House of Delegates and led by the Board of Trustees and APMA staff, made an enormous investment in the profession's future by creating a data registry (https://www.apma.org/PracticingDPMs/content.cfm?ItemNumber=24999).  The potential data from a qualified registry, such as APMA's registry, is invaluable. The registry is ramping up under the guidance of APMA CEO James Christina, DPM, and APMA Senior Medical Director and Director of Clinical Affairs Dyane Tower, DPM, MPH, MS. The registry is like an Indy race car revving its engine at the start line, waiting to floor it towards turn one of the Indianapolis Motor Speedway.

APMA recently created a research working group, for which I will serve as Co-Chair with Rachel Albright, DPM, MPH. Both Dr. Albright and Dr. Tower are former APMA/The Dartmouth Institute Public Health Fellows and are experienced researchers. The working group consists of leaders in podiatric research that will guide research projects, serve as a resource to those in the podiatric community doing research, and ultimately demonstrate the profession's value in the health care system via evidenced-based studies. The diabetic foot specialty has led the way in numerous research projects that prove the value of podiatric physicians in preventing and treating the diabetic foot.^1-5 

I recall seeing yet unpublished population health studies from the New York State Podiatric Medical Association (NYSPMA) on diabetes, fall prevention, opioid use, and obesity, which demonstrate podiatry's role in preventative care, improved therapeutic care outcomes, and reduced economic burden on the healthcare system. This research and approach are precisely the type of research that positions the podiatric profession for the evolving landscape.

The podiatric profession's role in the house of medicine is undeniable. However, the next step is research demonstrating outcomes, cost savings, complications, patient-reported outcome measures, and patient-reported experiences measures on numerous pathologies, surgical procedures, and conservative therapies. Retrospective data claims mining and registry data analysis typically provide the swiftest methodology for peer-reviewed publication. Concurrent, prospective research is a longer process to peer-reviewed publication but allows a study design to examine specific topics. The stacking of research demonstrating the crucial role of podiatry to policymakers and payors must be the priority.

Countering shoddy anti-podiatric research reeking of bias must not be the goal of profession-based research. The research need not be comparative, simply factual. I believe the facts will speak for themselves. The facts will captivate policymakers and payors alike as value-based care contracts and controlled patient moves forward. Research published in the Journal of the Podiatric Medical Association and the Journal of Foot and Ankle Surgery will strengthen these journals' impact factor ratings, further validating the research. Both journals' impact factor ratings are trending upwards but still lag significantly compared to similar orthopedic journals.

"You discover yourself through the research of your work."     -       Carine Roitfeld

"The reward for work well done is the opportunity to do more."     -       Jonas Salk

Dr. DeHeer is the Residency Director of the St. Vincent Hospital Podiatry Program in Indianapolis. He is a Fellow of the American College of Foot and Ankle Surgeons, a Fellow of the American Society of Podiatric Surgeons, a Fellow of the American College of Foot and Ankle Pediatrics, a Fellow of the Royal College of Physicians and Surgeons of Glasgow, and a Diplomate of the American Board of Podiatric Surgery. Dr. DeHeer is a Partner with Upperline Health and the Medical Director of Upperline Health Indiana.

References

1.     Chandra V, Glebova NO, Salvo NL, Wu T. Partnerships between podiatrists and vascular surgeons in building effective wound care centers. J Vasc Surg. 2017;66(3) 902-905.

2.     Sloan FA, Feinglos MN, Grossman DS. Receipt of care and reduction of lower extremity amputations in a nationally representative sample of US elderly. Health services research 2010;45(6p1):1740-1762.

3.     Skrepnek GH, Mills JL, Armstrong DG. Foot-in-wallet disease: tripped up by "cost-saving" reductions?. Diabetes Care 2014;37(9):e196-e197.

4.     Labovitz J, Kominski GF, Godwin J. Podiatric Services Could Reduce Costs of Treating Diabetes Complications in California by up to $97 Million. (2017). Available at: http://healthpolicy.ucla.edu/publications/Documents/PDF/2017/podiatricservices-brief-jun2017.pdf . Accessed April 12, 2022.

5.     Carls GS, Gibson TB, Driver VR, et al. The economic value of specialized lower-extremity medical care by podiatric physicians in the treatment of diabetic foot ulcers. J Am Podiatr Med Assoc. 2011;101(2):93.

6.     Corbacho B, Cockayne S, Fairhurst C, et al. Cost-effectiveness of a multifaceted podiatry intervention for the prevention of falls in older people: the reducing falls with orthoses and a multifaceted podiatry intervention trial findings. Gerontology. 2018;64:503-512.