Opinion

Reduce American Amputations by Enacting Comprehensive Solutions to PAD

In the 21st-century world, we have technologies that allow us to treat and cure life-threatening disease, yet we have not stopped the scourge of non-traumatic amputations that impact tens of thousands of Americans every year. Non-traumatic amputations are often unnecessarily the result of peripheral artery disease, a limb-threatening circulatory condition that data show affected nearly 20 million Americans in 2015 and is projected to increase to 25 million by 2030.

As we recognize PAD Awareness Month this September, lawmakers and leaders in the vascular care community are coming together to advance solutions to prevent non-traumatic, PAD-related amputations. PAD is a public health crisis that not only results in tens of thousands of preventable amputations but also costs taxpayers billions of dollars in additional, unnecessary spending. With 43,000 Medicare beneficiaries impacted by PAD and the average lifetime care costs for a patient with limb loss approaching $500,000, PAD is a disease with significant scope, cost and negative consequences for the health of Americans.

PAD is caused when the arteries carrying blood from the heart to the limbs become blocked due to plaque buildup, leading to cramping and pain or, if left untreated, lower-limb amputation. Typical high-risk groups for PAD are individuals who smoke, are over the age of 65, or have a history of high blood pressure, diabetes or high cholesterol. Racial, ethnic and geographic disparities compound the serious problem of PAD in the United States, as many PAD risk factors are more common in African, Native and Hispanic Americans, making them two to four times more likely to develop PAD and, over time, undergo an amputation.

As a vascular surgeon, interventional cardiologists and a cardiovascular clinical nurse specialist, we are well-acquainted with the dangers of PAD and the toll non-traumatic amputations have on American families every day. Sadly, not all medical professionals are. All providers — including physicians and advanced practice nurses — need to understand PAD to ensure a multidisciplinary approach to care for patients.

Further complicating PAD is a lack of awareness about the disease that causes some at-risk patients to never seek medical help or screening; an amputate-first environment that precludes patients from exploring other treatment options; and a health care system that lacks communication across disciplines.

Lawmakers in Congress have recently acknowledged the significant problem that PAD poses for American patients and the American health care system. Reps. Erik Paulsen (R-Minn.) and Donald Payne (D-NJ) recently sponsored a letter urging the Department of Health and Human Services and the Veterans Health Administration to adopt a national strategy to reduce non-traumatic amputations.

Bipartisan lawmakers recognize we need a comprehensive strategy to get the right treatment to the right people at the right time to stop this epidemic. By integrating public awareness and robust screening with non-amputation treatment measures and multidisciplinary care, we can speed up the “sprint to zero” initiative that seeks to eliminate senseless amputations in the United States.

The administration has the capacity to develop a standard and comprehensive model for caring for patients with PAD. An intragovernmental workgroup should be convened to develop a standardized model for amputation reduction and to raise awareness around PAD. The model should include an enhanced screening protocol for at-risk patients, vascular evaluations and risk assessments conducted by a multidisciplinary team. Last, it should require vascular evaluation before an amputation can be performed.

Further, the administration should act to reverse recently proposed reimbursement cuts to payment codes for several revascularization procedures, which are used to treat PAD and prevent the occurrence of lower-limb amputations. The 2019 Physician Fee Schedule Proposed Rule cuts reimbursement for revascularization by up to 30 percent or more, which could impact the delivery of care for PAD patients in the community setting. We hope Congress will help us to ensure these cuts are not included in the final payment rule for 2019.

A PAD diagnosis should not cost patients a limb, particularly when the technologies exist to identify these patients and treat them before an amputation is ever necessary. This PAD Awareness Month, we urge policymakers, providers and patients to work together to devise a comprehensive strategy based on a better understanding of PAD and adopt policies that are proven to prevent limb loss, reduce health care spending and save lives.

 

Dr. Ehrin Armstrong is an interventional cardiologist with the Society for Cardiovascular Angiography and Interventions. Dr. Lola Coke is a cardiovascular clinical nurse specialist with the Preventive Cardiovascular Nurses Association. Dr. Foluso Fakorede is an interventional cardiologist with the Association of Black Cardiologists. Dr. Bryan Fisher is a vascular surgeon with the CardioVascular Coalition. Their groups are members of the PAD Task Force.

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