Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Diabetes and leg amputations in McAllen, Texas

Merrill Goozner
Conditions
November 23, 2010
Share
Tweet
Share

The Dartmouth Atlas of Health is once again throwing a harsh spotlight on McAllen, Texas.

This time the Mexican border town has the highest rate of leg amputations in the nation, a new report released recently showed. McAllen’s rate was ten times the rate of Provo, Utah, which had the lowest rate of leg amputations among the Medicare eligible population. The national average was one-third of McAllen’s rate.

McAllen became notorious earlier this year because of a New Yorker article by Dr. Atul Gawande, which showed how overutilization of services in that city gave it the highest rate of Medicare spending in the country. Though a subsequent Medicare Payments Advisory Commission report concluded that adjusting for prices and other factors would rank McAllen’s Medicare spending rate as comparable to any number of southern and southwestern cities with inordinately high rates, the town’s reputation never recovered.

So I was curious about the latest uproar over amputation rates, which was reported by Kaiser Health News and given wider coverage on National Public Radio’s blog. Were McAllen doctors really whacking away at the limbs of elderly Medicare beneficiaries at an unnecessarily high rate? The implications were just too horrible to contemplate.

It turns out that the data in that one section of the report had not been adjusted for underlying disease patterns. The primary cause of leg amputations among elderly Medicare beneficiaries is poorly controlled diabetes and associated peripheral vascular disease. These conditions are disproportionately high in heavily Hispanic communities like McAllen.

It’s curious that the Dartmouth Atlas investigators didn’t adjust for diabetes. In the other sections of the report, which was written to show that access to primary care physicians did not necessarily lead to patients receiving better preventive care, they made those adjustments.

They looked at the the number of diabetic patients receiving annual blood sugar tests. They looked at the number of diabetic patients receiving annual eye exams. Both are key tests for primary care physicians if they want to keep track of their diabetic patients’ adherence to the medications that can control diabetes and peripheral vascular disease.

“The idea that primary care is going to solve our quality problems is just simply wrong,” said journalist Shannon Brownlee, who co-wrote the report. “The environment — poverty, smoking, exercise, diet — are the biggest determinants. Giving a hemoglobin A1C test once a year made no difference. Neither does having an eye exam.”

But when the researchers looked at amputations, the outcome of poor control, they didn’t looking at the rates among diabetic Medicare beneficiaies, they looked at the rate among all Medicare beneficiaries.

Now, it is true that McAllen was the outlier on the overall rate of amputations. And it is also true that the rate of primary care visits in McAllen was in the upper half of communities in the U.S. (Remember, the report’s larger theme was that primary care didn’t necessarily lead to good preventive care.) But until one knows the amputation rate among diabetic Medicare beneficiaries in McAllen and its relationship to primary care visits, it’s hard to draw conclusions about what it says about McAllen.

Merrill Goozner is senior correspondent for The Fiscal Times and blogs on health care and other issues at GoozNews.com.

Submit a guest post and be heard.

Prev

ACP: Health care innovation in the Affordable Care Act

November 23, 2010 Kevin 7
…
Next

There is no routine procedure in general surgery

November 23, 2010 Kevin 8
…

ADVERTISEMENT

Tagged as: Diabetes, Medicare, Public Health & Policy

Post navigation

< Previous Post
ACP: Health care innovation in the Affordable Care Act
Next Post >
There is no routine procedure in general surgery

ADVERTISEMENT

More by Merrill Goozner

  • a desk with keyboard and ipad with the kevinmd logo

    Curbing Medicare costs: Are seniors or the government responsible?

    Merrill Goozner
  • a desk with keyboard and ipad with the kevinmd logo

    Will health reform survive the Supreme Court?

    Merrill Goozner
  • a desk with keyboard and ipad with the kevinmd logo

    A look behind the growing cost of cancer drugs

    Merrill Goozner

More in Conditions

  • How nature is inspiring the future of pain medicine

    Varun Mangal
  • Psychiatrist tests ketogenic diet for mental health benefits

    Zane Kaleem, MD
  • The myth of biohacking your way past death

    Larry Kaskel, MD
  • Why Hollywood’s allergy jokes are dangerous

    Lianne Mandelbaum, PT
  • Coconut oil’s role in Alzheimer’s and depression

    Marc Arginteanu, MD
  • Ancient health secrets for modern life

    Larry Kaskel, MD
  • Most Popular

  • Past Week

    • Why doctors must fight for a just health care system

      Alankrita Olson, MD, MPH & Ashley Duhon, MD & Toby Terwilliger, MD | Policy
    • The human case for preserving the nipple after mastectomy

      Thomas Amburn, MD | Conditions
    • Nuclear verdicts and rising costs: How inflation is reshaping medical malpractice claims

      Robert E. White, Jr. & The Doctors Company | Policy
    • IMGs are the future of U.S. primary care

      Adam Brandon Bondoc, MD | Physician
    • Why I left the clinic to lead health care from the inside

      Vandana Maurya, MHA | Conditions
    • How physician burnout and system reform are shaping the future of U.S. health care

      Irim Salik, MD | Policy
  • Past 6 Months

    • Health equity in Inland Southern California requires urgent action

      Vishruth Nagam | Policy
    • How restrictive opioid policies worsen the crisis

      Kayvan Haddadan, MD | Physician
    • Why primary care needs better dermatology training

      Alex Siauw | Conditions
    • Why pain doctors face unfair scrutiny and harsh penalties in California

      Kayvan Haddadan, MD | Physician
    • How a doctor defied a hurricane to save a life

      Dharam Persaud-Sharma, MD, PhD | Physician
    • What street medicine taught me about healing

      Alina Kang | Education
  • Recent Posts

    • How physician burnout and system reform are shaping the future of U.S. health care

      Irim Salik, MD | Policy
    • How nature is inspiring the future of pain medicine

      Varun Mangal | Conditions
    • Why doctors must fight for a just health care system

      Alankrita Olson, MD, MPH & Ashley Duhon, MD & Toby Terwilliger, MD | Policy
    • Affordable postpartum hemorrhage solutions every OB/GYN can use worldwide [PODCAST]

      The Podcast by KevinMD | Podcast
    • When cancer costs too much: Why financial toxicity deserves a place in clinical conversations

      Yousuf Zafar, MD | Physician
    • Psychiatrist tests ketogenic diet for mental health benefits

      Zane Kaleem, MD | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 6 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why doctors must fight for a just health care system

      Alankrita Olson, MD, MPH & Ashley Duhon, MD & Toby Terwilliger, MD | Policy
    • The human case for preserving the nipple after mastectomy

      Thomas Amburn, MD | Conditions
    • Nuclear verdicts and rising costs: How inflation is reshaping medical malpractice claims

      Robert E. White, Jr. & The Doctors Company | Policy
    • IMGs are the future of U.S. primary care

      Adam Brandon Bondoc, MD | Physician
    • Why I left the clinic to lead health care from the inside

      Vandana Maurya, MHA | Conditions
    • How physician burnout and system reform are shaping the future of U.S. health care

      Irim Salik, MD | Policy
  • Past 6 Months

    • Health equity in Inland Southern California requires urgent action

      Vishruth Nagam | Policy
    • How restrictive opioid policies worsen the crisis

      Kayvan Haddadan, MD | Physician
    • Why primary care needs better dermatology training

      Alex Siauw | Conditions
    • Why pain doctors face unfair scrutiny and harsh penalties in California

      Kayvan Haddadan, MD | Physician
    • How a doctor defied a hurricane to save a life

      Dharam Persaud-Sharma, MD, PhD | Physician
    • What street medicine taught me about healing

      Alina Kang | Education
  • Recent Posts

    • How physician burnout and system reform are shaping the future of U.S. health care

      Irim Salik, MD | Policy
    • How nature is inspiring the future of pain medicine

      Varun Mangal | Conditions
    • Why doctors must fight for a just health care system

      Alankrita Olson, MD, MPH & Ashley Duhon, MD & Toby Terwilliger, MD | Policy
    • Affordable postpartum hemorrhage solutions every OB/GYN can use worldwide [PODCAST]

      The Podcast by KevinMD | Podcast
    • When cancer costs too much: Why financial toxicity deserves a place in clinical conversations

      Yousuf Zafar, MD | Physician
    • Psychiatrist tests ketogenic diet for mental health benefits

      Zane Kaleem, MD | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Diabetes and leg amputations in McAllen, Texas
6 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...