Category Archives: Coalition News

The letter from USPA describes the need for Congressional hearings to explore long-term Medicare payment solutions

WASHINGTON, DC — Today, the CardioVascular Coalition (CVC) announced it is supporting a letter sent by The United Specialists for Patient Access (USPA) to MedPAC, the Medicare Payment Advisory Commission (MedPAC). The letter outlines how ongoing cuts to office-based specialists under the Physician Fee Schedule are driving closures of community-based specialty care centers and causing a migration of services to higher cost sites-of-service.

Since 2006, specialties such as cardiology, radiology, radiation oncology, vascular surgery and others have been cut by 20-40% under the Physician Fee Schedule. Concurrent with these cuts, there has been an 11% decrease in private practice and an 11% increase in hospital employment or ownership of physician practices.

CLICK HERE TO VIEW THE LETTER

CLICK HERE TO VIEW “FAST FACTS” FROM THE LETTER

Jeffrey G. Carr, MD, an Interventional Cardiologist, Endovascular Specialist, and CVC Board member stated: “We strongly support the message USPA delivered to MedPAC because it relates to our members. Congress needs to step in and stop further cuts to office-based specialty centers from harming patients and forcing providers to close their doors. We also need Congress to focus on long-term solutions to a broken Physician Fee Schedule by working with providers to find solutions that benefit everyone.”

Congress failed to stop cuts in the 2023 Medicare Physician Fee Schedule

Washington, DC — Today, the CardioVascular Coalition (CVC) issued a statement expressing their frustration with the 2023 omnibus spending bill that failed to address the looming clinical labor cuts. The CVC has repeatedly called on Congress to step in and stop the cuts to revascularization services included in the finalized 2023 Medicare Physician Fee Schedule (MPFS) Rule. However, no action was taken.

Jeffrey G. Carr, MD, an Interventional Cardiologist, Endovascular Specialist, and CVC Board member stated:

“The current cuts to clinical labor have brought with them a dreadfully dark outlook for specialty providers across the country. Despite this, Congress chose not to intervene in this issue, and left vulnerable patients on the chopping block. The clinical labor cuts will lead to more unnecessary amputations and force providers to close their doors. To make matters worse, the cuts will worsen health equity problems and accelerate the consolidation trend across the United States. The CVC will continue to be engaged with policymakers regarding this important issue.”

CVC calls on Congress to stop clinical labor cuts before Dec. 31

Washington, DC— Today, the CardioVascular Coalition (CVC) – a coalition of physicians, care providers, advocates, and manufacturers — is calling on Congress to step in and stop the cuts to revascularization services included in the finalized 2023 Medicare Physician Fee Schedule (MPFS) Rule.

If Congress fails to act before the end of the year, the finalized MPFS will impose cuts of up to 9% on physicians who provide revascularization services in outpatient settings. This care is critical in preventing avoidable amputations and ensuring they receive the care they need.

On top of the long history of MPFS cuts over the last several years, including cuts exceeding 20% from the 2022 PFS / clinical labor policy, these cuts will continue to increase financial pressures on providers at a time of historic economic uncertainty.

If the cuts are left unaddressed, the end result will be providers closing their doors, therefore depriving peripheral artery disease (PAD) patients of care in the outpatient settings they prefer. The CVC believes that the cuts will worsen health equity problems and accelerate the consolidation trend across the United States.

“The sad reality is that these cuts will lead to more unnecessary amputations,” said Interventional Cardiologist and Endovascular Specialist Jeffrey G. Carr, MD, a CVC Board member. “We are asking for Congress to step in and stop these cuts from harming patients and forcing providers to close their doors. There is a bipartisan solution that can pass before the end of the year, but Congress must make this a priority.”

By Paul Gagne, M.D.

There is a little-known epidemic occurring in the medical world that will be made worse if Congress does not act to stop the ongoing clinical labor cuts outlined in the 2023 Medicare Physician Fee Schedule finalized rule.

The amputation epidemic is a troubling trend of preventable leg amputations being performed on patients, particularly people of color. Surgeons perform about 200,000 non-traumatic amputations annually, most of them due to peripheral artery disease (PAD), a common complication of diabetes, kidney disease and chronic hypertension. Some patients also undergo amputation due to long-standing non-healing venous ulcers. As many as 85% of those amputations could be prevented with early diagnostics and treatment.

The final rule for 2023 Medicare Physician Fee Schedule, released by the Centers for Medicare & Medicaid Services (CMS), would impose cuts of up to 9% on doctors in outpatient facilities who provide revascularization services, which are necessary to prevent leg amputation of patients with PAD. As a health care provider, I find this alarming, and I’m calling on Congress to prevent and reverse these cuts. We spend many millions of dollars treating patients who have had amputations addressing their disability, artificial leg needs, progression of other diseases associated with the inability to walk, depression due to loss of independence and the nursing home care necessary when patients lose the ability to care for themselves with loss of ambulation. Much of this could be avoided with patients having a better quality of life if we prevented the amputations. The fee schedule rule would adversely affect important sites of care, namely OBLs, or office based labs, where preventing amputations is our main focus. This is not a task that our post pandemic stretched hospitals can assume. This requires increased access for our most vulnerable patients that is filled by OBLs.

If the cuts are implemented, they will disrupt patients’ access to treatment, lead to higher amputation rates and worsen racial inequities. Revascularization services are not only critical to preventing avoidable amputations for people with PAD, they also often cost less and allow patients to be treated in a more specialized setting.

These cuts come after several years of clinical labor cuts by CMS, some of which caused providers to close their doors, particularly in rural and underserved communities where patients need care the most. If the current Physician Fee Schedule goes forward, patients’ access to revascularization services and other office-based care will be further hurt, and there will be devastating consequences. We will see an increase in amputation and all the associated costs Medicare will need to cover. More importantly, patients’ quality of life will be devastated.

Additionally, the cuts will further overwhelm our already strained hospitals, expose patients to unnecessary health risks and contribute to the trend of health care consolidation. Consolidations have time and again been shown to increase the cost of health care in our communities. It is not good for our patients and citizens.

This is a problem that disproportionately affects communities of color, making this a racial justice issue. According to the Dartmouth Atlas, the risk of amputation for Black Americans with diabetes is as much as four times higher than the national average. Native Americans are more than twice as likely to have an amputation and Hispanics are up to 75% more likely to have an amputation. Minorities are also known to be less likely to pursue hospital care. Losing outpatient options is a challenge to these valued members of our community.

We must prevent amputations through timely care and interventions to reverse end-stage PAD, improve patient’s quality of life, prevent depression due to chronic disability, and prevent chronic pain associated with amputation. We must make our patients’ lives more than figuring out how to live due to limb loss. Patients deserve more than the day-to-day hardship associated with routine tasks of daily living that follows amputation. Our legislators in Washington must step up to help us do that by preventing these cuts and supporting office-based specialists who provide essential services.

I’m calling on Congress to use its power to stop ongoing clinical labor cuts in the 2023 Medicare Physician Fee Schedule final rule. It is crucial to giving patients the appropriate medical care they need to prevent needless amputations, particularly in underserved areas.

Paul J. Gagne MD, FACS, RVT, is board-certified vascular surgeon, fellow of the Society of Vascular Surgery, and director of the Vascular Breakthroughs.

CVC comment letter highlights concerns over proposed rule

WASHINGTON, DC — Earlier this week, the CardioVascular Coalition (CVC) submitted official comments to the Centers for Medicare and Medicaid Services (CMS) on the proposed rule for the CY 2023

Physician Fee Schedule (CMS-1770-P).

The CVC letter, addressed to CMS Administrator Brooks-LaSure, emphasizes that ongoing cuts to office-based specialists under the Physician Fee Schedule are contributing to office-based center closures, health system consolidation, and a deepening of the existing health equity gaps.

CLICK HERE TO READ THE COMMENT LETTER.

The letter states, in part, “While the [Biden] Administration has launched a number of initiatives aimed at addressing health inequity through the elimination of disparities in health care, the 2023 PFS Proposed Rule actually threatens to undermine these initiatives in areas throughout the PFS by continuing to phase in the 2022 PFS clinical labor cuts.”

It continues, “The incentive is clear for beleaguered PFS providers who may no longer be able to sustain further cuts in the 2023 PFS Proposed Rule to simply close their centers and continue the migration to large health systems. As noted by the Medicare Payment Advisory Commission (MedPAC), ‘the preponderance of evidence suggests that hospital consolidation leads to higher prices.’”

The CVC comment letter goes on to state, “While ‘budget-neutrality’ sounds like good policy, when it operates within a Physician Fee Schedule that has not kept up with inflation, it results in massive swings in reimbursement and punishes providers irrespective of the value they add to the healthcare system. This is because, while reimbursement under the overall Physician Fee Schedule has increased 11 percent over the last two decades, the cost of running a medical practice has increased 39 percent over that same period.”

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Just hours after being inaugurated, President Biden signed an executive order commanding the federal government to make racial equity a top priority. Given the stark disparities that continue to plague communities of color—especially when it comes to America’s health care system—this was a welcome first step by the administration.

While the administration’s commitment to health equity is encouraging, regulations from the Centers for Medicare & Medicaid Services (CMS) that were implemented on Jan. 1 seem to contradict this promise just a year after it was made. Despite underserved communities still facing access barriers to health care providers, Medicare slashed funding for specialty care services by upwards of 20 percent. If left in place, these severe cuts will lead to significantly worse health outcomes for Black, Hispanic, and Native Americans—including an increase easily preventable limb amputation.

Click here to see the full article on The Hill.

Vascular care leaders urge Congressional action to prevent implementation of deep Medicare cuts to specialty care services in 2022

Washington, D.C. –– The CardioVascular Coalition (CVC) – a coalition of physicians, care providers, advocates, and manufacturers working to improve awareness and prevention of peripheral artery disease (PAD) – expressed disappointment in the Centers for Medicare & Medicaid Services’ (CMS) Final Physician Fee Schedule (PFS) Rule for CY 2022 that finalizes severe cuts to amputation prevention procedures, including revascularization. The vascular care community plans to immediately seek legislative solutions to ensure these cuts are not implemented as planned in 2022.

“We continue to have significant concerns with the cuts finalized by CMS this week, which we have warned could negatively impact clinical outcomes, limit patient choice, and ultimately drive providers out of business,” said Dr. Jeff Carr, CVC Board Member. “Despite strong, bipartisan opposition to these cuts and the threats they pose to healthcare equality and consolidation, it is upsetting that CMS chose to move forward with these policies. We now look forward to working with our champions in Congress to address these harmful payment cuts before they take effect in 2022.”

On September 13, Representatives Bobby Rush (D-IL), Gus Bilirakis (FL), and 73 of their House colleagues sent a letter to CMS urging the agency not to finalize the cuts to specialty care providers included in the proposed 2022 Medicare Physician Fee Schedule (PFS). The lawmakers expressed particular concern on the cuts’ impact on minority health. According to the letter, cuts of 22% to reimbursement for revascularization services will harm Black and Latino Medicare beneficiaries who are three times more likely and twice as likely, respectively, to receive an amputation due to peripheral artery disease. 

Limiting patient access to revascularization services could lead to higher amputation rates and exacerbate inequities that already exist, particularly in America’s communities of color.  According to the Dartmouth Atlas, amputation risks for African Americans living with diabetes are as much as four times higher than the national average.

The main driver of payment cuts in the 2022 PFS Final Rule are CMS’ updates to clinical labor data. Hardest hit are cardiology, vascular surgery, venous, radiation oncology, and radiology practices. On its face, updating clinical labor data in the CMS database makes sense. Indeed, every specialty under the PFS should be seeing increases to resources based on new clinical data from the Bureau of Labor Statistics. However, including new clinical labor data results in massive cuts of up to 22% over four years to critical revascularization services at a time when patients are choosing to access health services in outpatient facilities that are convenient and less costly. 

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Letter urges CMS to prevent up to 20% cuts by not  finalizing the clinical labor policy in the 2022 Physician Fee Schedule (PFS) proposed rule 

Washington, D.C. –– The CardioVascular Coalition (CVC) – a coalition of physicians, care providers, advocates, and manufacturers working to improve awareness and prevention of peripheral artery disease (PAD) – today applauded 75 bipartisan lawmakers in the U.S. House for urging the Centers for Medicare & Medicaid Services (CMS) to address the severe proposed cuts included in the 2022 Physician Fee Schedule (PFS) proposed rule.  

In a letter submitted to CMS Deputy Administrator Dr. Meena Seshamani, 75 bipartisan lawmakers led by Rep. Bobby Rush (D-IL) and Rep. Gus Bilirakis (R-FL), called on CMS to not finalize the clinical labor policy that would cause specialties—including cardiology, radiology and vascular surgery—to face serious cuts of up to 20% in 2022. The proposed cuts, which would be imposed as a direct result of CMS’ “budget neutrality” policy and come on top of years of successive cuts, would be devastating for both patients and providers. Unless CMS reverses course on its proposed clinical labor provision, the lawmakers warned that the severe cuts would accelerate health system consolidation, reduce competition, increase Medicare spending, and exacerbate healthcare inequities for patients of color. To prevent these issues and ensure patients’ access to care, the lawmakers urged CMS to work with Congress on fundamental reforms to the PFS. 

In asking CMS to prevent the severe cuts, the lawmakers expressed particular concern on the proposed rule’s impact on minority health. According to the letter, the 2022 PFS proposed rule threatens to cut reimbursement to revascularization services by 22% despite the fact that Black and Latino Medicare beneficiaries are three times more likely and twice as likely, respectively, to receive an amputation due to peripheral artery disease.  

“Given the strong correlation between ongoing cuts and reimbursement volatility for PFS providers vis-à-vis the health system consolidation trend, we believe the best characterization of the so-called PFS ‘budget neutrality’ provision is that it is a driver of PFS center closures and increased costs to the Medicare program,” the letter stated. The lawmakers went on to note that the cuts may cause “PFS providers who may no longer be able to sustain cuts in the 2022 PFS Proposed Rule to simply close their centers and continue the migration to large health systems.”  

In order to address the severe proposed cuts, the lawmakers strongly recommended CMS not finalize the clinical labor policy in the 2022 PFS Final Rule. In addition, they urged CMS to work closely with Congress on reforming the PFS system in order to address a scheduled 3.75 percent 

cut to the conversion factor in 2022, which also threatens provider stability.  

To read the text of the letter, CLICK HERE. 

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About the CardioVascular Coalition (CVC) 

Our Mission is to advance patient access to care for peripheral artery disease (PAD). Physicians, care providers, advocates, and manufacturers who comprise the CVC are dedicated to community-based solutions designed to improve awareness and prevention of PAD, reduce geographic disparities in access to care, and secure patient access to high-quality, cost-effective interventional treatment across America. Learn more at cardiovascularcoalition.org. 

If finalized, the proposed ~23% cuts would have a devastating impact on patient access and systemic disparities by accelerating America’s amputation epidemic

Washington, D.C. –– The CardioVascular Coalition (CVC) – a coalition of physicians, care providers, advocates, and manufacturers working to improve awareness and prevention of peripheral artery disease (PAD) – today called on Congress and the Centers for Medicare & Medicaid Services (CMS) to address severe proposed cuts to specialty provider services in order to help increase access to care. As Peripheral Artery Disease (PAD) Awareness Month begins today, it is a time to reflect on the nearly 20 million Americans impacted by PAD, including an estimated 200,000 individuals who suffer preventable amputations every year due to complications from the chronic disease, and to ensure patients’ access to vascular care that is shown to improve quality of life, reduce care costs, and prevent limb loss.

CMS recently proposed cutting payments for revascularization services by approximately 23% in the proposed Physician Fee Schedule (PFS) Rule for CY2022. The proposed cuts, which are being driven by a provision that purports to update clinical labor data, would have a severe impact on cardiology, vascular surgery, venous, radiation oncology, and radiology practices. Though outpatient health services – including revascularization – are cost-effective and convenient for patients, the proposed cuts would have profoundly negative effects on patient access and health equity. If the proposed cuts are finalized as currently proposed, Medicare beneficiaries will face more serious risks of limb loss.

“As we recognize PAD Awareness Month and the major impact that peripheral artery disease has on Americans – particularly people of color – I’m deeply troubled by CMS’ flawed proposal to cut vital services like revascularization by as much as 23%,” said Dr. Jeff Carr, CVC Board Member. “At a time when America is suffering a PAD and amputation crisis on top of the COVID-19 pandemic, it is absolutely critical to ensure patients’ continued access to the services that are proven to help prevent amputations and slow disease progression. Unless Congress and CMS act to address these proposed cuts, I fear that it will be harder for patients to access necessary care, resulting in even more amputations, worse outcomes, and even greater healthcare disparities.”

According to estimates, PAD affects nearly 20 million Americans and is responsible for 80 percent of the 200,000 non-traumatic limb amputations that take place in the U.S. each year. These non-traumatic amputations often occur without any diagnostic testing, meaning PAD patients are losing limbs before they receive testing to determine if limb-saving interventions are an option.

PAD is exacerbated by conditions like diabetes, chronic hypertension, and renal disease, which are most prevalent in minority populations. Access to revascularization therapies is especially vital to the African American, Hispanic, and Native American populations who are two to four times more likely to undergo a limb amputation due to PAD because of the increased prevalence of diabetes, obesity, and other risk factors.

“To address the issues of patient access and systemic health inequity in our country, CMS must reverse course and not finalize the clinical labor policy in the 2022 PFS Proposed Rule,” continued Dr. Carr. “Further, CMS should work closely with Congress to fundamentally reform the Physician Fee Schedule so that any future unjustified cuts to specialty provider services can be avoided.”

To learn more about PAD and PAD Awareness Month, CLICK HERE.

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About the CardioVascular Coalition (CVC)

Our Mission is to advance patient access to care for peripheral artery disease (PAD). Physicians, care providers, advocates, and manufacturers who comprise the CVC are dedicated to community-based solutions designed to improve awareness and prevention of PAD, reduce geographic disparities in access to care, and secure patient access to high-quality, cost-effective interventional treatment across America. Learn more at cardiovascularcoalition.org.

Deep payment cuts proposed by the Centers for Medicare & Medicaid Services (CMS) threatens to reduce access to Medicare beneficiaries at risk for limb loss 

Washington, D.C. –– The CardioVascular Coalition (CVC) – a coalition of physicians, care providers, advocates, and manufacturers working to improve awareness and prevention of peripheral artery disease (PAD) – expressed grave concern regarding deep ~20% payment cuts to revascularization services in the proposed Physician Fee Schedule (PFS) Rule for CY2022.   

“Revascularization services that treat blood flow to legs and feet are absolutely vital for older Americans at risk of severe arterial blockages and limb loss,” said Dr. Jeff Carr, CVC Board Member. “CMS’ proposed cuts, despite the well-documented improvement in clinical outcomes resulting from revascularization performed in the outpatient setting, are severe, unwarranted, and may limit patient choice, and threaten to drive providers out of business. If the proposed 20% cut is finalized by the agency, the downstream effects on patient access, health system consolidation, and systemic inequities will be devastating.” 

The main driver of payment cuts in the 2022 PFS Proposed Rule relates to a CMS proposal to update clinical labor data.  Hardest hit are cardiology, vascular surgery, venous, radiation oncology, and radiology practices. On its face, updating clinical labor data in the CMS database makes sense. 

Indeed, every specialty under the PFS should be seeing increases to resources based on new clinical data from the Bureau of Labor Statistics.  However, including new clinical labor data results in massive cuts of up to 20% to critical revascularization services at a time when patients are choosing to access health services in outpatient facilities that are convenient and less costly.   

These impacts will have profoundly negative effects on health equity.  The decrease in access to revascularization services could lead to higher amputation rates and exacerbate inequities that already exist, particularly in America’s communities of color.  According to the Dartmouth Atlas, amputation risks for African Americans living with diabetes are as much as four times higher than the national average. Data analyses have similarly found that Native Americans are more than twice as likely to be subjected to amputation and Hispanics are up to 75 percent more likely to have an amputation. 

“As frontline medical professionals dedicated to improving access to quality vascular care, we strongly urge CMS not to finalize the clinical labor policy in the 2022 PFS Proposed Rule as the second-order negative impacts far outweigh any benefit from updated clinical labor data at this time,” continued Dr. Jeff Carr.  “Moreover, considering the 2021 PFS Final Rule E/M scheduled 3.75 percent cut to the conversion factor is still causing negative impacts in 2022, we urge CMS to work with Congress on fundamental reform to the PFS in order that Congress may better address the upcoming 3.75 percent cut in legislation later this year.” 

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About the CardioVascular Coalition (CVC) 

Our mission is to advance patient access to care for peripheral artery disease (PAD). Physicians, care providers, advocates, and manufacturers who comprise the CVC are dedicated to community-based solutions designed to improve awareness and prevention of PAD, reduce geographic disparities in access to care, and secure patient access to high-quality, cost-effective interventional treatment across America. Learn more at cardiovascularcoalition.org. 

Discussions about ending racial health care disparities and finding solutions have finally started to emerge. For far too long, Black, Native American and Latino Americans have exhibited higher rates of serious conditions such as diabetes and kidney disease and suffered worse outcomes than white individuals.

Click here to see the full article on the NJ.com website.

Amputation Reduction and Compassion Act, introduced in recognition of National Minority Health Month, will expand coverage for PAD screening among at-risk populations

Washington, D.C. –– The CardioVascular Coalition (CVC) – a coalition of physicians, care providers, advocates, and manufacturers working to improve awareness and prevention of peripheral artery disease (PAD) – today applauded lawmakers in Congress for re-introducing the Amputation Reduction and Compassion (ARC) Act (H.R. 2631), bipartisan legislation to improve peripheral artery disease (PAD) education, increase access to PAD screening and reduce lower limb amputations.  The bill would provide coverage of PAD screening for at-risk beneficiaries under the Medicare and Medicaid programs without the imposition of cost-sharing requirements, thereby ensuring early detection and intervention to prevent amputation. 

The bill is sponsored by Representative Donald M. Payne, Jr. (D-NJ) and originally co-sponsored by Representatives Jeff Van Drew (R-NJ), Ruben Gallego (D-AZ), Bobby L. Rush (D-IL), Mark Takano (D-CA), Raúl M. Grijalva (D-AZ), Katie Porter (D-CA), Darren Soto (D-FL), G.K. Butterfield (D-NC), Ayanna Pressley (D-MA) and Albio Sires (D-NJ).

By expanding coverage for PAD screening for at-risk beneficiaries, the bipartisan bill would help prevent vulnerable individuals from developing serious complications from PAD, which can lead to lower limb amputation. To reduce unnecessary limb loss, the ARC Act would prohibit reimbursement for amputation unless arterial testing was previously carried out to determine if alternative interventions could be applied. Further, the bill would establish a PAD education program to support, develop, and implement awareness initiatives that inform health care professionals and the public about the dangers of PAD and methods to reduce amputation. This is especially important with respect to at-risk populations, including racial and ethnic minorities who are more likely to face non-traumatic amputation than whites.

While an estimated 20 million Americans have PAD, many are unaware of the serious risks of the disease and are not encouraged to undergo preventative tests that could save their limbs, improve patient outcomes, and reduce costs to the healthcare system. Data suggest an estimated 200,000 patients – a disproportionate number of whom are people of color – suffer non-traumatic amputations each year. Yet, with access to timely screening and proper care, as many as 85% of those amputations can be prevented.

“With the introduction of the ARC Act we have the opportunity to expand coverage for simple, non-invasive screening tests that will empower patients to more effectively manage their PAD before amputation becomes necessary,” said Dr. Jeffrey Carr, co-founder of the Outpatient Endovascular and Interventional Society (OEIS) and a member of the CVC. “Amputation should be a last resort, yet research shows that most non-traumatic amputations can be prevented with access to early screening and detection—underscoring the need for increased access and coverage. We applaud these bipartisan lawmakers for introducing this critical legislation, which will go a long way toward saving lives and limbs, particularly in communities of color who bear the brunt of the PAD crisis.”

According to the Dartmouth Atlas, amputation risks for African Americans living with diabetes are as much as four times higher than the national average. Similarly, that Native Americans are more than twice as likely to be require amputation related to PAD, while Hispanics are up to 75 percent more likely to have an amputation.

“As the PAD crisis continues to ravage the country, especially among communities of color who are the most at-risk for amputation, we urge Congress to quickly pass the ARC Act,” added Carr. “As we recognize National Minority Health Month this April, we look forward to supporting this bipartisan bill and working collaboratively with lawmakers, advocates, patients, and physicians to address health inequities that persist in America today.”

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Lawmakers Urge President Biden to Prioritize Amputation Prevention Strategies and Invest in Preventative Care to Reduce Incidence and Harm of Vascular Disease

WASHINGTON – The CardioVascular Coalition (CVC) – a coalition of physicians, care providers, advocates, and manufacturers working to improve awareness and prevention of peripheral artery disease (PAD) – today commended Members of Congress for urging President Joe Biden and his Administration to support greater efforts to prevent unnecessary amputations in the United States.

In a letter signed by 16 bipartisan lawmakers, the group highlighted the risks of untreated peripheral artery disease (PAD) which lead to amputation, an issue that disproportionately impacts communities of color. To prevent thousands of unnecessary amputations from taking place every year, the lawmakers called on President Biden to prioritize amputation prevention as a vital form of preventive care by bringing policies at both the U.S. Department of Health and Human Services and the National Institutes of Health in line with a strategy to prevent unnecessary amputations.

The letter was organized by Congressman Donald M. Payne, Jr. (D-NJ), Chairman of the Congressional PAD Caucus which was formed to educate Congress and communities about PAD while supporting legislative activities to improve PAD research, education, and treatment, with the goal of preventing non-traumatic amputations due to PAD and other related diseases.

In addition to Congressman Donald M. Payne, Jr., the letter was signed by Representatives Gus M. Bilirakis (FL-12), Ruben Gallego (AZ-7), Barbara Lee (CA-13), Alcee L. Hastings (FL-20), Nanette Diaz Barragán (CA-44), Sanford D. Bishop, Jr. (GA-20), André Carson (IN-7), Lisa Blunt Rochester (D-At Large), Henry C. “Hank” Johnson, Jr. (GA-4), Katie Porter (CA-45), Marilyn Strickland (WA-10), Jenniffer González-Colón (PR-At Large), Eleanor Holmes Norton (DC-At Large), Sheila Jackson Lee (TX-18) and Linda T. Sánchez (CA-38).

“While an estimated 200,000 Americans have their limbs surgically removed every year due to complications from peripheral artery disease – particularly in Black, Native American, and Hispanic communities – we know that preventative care and early screening can help Americans avoid amputation and live longer, healthier lives,” said Dr. Jeffrey Carr, co-founder of the Outpatient Endovascular and Interventional Society (OEIS) and a member of the CVC. “We commend Representative Payne for his leadership and all the lawmakers who signed this letter for their commitment to ensuring Americans at high risk of amputation can access the preventative and interventional care they need.”

“Federal healthcare spending should incentivize preventative screenings for high-risk individuals so that PAD can be caught and treated early, before it leads to amputation and discouraging non-traumatic amputations if anatomical testing is not performed first,” the lawmakers wrote to President Biden. “The U.S. Department of Health and Human Services should work with providers to establish quality measures to reduce avoidable amputations. On the research side, the National Institutes of Health should work with doctors to increase awareness of PAD and PAD symptoms, which will help them quickly and accurately diagnose this disease and begin treatments.”

As many as 85% of the nation’s 200,000 non-traumatic amputations could be prevented with access to early detection and preventative testing. By screening for symptoms such as critical limb ischemia, the likelihood of an individual needing a PAD-related amputation can be reduced by up to 90%. Unfortunately, too few Americans are offered routine screening for PAD. As a result, many do not know they even have the disease until it is too late to prevent amputation. This is problem is particularly acute in communities of color. For example, Black American patients are up to four times more likely to have their limbs surgically removed than their white counterparts due to advanced peripheral artery PAD.

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End-Of-Year Spending Package is Good First Step by Providing One-Year, 3.75% Increase to the Physician Fee Schedule, Delaying Add-On Code for Three Years

WASHINGTON – The CardioVascular Coalition (CVC) – a coalition of physicians, care providers, advocates, and manufacturers working to improve awareness and prevention of peripheral artery disease (PAD) – today commended Congress for taking action to ease the severe Medicare payment cuts that were set to go into effect on January 1.  In the end-of-year spending package that passed with strong bipartisan support, Congress delayed the reimbursement cuts and added $3 billion in funding into the CY2021 Medicare Physician Fee Schedule (PFS), reducing cuts to vascular surgery, cardiac surgery, and interventional radiology by approximately two-thirds. The legislative package also suspends the 2 percent sequester cuts for three additional months.

While a temporary fix that does not fully eliminate the PFS cuts in 2021, this legislation will offer much-needed relief to the more than 30 specialty providers slated for deep reimbursement reductions.  If implemented as scheduled, the cuts to “vascular surgery” (-7%), “cardiac surgery,” (-9%) and “interventional radiology” (-9%) would have hampered providers’ ability to remain stable during the ongoing COVID-19 public health emergency.

“Recognizing the severe strain that specialty providers are facing, we are pleased that Congress took decisive action to ease the deep Medicare cuts slated to go into effect on January 1,” said Dr. Jeffrey Carr, co-founder of the Outpatient Endovascular and Interventional Society (OEIS) and a member of the CVC. “Healthcare practitioners who offer specialty services – including vascular surgery, cardiac surgery, and interventional radiology – will be in a better position in 2021 to preserve continued patient access to the care they need, especially during the COVID-19 pandemic.  However, we know there is still more work to be done and we look forward to working with Congress and the Administration next year to further advance policies that will provide payment stability to PFS services over the long-run.”

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Vascular care providers call on Congress to pass legislation in year-end package to block 2021 payment cuts and protect patient access to specialty care

WASHINGTON – The CardioVascular Coalition (CVC) – a coalition of physicians, care providers, advocates, and manufacturers working to improve awareness and prevention of peripheral artery disease (PAD) – today expressed disappointment in the Centers for Medicare & Medicaid Services’ (CMS) decision to finalize deep cuts to specialty providers in the Final Physician Fee Schedule Rule for CY2021.

Despite vocal opposition from patients, providers, and bipartisan lawmakers, CMS’ decision to slash Medicare reimbursement rates for “vascular surgery” (-7%), “cardiac surgery,” (-9%) and “interventional radiology” (-9%) – among other specialties – undercuts providers’ ability to remain viable during the unpredictable COVID-19 pandemic. If not addressed by Congress before the PFS rule goes into effect on January 1, 2021, these devastating cuts will ultimately impact patient access to the vital specialty services they need.

“The severe Medicare cuts finalized by CMS are deeply troubling for both patients and providers,” said Dr. Jeffrey Carr, co-founder of the Outpatient Endovascular and Interventional Society (OEIS) and a member of the CVC. “With America’s healthcare system under unprecedented stress by the COVID-19 pandemic, now is the absolute worst time to push through new payment cuts. In order to protect patients’ continued access to specialty services, we urge Congress to advance a legislative solution in the next relevant year-end legislative package.”

Bipartisan Members of Congress have consistently spoken out against the now-finalized cuts, introducing two pieces of legislation to address the cuts, H.R. 8702 and H.R. 8505, which would both provide a necessary reprieve for the dozens of specialty providers that are scheduled to see reimbursement reductions in 2021. The CVC supports legislative action to protect a wide array of specialties including “vascular surgery,” “cardiac surgery,” and “interventional radiology” from being cut without affecting the much-needed payment increases for evaluation and management (E/M) services from going into effect.

“The clock is ticking. Without quick Congressional action, these deep cuts will start impacting America’s specialty providers on January 1,” continued Dr. Carr. “In the interest of protecting Medicare beneficiaries’ health and safety—especially during the ongoing COVID-19 public health emergency—we urge Congress to swiftly pass legislation to stop these harmful cuts.”

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Despite Congressional and stakeholder opposition, the Centers for Medicare & Medicaid Services finalized sharp payment cuts to specialty providers including vascular surgery, cardiac surgery and interventional radiology

Washington, D.C. – The CardioVascular Coalition (CVC) – a coalition of physicians, care providers, advocates, and manufacturers working to improve awareness and prevention of peripheral artery disease (PAD) – commends bipartisan lawmakers in both chambers of Congress for recently sending a series of letters to House and Senate leadership urging support for legislation to address deep payment cuts to specialty providers in the CY2021 Medicare Physician Fee Schedule (PFS).

Specifically, 50 Members of the U.S.  Senate, 26 Members of the Congressional Black Caucus and 19 physicians in the U.S. House of Representatives united to urge Congressional leaders to include legislation in any end-of-the-year legislative package to protect American seniors and our nation’s healthcare system by blocking planned cuts to more than 30 specialty provider services scheduled to take effect January 1, 2021. 

Despite thousands of comments opposing the cuts made by providers, patients and bipartisan Members of Congress, Medicare maintained harmful cuts in the final PFS rule for 2021, including cuts to  “vascular surgery” by -7%, “cardiac surgery” by -9% and “interventional radiology” by -9%.

Two pieces of bipartisan legislation have been introduced in the U.S. House of Representatives to mitigate the cuts, including H.R. 8702, which would hold any codes receiving a cut harmless for two years, and H.R. 8505, which would provide a one-year waiver of budget neutrality adjustments under the PFS.

The bipartisan group of Senators, led by Sens. Steve Daines (R-MT) and Debbie Stabenow (D-MI),  asserts, “The payment cuts proposed by CMS would pose a threat to providers and their patients under any circumstances, but during a pandemic the impact is even more profound.”

In expressing their opposition to the sharp specialty provider cuts, the Congressional Black Caucus (CBC) lawmakers wrote, “We are aware of solutions to either waive budget neutrality requirements (H.R. 8505) or to hold specialists harmless (H.R. 8702). While not perfect, either of these solutions would give healthcare specialists the financial security they need to weather the COVID-19 pandemic. As such, we urge you to include a provision in the end of year spending package to prevent these reckless cuts from taking effect, while allowing the increases to proceed as scheduled on January 1, 2021.”

In their letter to leadership, the House physicians added, “As Members of Congress who directly care for patients, we understand the consequences that the upcoming reimbursement cuts will have on patient care and patient access to care. We look forward to working with you to prevent the harm that will inevitably arise if the impending cuts in the PFS go into effect on January 1, 2021.”

To view the Senate letter, click here.

To view the CBC letter, click here.

To view the House physician letter, click here.

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Amputation Reduction and Compassion (ARC) Act supports patient education and screening of at-risk populations to reduce lower limb amputation

Washington, D.C. – In recognition of American Diabetes Month, the CardioVascular Coalition (CVC) – a coalition of physicians, care providers, advocates, and manufacturers working to improve awareness and prevention of peripheral artery disease (PAD) – is urging lawmakers in Congress to support the Amputation Reduction and Compassion (ARC) Act (H.R. 8615), legislation to expand education and screening for peripheral artery disease (PAD).  PAD is a vascular disease that is often associated with diabetes and other related co-morbidities.

The ARC Act was introduced last month by Representative Donald Payne, Jr. (NJ-10) and co-sponsored by Reps. Bobby Rush (IL-01) and Ruben Gallego (AZ-7), to reduce amputations and close the racial disparities gap in PAD by increasing screening and education.  The bill calls for Medicare and Medicaid coverage to include PAD screening tests and policies to prevent medical providers from being reimbursed for amputation procedures without first completing arterial testing. The ARC Act would also establish educational initiatives that inform health care professionals and the public about peripheral artery disease and the importance of early detection.

More than 34.2 million Americans have diabetes, and an additional 88 million more are pre-diabetic, putting them at a higher risk for developing PAD. PAD is responsible for more than 80% of non-traumatic lower limb amputations in the U.S. each year, many of which could be avoided with appropriate screening and intervention.  Early PAD screening has proven to reduce the probability of an amputation resulting from PAD by 90 percent, underscoring the critical importance of policies to expand patient access to screening to reduce the occurrence of amputation in the U.S.

Unfortunately, PAD-related amputations occur more frequently among minority communities. Research shows that right now, Black Americans with diabetes are up to four times more likely to undergo an amputation as a consequence of PAD compared to white Americans.  Similarly, Hispanic and Native Americans with diabetes experience PAD at a measurably higher rates than white Americans.

“We commend Rep. Donald R. Payne, Jr. and his co-sponsors, Rep. Ruben Gallego and Rep. Bobby Rush, for their leadership on this issue,” said Dr. Jeffrey Carr, founding and past president of the Outpatient Endovascular and Interventional Society (OEIS) and a member of the CVC. “We hope lawmakers in Congress will support H.R. 8615 to bring early screening to America’s most high-risk individuals, including those who are diabetic and pre-diabetic.”

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229 bipartisan lawmakers join growing chorus of leaders opposing Medicare specialty cuts  

Washington, D.C. – Today the CardioVascular Coalition (CVC) – a coalition of physicians, care providers, advocates, and manufacturers working to improve awareness and prevention of peripheral artery disease (PAD) – applauded a bipartisan letter signed by 229 Congressional lawmakers – led by Reps. Larry Bucshon, MD (IN-8) and Ami Bera (CA-7) – urging House leadership to take action to prevent or mitigate significant provider payment cuts included in the Medicare Physician Fee Schedule (PFS) Proposed Rule for 2021.

“Over the past eight months, specialty providers have grappled with historic operational and financial challenges, which have made it increasingly difficult to remain sustainable,” said Jeffrey Carr, MD, a CVC member. “As the COVID-19 pandemic continues into next year, saddling already beleaguered providers with steep payment cuts will only serve to destabilize America’s healthcare marketplace and undermine patient access to critical care services.”

Issued on August 3rd, the PFS Proposed Rule for CY2021 would impose deep payment cuts to 33 specialty providers – including “vascular surgery,” “cardiac surgery,” and “interventional radiology” – in 2021. Specifically, Medicare plans to cut “vascular surgery” by seven percent (-7%), “cardiac surgery,” by nine percent (-9%) and “interventional radiology” by nine percent (-9%).

As the letter notes, “specialists now face substantial cuts beginning on January 1, 2021, if Congress does not act before the end of the year. Payment cuts of this magnitude will surely strain a health care system that is already stressed by the COVID-19 pandemic and could jeopardize patient access to medically necessary services.”

“We commend these lawmakers for fighting on behalf of specialty care providers and the patients they serve,” Carr concluded. “We urge House leadership to take immediate action to protect this critical pillar of America’s healthcare infrastructure.”

To read the Bucshon-Bera letter, CLICK HERE.

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The Amputation Reduction and Compassion (ARC) Act aims to prevent amputations by expanding Medicare and Medicaid coverage for PAD and establishing a PAD education program

Washington, D.C. – Today the CardioVascular Coalition (CVC) – a coalition of physicians, care providers, advocates, and manufacturers working to improve awareness and prevention of peripheral artery disease (PAD) – thanked Representative Donald Payne, Jr. (D-NJ) for his exemplary leadership and commitment to addressing the inequities and health disparities plaguing our healthcare system by introducing The Amputation Reduction and Compassion (ARC) Act (H.R. 8615).

If passed, the ARC Act would expand Medicare and Medicaid coverage to include PAD screening tests, while also preventing reimbursement for amputation without the prior arterial testing that could potentially mitigate complications and prevent amputation. In addition to expanding access to PAD screening tests, the ARC Act would establish a program to help develop, support, and implement educational initiatives that inform health care professionals and the public about the existence of peripheral artery disease and the importance of early detection.

The ARC Act demonstrates Rep. Payne’s continued dedication to creating an equitable healthcare system, which began when he co-founded the Congressional PAD Caucus with Rep. Gus Bilirakis (R-FL) in April 2019. The PAD Caucus seeks to educate Congress about PAD while supporting legislative activities to improve PAD research, education, and treatment.

Providing adequate healthcare for vulnerable individuals is essential, particularly those most at risk for PAD. Today, an estimated 21 million Americans have PAD, and an estimated 200,000 of them are at risk of undergoing a lower limb amputation because of late detection. The vulnerable individuals at risk of lower limb amputation are disproportionately racial and ethnic minorities. In particular, Black Americans are up to four times more likely to undergo an amputation than their Caucasian counterparts. Native Americans are more than twice as likely to be subjected to amputation, and Hispanic Americans are up to 75 percent more likely to have an amputation.

The ARC Act will fill the policy gap that allows these inequities to fester by increasing access to preventive screening and providing education to improve the early detection rate and prevent thousands of vulnerable beneficiaries from undergoing unnecessary amputations every year.

“We applaud Congressman Payne for his persistent leadership in addressing our nation’s health disparities and developing policy solutions to measurably prevent amputation,” said Dr. Eric J. DeLaura, an interventional radiologist and Medical Director of Image Guided Surgery & Aesthetics in Union, NJ. “We are now urging Congress to quickly pass the ARC Act and prevent thousands of Americans from undergoing needless amputation.”

Rep. Payne is co-sponsoring the ARC Act alongside Reps. Bobby Rush (IL-1) and Ruben Gallego (AZ-7).

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H.R. 8505 would block severe payment cuts to over 30 healthcare specialties including vascular surgery, cardiac surgery, interventional radiology and  interventional cardiology

Washington, D.C. –– The CardioVascular Coalition (CVC) – a consortium of physicians, care providers, advocates, and manufacturers working to improve awareness and prevention of peripheral artery disease (PAD) – today praised House lawmakers for introducing H.R. 8505. The bipartisan bill, sponsored by Reps. Michael Burgess (TX-26) and Bobby Rush (IL-1) is intended to prevent severe Medicare reimbursement cuts to a slew of specialty providers from going into effect on January 1, 2021. By waiving budget neutrality rules for one year, the legislation would allow the Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) to allow scheduled evaluation and management (E/M) increases to go into effect without requiring Medicare to curtail reimbursements from 33 specialty providers, including vascular surgery, cardiac surgery, interventional radiology and interventional cardiology.

According to the CY2021 Physician Fee Schedule proposed rule issued in early August, CMS intends to cut vascular surgery by seven percent (-7%), cardiac surgery, by nine percent (-9%) and interventional radiology by nine percent (-9%) as well as interventional cardiology in order to offset the costs involved with increasing increases to E/M services. Unless Congress waives Medicare’s budget neutrality requirement, the deep cuts will go into effect on January 1, drastically increasing the financial strain that specialty providers face as they continue to deal with the fallout stemming from the ongoing COVID-19 public health emergency. In turn, the cuts threaten to seriously reduce Medicare beneficiaries’ access to these critical services—an outcome that would be devastating for America’s seniors.

“Patient access is paramount for proper treatment and amputation prevention for individuals with peripheral artery disease (PAD),” said Dr. Jeffrey Carr co-founder of the Outpatient Endovascular and Interventional Society (OEIS) and a member of the CVC. “At a time when the entire healthcare system is under unprecedented strain from the COVID-19 pandemic, it is completely irresponsible for CMS to push forward with severe specialty cuts that threaten to undermine Medicare beneficiaries’ access to dozens of critical services.”

“We applaud Reps. Burgess and Rush for their commitment to ensuring America’s seniors continue uninterrupted access to specialty care, and urge Congress to quickly pass the bipartisan H.R. 8505,” continued Dr. Carr.

A substantial number of bipartisan lawmakers have voiced concerns about Medicare’s proposed cuts and have called for budget neutrality requirements to be waived. In late September, more than 160 lawmakers, led by Representatives Roger Marshall (KS-1) and Bobby Rush (IL-1), sent a letter to CMS expressing deep concern about slashing support to specialty providers during the COVID-19 public health emergency.

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Reps. Donald Payne, Jr., Bobby Rush and Ruben Gallego introduce Amputation Reduction and Compassion (ARC) Act to expand coverage for PAD screening and intervention

Washington, D.C. –– The CardioVascular Coalition (CVC) – a consortium of physicians, care providers, advocates, and manufacturers working to improve awareness and prevention of peripheral artery disease (PAD) – today commended Reps. Donald Payne, Jr. (NJ-10), Bobby Rush (IL-1) and Ruben Gallego (AZ-7) for introducing a bill to reduce amputations while increasing education and testing for PAD. If passed, the Amputation Reduction and Compassion (ARC) Act (H.R. 8615) would provide coverage of PAD screening for at-risk beneficiaries under the Medicare and Medicaid programs without the imposition of cost-sharing requirements.

By expanding coverage for PAD screening such as the ankle-brachial index test for at-risk beneficiaries, the bill would help prevent vulnerable individuals from developing serious complications from PAD, which can lead to lower limb amputation. While an estimated 20 million Americans have PAD, many are unaware of the serious risks of the disease and are not encouraged to undergo preventative tests that could improve patient outcomes and reduce costs to the healthcare system. Unfortunately, an estimated 200,000 patients – a disproportionate number of whom are minorities – suffer avoidable amputations every year as a result of PAD.

The bill would prohibit the use of amputation without the completion of arterial testing to determine if alternative interventions could be applied. It would also establish a PAD education program to support, develop, and implement educational initiatives that inform health care professionals and the public about the existence of peripheral artery disease and methods to reduce amputations, particularly with respect to at-risk populations, such as racial and ethnic minorities who are more likely to face non-traumatic amputation than whites.

“By expanding coverage for simple, non-invasive screening tests, we have the power to help thousands of Americans avoid unnecessary amputations every year,” said Dr. Jeffrey Carr co-founder of the Outpatient Endovascular and Interventional Society (OEIS) and a member of the CVC. “We commend Reps. Payne, Rush and Gallego for introducing his critical legislation, which will go a long way toward saving lives and reducing racial and ethnic disparities in healthcare. With these goals in mind, we urge Congress to quickly pass the ARC Act.”

According to the Dartmouth Atlas, amputation risks for African Americans living with diabetes are as much as four times higher than the national average. Data analyses have similarly found that Native Americans are more than twice as likely to be subjected to amputation and Hispanics are up to 75 percent more likely to have an amputation.

“We look forward to working collaboratively with Reps. Payne, Rush and Gallego, and advocates across our profession, to build support for this pro-patient legislation, which is a giant step forward for the patients we serve and others at risk for PAD,” added Carr.

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Advocates call for policies to block planned specialty provider cuts before January 2021

Washington, DC – The CardioVascular Coalition (CVC), a leading group of providers, physicians, and manufacturers, today urged lawmakers in Congress to support policies to improve peripheral artery disease (PAD) screening, diagnoses and treatment to reduce unnecessary lower limb amputations in recognition of PAD Awareness Month.

Specifically, CVC is asking Congress to advance legislation to block planned Medicare payment cuts to specialty providers in 2021. In the Medicare Physician Fee Schedule (MPFS) Proposed Rule for 2021, the Centers for Medicare & Medicaid Services (CMS) plans to deeply cut payments to specialty providers – “vascular surgery” by seven percent (-7%), “cardiac surgery,” by nine percent (-9%) and “interventional radiology” by nine percent (-9%).

To mitigate these cuts, Congress must take steps to ensure Medicare waives the budget neutrality requirements for the E/M codes scheduled for implementation on January 1, 2021 in any relevant or upcoming legislation.

“As we recognize PAD Awareness Month this September, we urge policymakers to stop these harmful payment cuts to the specialty providers who screen, diagnose and perform interventional care to prevent limb loss,” said Dr. Jeffrey Carr, founding and past president of the Outpatient Endovascular and Interventional Society (OEIS) and a member of the CVC. “CMS should not proceed with any specialty provider cuts while we are in the middle of a public health crisis. Doing so will be harmful to both vulnerable older Americans and their healthcare providers.”

Bipartisan lawmakers agree. Last month a group of 93 House lawmakers sent a letter to House leadership asking them to waive budget neutrality in any relevant or upcoming legislation for Calendar Years 2021 and 2022 for the E/M codes scheduled for implementation on January 1, 2021.

Further, the CVC applauds efforts supported by the Congressional PAD Caucus, chaired by Congressmen Donald Payne, Jr. (D-NJ) and Gus Bilirakis (R-FL). The CVC is also a member of the PAD Task Force – alongside the Association of Black Cardiologists, Preventative Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions and Society of Interventional Radiology – which came together to advance a comprehensive strategy that combines increased public awareness and robust screening with non-amputation treatment measures and multidisciplinary care.

According to estimates, PAD affects nearly 20 million Americans and is responsible for 80 percent of the 200,000 non-traumatic limb amputations that take place in the U.S. each year. These non-traumatic amputations often occur without any diagnostic testing, meaning PAD patients are losing limbs before they receive testing to determine if limb-saving treatments are an option.

PAD is exacerbated by conditions like diabetes, chronic hypertension, and renal disease, which are most prevalent in minority populations. Access to revascularization therapies is especially vital to the African American, Hispanic and Native American populations who are two to four times more likely to undergo a limp amputation due to PAD because of increased prevalence of diabetes, obesity and other risk factors.

To learn more about PAD and PAD Awareness Month, CLICK HERE.

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A bipartisan group of U.S. House members are asking congressional leaders to quash a Medicare payment change that could cost radiology billions in the years to come.

Spearheaded by Rep. Bobby Rush, D-Ill., the 92 lawmakers want Congress to waive budget-neutrality requirements stemming from a proposed pay increase for office-based evaluation and management services in 2021. Absent such a decision, the imaging industry stands to lose some $10 billion over the next decade, advocates estimate.

Click here to read the full article on the Radiology Business website. 

Lawmakers call for policies to waive budget neutrality requirements in E/M codes and block planned specialty provider cuts before January 2021 

WASHINGTON – The CardioVascular Coalition (CVC) – a consortium of physicians, care providers, advocates, and manufacturers working to improve awareness and prevention of peripheral artery disease (PAD) – today commended Congressman Bobby Rush (IL-1) and 92 of his bipartisan colleagues in the U.S. House for sending a letter to House leaders asking them to waive budget neutrality in any relevant or upcoming legislation for Calendar Years 2021 and 2022 for the E/M codes scheduled for implementation on January 1, 2021.

“If these cuts go into effect, they will be devastating for providers and will ultimately result in decreased access to care for patients.  Our healthcare system is already under tremendous financial strain, as it continues to grapple with both the economic and health consequences of the coronavirus. Now is not the time to implement these reckless cuts,” the bipartisan lawmakers write.

In the Medicare Physician Fee Schedule (MPFS) Proposed Rule for CY2021 issued on August 3, the Centers for Medicare & Medicaid Services (CMS) plans to deeply cut payments to specialty providers – including “vascular surgery,” “cardiac surgery,” and “interventional radiology” – in 2021. Specifically, Medicare plans to cut “vascular surgery” by seven percent (-7%), “cardiac surgery,” by nine percent (-9%) and “interventional radiology” by nine percent (-9%).

“We ask that, in any upcoming and relevant legislation moving through the House, you waive budget neutrality for Calendar Years 2021 and 2022 for the E/M codes scheduled for implementation on January 1, 2021 as described in the final rule (84. Fed. Reg. 62568, 62847-62860),” the lawmaker letter continues.

The CVC stressed that the impact of such deeps cuts would be magnified as a result of the COVID-19 public health emergency (PHE), particularly on minority populations who are at greatest risk for peripheral artery disease (PAD) and other forms of vascular disease, and whom have already suffered disproportionately from the COVID-19 crisis.

“We applaud Congressman Rush for his leadership on this issue and thank all 93 bipartisan lawmakers for lending their names to this important patient care issue,” said Dr. Jeffrey Carr, founding and past president of the Outpatient Endovascular and Interventional Society (OEIS) and a member of the CVC. “CMS should not proceed with any specialty provider cuts while we are in the middle of a public health crisis. Doing so will be harmful to both vulnerable older Americans and their healthcare providers.”

To read the letter to House leadership, click here.

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Congressional action needed to waive budget neutrality requirements in E/M codes and block planned specialty provider cuts before January 2021

WASHINGTON – The CardioVascular Coalition (CVC) – a consortium of physicians, care providers, advocates, and manufacturers working to improve awareness and prevention of peripheral artery disease (PAD) – today expressed disappointment in the Centers for Medicare & Medicaid Services (CMS) proposal to deeply cut Medicare payment for specialty providers – including “vascular surgery,” “cardiac surgery,” and “interventional radiology” – contained in the proposed Physician Fee Schedule Proposed Rule for CY2021. If finalized as proposed, these specialties will be cut by seven to nine percent in 2021.

According to the CVC, now is not the time for severe Medicare cuts on specialties providers who frequently care for patients living with vascular disease, including PAD, which disproportionally impacts African Americans and other minority populations who have been hardest hit by the COVID-19 pandemic. If left untreated with proper vascular intervention, PAD can result in lower-limb amputation.

“We are deeply disappointed in the agency’s proposal, which hits specialty providers at a time when we are already operating under severe financial stress due to the current public health crisis. Now is not that time to inflict new payment cuts,” said Dr. Jeffrey Carr, founding and past president of the Outpatient Endovascular and Interventional Society (OEIS) and a member of the CVC.

Lawmakers and healthcare stakeholders alike oppose these significant cuts.

In May, dozens of bipartisan members of the U.S. House of Representatives sent a letter to Congressional leaders asking them to include a waiver for the budget neutrality requirements included in the 2019 “evaluation and management” (E/M) code rule in any relevant legislation moving through Congress. By waiving the budget neutrality requirements, Congress can prevent the specialty cuts from taking effect while still allowing for the E/M payment increases.

In a letter sent on June 18 to congressional leaders, the CVC and more than a hundred stakeholder groups urged Senate Majority Leader Mitch McConnell and House Speaker Nancy Pelosi to help stop harmful payment cuts to specialty healthcare providers, including vascular and cardiac surgery. The CVC, alongside the American Medical Association and hundreds of other specialty provider groups, have advocated for Congress to stop the pending Medicare cuts to specialty providers by waiving budget neutrality for the E/M code proposal for 2021.

“We will now work with lawmakers in Congress to stop these potentially harmful cuts by securing provisions in future legislation to waive the budget neutrality requirement driving this cut, while also allowing increases to the E/M codes to go into effect,” added Carr.

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PAD Task Force urges lawmakers to join Congressional PAD Caucus to advance policies to improve access to screening for at-risk populations and reduce preventable amputations

WASHINGTON – Members of the Peripheral Artery Disease (PAD) Task Force – including the Association of Black Cardiologists, CardioVascular Coalition, Preventative Cardiovascular Nurses Association and Society for Cardiovascular Angiography and Interventions – today welcomed the Society of Interventional Radiology (SIR). The PAD Task Force, originally formed in 2018, came together to advance a comprehensive strategy that combines increased public awareness and robust screening with non-amputation treatment measures and multidisciplinary care.

The Society of Interventional Radiology is a national organization of physicians, scientists and allied health professionals dedicated to improving public health through the use of minimally invasive therapeutic interventions for disease management, including PAD. SIR supports “legislative activities to raise awareness and improve the treatment of PAD.”

PAD is a limb-threatening circulatory condition, that when left undiagnosed and untreated can result in lower-limb amputation. It is exacerbated by conditions like diabetes, chronic hypertension, and renal disease, which are most prevalent in minority populations. According to estimates, PAD results in as many as 200,000 amputations annually in the United States. These non-traumatic amputations often occur without any diagnostic testing, meaning PAD patients are losing limbs before they receive the testing to determine if limb-saving treatments are an option.

In 2019, Congressmen Donald Payne, Jr. (D-NJ) and Gus Bilirakis (R-FL) formed the Congressional PAD Caucus to educate Congress and communities about PAD. Key priorities for the caucus include:

• Increasing funding to raise awareness about PAD;
• Improving access to PAD screening; and
• Disallowing non-traumatic amputations without anatomical testing.

“We look forward to working with Congressmen Payne and Bilirakis, and members of the PAD Task Force,  to call attention to the devastating impact of PAD on communities across the country and advance a comprehensive strategy to combat PAD and reduce amputations in the United States that includes increased awareness of peripheral artery disease, increased screenings for at risk populations, and the avoidance of amputation of limbs without anatomical imaging,” said Michael D. Dake, MD, FSIR, SIR president and senior vice president of the University of Arizona Health Sciences in Tucson.

The PAD Task Force notes that its concerns around PAD are not restricted to government programs and urges private payers as well to adopt policies to raise awareness about PAD, improve access to PAD screening, and disallow non-traumatic amputations without anatomical testing.

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Amid the escalating volume of patients with COVID-19 in hospitals, doctors recently noticed something puzzling: the typical volume of patients with symptoms of heart attack, stroke, appendicitis, and other emergent or urgent health problems were no longer seeking care as frequently. As much as we wish that Americans are no longer suffering from these serious conditions, the reality is that these “missing” patients likely did not seek or have adequate access to care.

It’s an interesting (and somewhat frightening) byproduct of the coronavirus pandemic. Although health officials have been successful in keeping hospital inpatient beds and emergency departments open for surges of COVID-19 patients, some Americans who desperately need care are delaying it — or going without it altogether.

This situation is distressing, particularly for the estimated 20 million Americans suffering from limb-threatening conditions, such as peripheral artery disease, that require prompt intervention to prevent lower limb amputation. But the COVID-19 emergency, paired with looming Medicare cuts approved late last year, has created a uniquely troubling situation for Americans who need revascularization procedures — and the providers who care for them.

Click here to read the full article on the MedPage Today website.

IT WAS A FRIDAY EVENING in the hospital after a particularly grueling week when Dr. Foluso Fakorede, the only cardiologist in Bolivar County, Mississippi, walked into Room 336. Henry Dotstry lay on a cot, his gray curls puffed on a pillow. Fakorede smelled the circumstances — a rancid whiff, like dead mice. He asked a nurse to undress the wound on Dotstry’s left foot, then slipped on nitrile gloves to examine the damage. Dotstry’s calf had swelled to nearly the size of his thigh. The tops of his toes were dark; his sole was yellow, oozing. Fakorede’s gut clenched. Fuck, he thought. It’s rotten.

Fakorede, who’d been asked to consult on the case, peeled off his gloves and read over Dotstry’s chart: He was 67, never smoked. His ultrasound results showed that the circulation in his legs was poor. Uncontrolled diabetes, it seemed, had constricted the blood flow to his foot, and without it, the infection would not heal. A surgeon had typed up his recommendation. It began: “Mr. Dotstry has limited options.”

Click here to read the full article on the ProPublica website.

CVC urges USPSTF to update PAD screening recommendations to include at-risk populations to prevent amputation, reduce healthcare costs, and eliminate racial disparities

WASHINGTON – The CardioVascular Coalition (CVC), a consortium of physicians, care providers, advocates, and manufacturers working to improve awareness and prevention of peripheral artery disease (PAD), released a new white paper urging the United States Preventative Services Task Force (USPSTF) to revisit its PAD screening recommendation guidelines. The white paper, Mind the Gap: The Case for Screening High-Risk Communities for PAD, argues recommendations should be updated to ensure Americans at high risk of developing the disease have better access to screening, which has been shown to significantly improve patient outcomes by preventing amputation.

The USPSTF has consistently found “insufficient evidence to assess the balance of benefits and harms” of the ankle-brachial index (ABI) screening methodology. However, this assessment is flawed because the USPSTF focused its guidelines on PAD screening for the general population (i.e. Americans of all ages, ethnic and racial backgrounds, socioeconomic status, and health histories), while ignoring the increased risk factors that certain populations face. This conclusion makes it significantly less likely that minorities, people with a history of diabetes or cardiovascular disease, and individuals in high-risk communities will be screened for PAD until it is too late to save their limbs.

Screening and early detection has been shown to reduce the probability of an amputation due to PAD by 90 percent but is greatly underutilized, as only 12.5 percent of patients with PAD are identified by physicians and treated. Overall, a majority of the estimated 200,000 annual non-traumatic amputations that occur in the United States every year can be avoided with the proper care.

Across the country, approximately 20 million Americans have been diagnosed with PAD, including 1 in 20 Americans over the age of 50. When common risk factors such as diabetes and nicotine use are included in the analysis of prevalence, as many as one-third of patients are estimated to suffer from the disease. Similarly, more than 30 million Americans with diabetes and an additional 84.1 million Americans with prediabetes are at an elevated risk of developing PAD in their lifetimes.

Moreover, a growing body of research shows that ethnic and racial minorities have a substantially greater risk of developing PAD and requiring amputations than their white counterparts. For example, African American patients with diabetes are more than three times as likely to have their limbs surgically removed than their white counterparts. Native Americans in the western U.S. are twice as likely to suffer from PAD than white Americans, while Hispanics are 75 percent more likely to develop the disease. While all older Americans tend to be more susceptible to PAD than younger Americans, elderly patients of color suffer from a disproportionately high rate of PAD.

In the white paper, CVC urges the USPSTF to revisit its recommendation on PAD screening and review the data as it relates to PAD screening for at-risk populations, including those with a history of smoking, diabetes, and other cardiovascular diseases. By recognizing that at-risk populations are more vulnerable to PAD than the general population, USPSTF should seize the opportunity to improve patient outcomes, reduce long-term healthcare costs, and eliminate racial disparities in the cardiovascular space.

To read Mind the Gap: The Case for Screening High-Risk Communities for PAD, click here.

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Because diabetes is a primary risk factor for PAD, patient education and screening of at-risk populations is critical to reducing lower limb amputations

WASHINGTON – In recognition of American Diabetes Month, which starts on November 1, the Cardiovascular Coalition (CVC), a consortium of physicians, care providers, advocates, and manufacturers working to improve awareness and prevention of peripheral artery disease (PAD), encourages Americans living with diabetes and pre-diabetes to learn more about their risks for PAD.

More than 30 million Americans with diabetes and an additional 84.1 million Americans with prediabetes are at an elevated risk of developing PAD, which causes severe leg pain and often leads to multiple complications including gangrene, diabetic foot ulcers, and amputation if left untreated. PAD, which causes an estimated 85 percent of the 200,000 non-traumatic limb amputations in the U.S. each year, disproportionally impacts minority populations. It is caused by a build-up of fatty deposits in a person’s arteries over time and because high blood glucose can damage blood vessels, diabetes is considered a primary risk factor for PAD.

Early PAD screening among at-risk populations has been shown to reduce the probability of an amputation resulting from PAD by 90 percent, but is greatly underutilized as only 12.5 percent of PAD cases are identified by doctors and treated. Overall, many of the non-traumatic amputations that occur in the United States each year could be avoided with the proper clinical intervention and treatment.

Unfortunately, screening for PAD is still not commonplace, even amongst at-risk patients. Despite the clear risks, the U.S. Preventative Services Task Force (USPSTF) released guidelines that conclude “the current evidence is insufficient to assess the balance of benefits and harms of screening for peripheral artery disease and cardiovascular disease risk with the ankle-brachial index (ABI) in asymptomatic adults.” Unfortunately, by making recommendations for the general public—as opposed to at-risk individuals and communities— the USPSTF’s guidelines do a disservice to at-risk patients.

Instead, the American College of Cardiology and American Heart Association joint practice guidelines recommend PAD screening for high-risk patients.

Lawmakers in Congress are also drawing attention to the importance of understanding PAD. Earlier this year, bipartisan lawmakers in the U.S. House of Representatives launched a Congressional PAD Caucus to educate Congress and communities about PAD while supporting legislative activities to improve PAD research, education, and treatment, with the goal of preventing non-traumatic amputations due to PAD and other related diseases.  As part of their policy agenda to support our goal of preventing amputations, the caucus is urging the USPSTF to review screening for PAD for at-risk patients.

“In recognition of American Diabetes Month, Americans with diabetes and prediabetes are encouraged to talk to their doctor about their risks for PAD, which can help them avoid dangerous complications including amputation,” said Dr. Jeffrey Carr, MD, FACC, founding and immediate past president of the Outpatient Endovascular and Interventional Society and a member of the CVC . “We look forward to working with lawmakers in the Congressional PAD Caucus to advance policies that ensure patient access to clinically appropriate PAD care to prevent limb loss, improve lives, and reduce healthcare costs.”

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