August 19, 2021 at 5:00 am ET
Few people realize that America is in the middle of an amputation epidemic. Statistics show that 200,000 Americans have part of their feet or legs surgically removed every year due to complications from peripheral artery disease, a vascular condition that restricts lower-body blood flow for approximately 20 million Americans. In yet another blow to health equity, communities of color are disproportionately impacted, with African Americans, Native Americans, and Hispanics, much more likely than whites to require amputation.
If this weren’t bad enough, roughly 85 percent of amputations are preventable if people with PAD have access to timely vascular care and revascularization services. But despite the life-changing impact of preserving peoples’ limbs, the Centers for Medicare & Medicaid Services has just proposed slashing payments to a variety of specialty providers who treat patients with vascular disease, which will result in dire consequences for patient access. By proposing payment cuts estimated as high as 20 percent to revascularization services in the proposed Physician Fee Schedule rule for CY2022, CMS not only risks creating worse outcomes for patients, it increases the likelihood of higher health spending, increases health system consolidation and extends stubbornly persistent health inequities. CMS must reverse course on the cuts — and quickly.
Revascularization services are essential to Medicare beneficiaries who are at risk of severe arterial blockages and limb loss due to PAD, a chronic disease often co-morbid with and complicated by diabetes, chronic hypertension and kidney disease. Without proper vascular treatment, patients are increasingly at risk of suffering irreparable damage. When that occurs, amputation becomes the only option — underscoring the importance of timely access to interventional care.
Office-based vascular care providers operating in the community setting ensure that patients can more easily receive these interventional services in a safe, convenient and accessible location. Further, most patients prefer to seek revascularization services in the outpatient setting because physician offices are often closer to home and less expensive than care provided in the hospital outpatient setting.
Given the value of vascular care to a patient’s overall health, ensuring continued access is critical. Yet, the proposed Physician Fee Schedule rule for CY2022 threatens to force office-based revascularization providers to close their doors for good, reducing Medicare beneficiaries’ access to the procedures that could literally save life and limb. The sharp 20 percent payment cuts proposed by CMS are simply unsustainable, and if not reversed, could greatly exacerbate the amputation epidemic and disproportionately harm communities of color.
The unwarranted cuts are based solely on the PFS “budget neutrality” provision, which according to CMS, requires the agency to offset increased payments for evaluation and management services by slashing payments elsewhere. The increase to E/M services relates to new clinical data from the Bureau of Labor Statistics that suggests that every specialty under PFS should be receiving increases, yet CMS is proposing to cut specialties such as cardiology, vascular surgery, radiation oncology and radiology, underscoring just how out of touch this proposal actually is.
Moreover, the 20 percent cuts to revascularization services will drive further consolidation in the health care system. If the PFS cuts drive outpatient providers out of business, many patients will have no other choice but to seek care in the hospital setting — if they can even access revascularization services at all. It is a well-documented trend that hospital systems are rapidly absorbing independent practices, which has contributed to higher spending and less competition. Bewilderingly, the new PFS cuts were announced just days after President Biden unveiled an Executive Order calling for greater competition in the healthcare marketplace—a move widely hailed by patients and providers. With medical costs becoming one of the American public’s top issues in recent years, it does not make sense for CMS to implement policies that could actually accelerate consolidation and drive up costs further.
If CMS implements the severe 20 percent cuts to revascularization services as proposed, the result would be less patient choice, higher costs, increased consolidation and ultimately, worse outcomes, particularly for communities of color. I fear that thousands of Americans would unnecessarily lose limbs under such a scenario, even though thousands of them could be saved with access to timely care. CMS must reverse course and remove the 20 percent cuts from the final PFS rule.
Foluso A. Fakorede, MD, is an interventional cardiologist and CEO of Cardiovascular Solutions of Central Mississippi in Cleveland, Miss.
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