Category Archives: Coalition News

PAD Task Force Commends Reintroduction of ARC Act in the U.S. in Recognition of National Minority Health Month

H.R. 2631 will increase education and screening for at-risk populations in order to reduce limb loss

WASHINGTON – Members of the Peripheral Artery Disease (PAD) Task Force – including the Association of Black Cardiologists (ABC), CardioVascular Coalition, CLI Global Society, Preventative Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions and Society of Interventional Radiology – today commended introduction of the Amputation Reduction and Compassion (ARC) Act (H.R. 2631), legislation intended to reduce unnecessary amputations due to peripheral artery disease. The bill, introduced by Representative Donald Payne, Jr. (NJ-10) along with original co-sponsors Representatives Jeff Van Drew (R-NJ), Bobby Rush (D-IL), Ruben Gallego (D-AZ), Mark Takano (D-CA), Raul 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), provides coverage of PAD screening for at-risk beneficiaries under the Medicare and Medicaid programs without the imposition of cost-sharing requirements.

In order to encourage appropriate screening and early detection of dangerous complications, the ARC Act further disallows payment for non-emergent amputations – unless anatomic testing has been done in the three months prior to amputation. The legislation also provides resources for a PAD education program to support, develop, and implement educational initiatives that inform health care professionals and the public about PAD- as well as methods to reduce amputations, particularly with respect to at-risk populations including racial and ethnic minorities.

“The ARC Act is a historic intervention destined to alter the cardiovascular health outcomes of at-risk PAD patients and address the virulent practice of PAD-related amputations,” Foluso Fakorede, MD, Co-chair of the ABC PAD Initiative. “The ABC welcomes this bipartisan effort and implementation of policy action in hopes of achieving genuine health equity.”

“With the introduction of the ARC Act, and in recognition of National Minority Health Month, we have the opportunity to expand coverage for simple, non-invasive screening tests that will empower patients to take steps to manage their peripheral artery disease before amputation becomes necessary,” said Dr. Jeffrey Carr co-founder of the Outpatient Endovascular and Interventional Society (OEIS) and a member of the CardioVascular Coalition.

“The ARC Act constitutes an important step towards preventing unnecessary amputations related to PAD,” said Dr. Lola Coke, a cardiovascular clinical nurse specialist with the Preventive Cardiovascular Nurses Association. “By expanding coverage for screening tests and supporting public and provider education especially in high risk patients like chronic smokers and diabetics, we have the opportunity to minimize the progression of the disease and save limbs for those diagnosed with PAD.“

“Approximately 20 million Americans have peripheral artery disease (PAD) and an estimated 200,000 of them – disproportionately from minority communities – suffer unnecessary amputations every year. The Society for Cardiovascular Angiography and Interventions (SCAI) supports this bill because we believe 200,000 is too many,” said Joaquin Cigarroa, MD, SCAI Government Relations Committee chair.   

“Patients deserve to know and have access to all treatment options. With non-invasive screenings, the ARC Act will empower patients to make informed decisions about their peripheral artery disease treatment. The earlier we are able to catch and treat PAD, the more likely we are able to avoid amputations and preserve patients’ quality of life,” said SIR President Matthew S. Johnson, MD, FSIR, an interventional radiologist and Gary J. Becker Professor of Radiology Research at Indiana University School of Medicine in Indianapolis.

Minority populations in the U.S. are at disproportionately higher risk for amputations from PAD. According to data compiled by the Dartmouth Atlas of Health Care, Black Americans are over three times more likely than Whites to experience a non-traumatic amputation as a result of diabetes, a common PAD risk factor. Similarly, Native Americans are more than twice as likely to be subjected to amputation, while Hispanics are up to 75 percent more likely to have an amputation.

Congressmen Donald Payne, Jr. (D-NJ) and Gus Bilirakis (R-FL) formed the Congressional PAD Caucus in 2019 to educate Congress and communities about PAD in order to ensure increased PAD awareness, better access to PAD screening, and the prevention of non-traumatic amputations through the use of anatomical testing.

The PAD Task Force, originally formed in 2018, came together to advance strategies to increase public awareness and robust screening to ensure non-amputation treatment measures through a multidisciplinary team care approach.  The PAD Task Force notes that its concerns around PAD are not restricted to government programs and urges private payers to also adopt policies to raise awareness about PAD, improve access to PAD screening, and disallow non-traumatic amputations without anatomical testing.

PAD is a limb-threatening circulatory condition, which 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 disproportionately 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, which indicates that many PAD patients are losing limbs before they receive the appropriate testing to determine if limb-saving treatments are an option.

To learn more about the ARC Act, click here.

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CardioVascular Coalition Applauds Introduction of Bipartisan Bill to Prevent Amputations, Increase PAD Screening & Improve Education

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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CardioVascular Coalition Applauds Bipartisan Congressional Letter Urging National Effort to Prevent Amputations

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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CardioVascular Coalition Thanks Congress for Easing Specialty Payment Cuts

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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CardioVascular Coalition Expresses Concern with CMS Decision to Finalize Deep Cuts to Specialty Services Despite COVID-19 Pandemic, Widespread Opposition

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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Vascular Care Leaders Commend Lawmakers for Supporting Legislation to Address Dramatic Payment Cuts in 2021 Medicare Physician Fee Schedule Rule

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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CVC Urges Lawmakers to Support Peripheral Artery Disease (PAD) Testing and Education During American Diabetes Month

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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CardioVascular Coalition Commends Bipartisan Congressional Letter to House Leadership Urging Action on Pending Healthcare Cuts

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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Vascular Care Leaders Applaud Rep. Donald Payne, Jr. for Introducing Bill to Address Health Inequities in Peripheral Artery Disease

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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CVC Commends Introduction of Bipartisan Bill to Protect Specialty Care from Severe Medicare Reimbursement Cuts

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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CardioVascular Coalition Applauds Introduction of Legislation to Reduce Amputations, Improve Peripheral Artery Disease Awareness & Screening

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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CardioVascular Coalition Urges Congress to Support Limb Loss Prevention During Peripheral Artery Disease (PAD) Awareness Month

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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Radiology Business: Quash ‘reckless’ Medicare cuts that could cost radiology billions, lawmakers urge Congress

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. 

CardioVascular Coalition Commends Congressman Bobby Rush for Leading Effort of 93 Bipartisan Lawmakers to Block Medicare Specialty Cuts

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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CardioVascular Coalition Warns Deep Cuts to Specialty Services in Physician Fee Schedule Proposed Rule Will Restrict Patient Access to Limb-Saving Interventions

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 Welcomes Society of Interventional Radiology

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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AJMC: Why Amputations Are on the Rise in Some States, Even as Diabetes Care Improves

The last decade has brought great strides in diabetes care. Better insulins and better technology can allow people with diabetes—both type 1 and type 2—to keep their blood sugar from rising and falling in ways that cause long-term damage to their eyesight and vascular systems. New classes of drugs for patients with type 2 diabetes have been shown to cut the risk of heart and renal failure, and more widespread use could help some patients avoid dialysis.

But the good news is not felt by everyone. Amid this progress, the rate of amputations rose 50% between 2009 and 2015. African American patients lose limbs at triple the rate of other groups.

The mission of the Affordable Care Act—spend more to prevent disease and complications, and save money later—has bypassed many of these patients for one reason: they lack access to care. Fourteen states have not expanded Medicaid, including several Deep South states where diabetes and obesity rates are highest.

The result of these state-level policy decisions is becoming clear. Research presented at the recent meeting of the American Diabetes Association found a 17% decrease in the risk of amputation when patients lived in states that expanded Medicaid. What’s more, the number of hospital admissions for diabetic foot ulcers plummeted in states that expanded Medicaid, while rising 21% in states that rejected expansion.

None of this is news to Foluso Fakorede, MD, who treats patients at risk of limb loss in the Mississippi Delta. Fakorede spoke with The American Journal of Managed Care® about his work in Mississippi, through his practice, Cardiovascular Solutions of Central Mississippi.

Click here to see the full interview on the AJMC website. 

ProPublica Reporting Underscores Need for Improved PAD Screening for African Americans

CVC working collaboratively with bipartisan lawmakers to advance policies to improve access to screening for at-risk populations and reduce preventable amputations

WASHINGTON – The CardioVascular Coalition – a coalition of stakeholders and advocates created to improve awareness, prevention, and intervention of vascular disease including peripheral artery disease (PAD) – today stressed the importance of policies to support access to clinically appropriate PAD screening and treatment for America’s most at-risk patient populations in response to a new report, The Black American Amputation Epidemic, published by ProPublica.

The article profiles a community in the Mississippi Delta – primarily home to minority communities – and  the challenges individuals face accessing PAD screening and treatment, which results in the proliferation of unnecessary lower-limb amputations across the country.  The article highlights the need for the United States Preventive Services Task Force (USPSTF) to change their guidelines to recommend PAD screening of at-risk population. By recognizing that at-risk populations are more vulnerable to PAD than the general population, USPSTF could help to improve patient outcomes, reduce long-term healthcare costs, and eliminate racial disparities in PAD care.

Bipartisan lawmakers in Congress are also giving this issue attention. 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 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. Key priorities for the caucus include:

  • U.S. Preventive Services Task Force should review screening for PAD for at-risk patients;
  • The Administration should form an intragovernmental work group to implement a comprehensive amputation prevention program for PAD patients in Medicare, the IHS and other federal programs;
  • Medicare should incentivize multidisciplinary review of PAD patients in Medicare; and
  • Medicare should disallow non-traumatic amputations without arterial testing.

CVC is also a member of the PAD Task Force, which was formed in 2018 to advance a comprehensive strategy that combines increased public awareness and robust screening with non-amputation treatment measures and multidisciplinary care.

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.

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MedPage Today: COVID Could Cost Life and Limb — Literally

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.

Clarion Ledger: Amputations are soaring in the Delta among Black diabetics. One doctor is trying to end it

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.  F—, 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 see the full article on the Clarion Ledger website.

Mississippi Today: The black American amputation epidemic: Black patients losing limbs at triple the rate of others

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.

Click here to see the full article on the Mississippi Today website.

ProPublica: The Black American Amputation Epidemic

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.

National Kidney Month: Vascular Care Community Stresses PAD Risks in Patients with Chronic Kidney Disease

Minority populations with CKD are at a much higher risk than the general population of developing peripheral artery disease (PAD)

WASHINGTON – The Cardiovascular Coalition (CVC), a coalition of cardiovascular and endovascular care providers, physicians and manufacturers created to improve awareness, prevention, and intervention of vascular disease, urges increased awareness for kidney health and better understanding of related health conditions including Peripheral Artery Disease (PAD) in recognition of National Kidney Month.

Chronic Kidney Disease (CKD) is the ninth leading cause of death in the United States affecting an estimated 30 million American adults, a number that has been on the rise. Studies have shown that PAD is especially prevalent in patients with CKD, more so than the general population. PAD causes narrowing or blockage of the vessels that carry blood from the heart to the legs and other extremities and can eventually lead to amputation, if left untreated.

In the United States, approximately 20 million Americans have been diagnosed with PAD. Much like CKD, PAD disproportionately affects racial minorities due to higher prevalence of diabetes, limited access to appropriate clinical intervention and other underlying risk factors. The most at-risk groups for developing CKD, and eventually kidney failure, include African Americans, Hispanic and Native Americans, Pacific Islanders, and seniors. Similarly, elderly patients of color suffer from a disproportionately high rate of PAD.

“Understanding the correlation between PAD and CKD is especially critical for older Americans who often suffer from multiple comorbidities including hypertension and diabetes, which represent two of the most significant risk factors for these chronic conditions,” said Jeffrey G. Carr, MD, FACC. “I commend educational efforts to address general awareness and understanding of both CKD and PAD, especially by lawmakers in Congress who are ushering in policy change through both the Congressional Kidney Caucus and Congressional PAD Caucus.”

Studies have shown that patients with CKD are less likely to receive ‘optimal’ PAD care, underscoring the need for increased understanding of PAD by all stakeholders. Without the proper clinical care, PAD can lead to non-traumatic lower limb amputations, which data show lead to lower quality of life, increased mortality and higher healthcare costs.

“We look forward to our continued work with community stakeholders and bipartisan leaders in Congress to create a better understanding of PAD as well as public policies that encourage and support access to clinically-appropriate PAD screening and intervention, especially among our nation’s most at risk populations,” added Carr.

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CardioVascular Coalition Commends Congress for Inclusion of Peripheral Artery Disease Language in End-of-Year Appropriations Package

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 lawmakers in Congress for including language specific to peripheral artery disease education and awareness in Congress’ year-end legislative package. The appropriations language encourages the Centers and Disease Control and Prevention (CDC) to specifically focus on PAD.

The provision reads, “Peripheral Arterial Disease (PAD). – The agreement encourages CDC to support education and awareness activities that promote early diagnosis of PAD.”

Across the country, approximately 20 million Americans have been diagnosed with PAD, including 1 in 20 Americans over the age of 50. PAD is a vascular disease, which left undiagnosed and untreated can lead to lower limb amputation. 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.

Earlier this year, Congressman Payne – alongside Congressman Gus Bilirakis (R-FL-12) – launched a new 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.

The CVC will continue to work with bipartisan lawmakers in Congress on PAD issues in 2020 to advance additional policy efforts to increase awareness and understanding of PAD with the ultimate goal of improving patient outcomes and reducing amputations.

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CardioVascular Coalition Releases New White Paper on Value of Peripheral Artery Disease Screening Among At-Risk Populations

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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CVC Stresses Importance of Understanding Peripheral Artery Disease (PAD) Risks During American Diabetes Month

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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Fierce Healthcare: Too many minorities are experiencing unnecessary leg amputations

Across the U.S., the drug overdose epidemic took the lives of more than 70,000 Americans last year and remains a highly visible killer. Meanwhile, infectious diseases such as measles, which was declared eradicated from the U.S. in 2000, are on the rise again—reaching a 27-year high in 2019.

These epidemics rightly receive a lot of attention from policymakers and the media, but there’s another epidemic plaguing our communities—especially our communities of color—that is too often overlooked: peripheral artery disease (PAD).

PAD is a dangerous and expensive complication of diabetes, which afflicts over 30 million Americans. If a patient does not manage their diabetes well, he or she is at serious risk of developing PAD, which causes plaque to build up in blood vessels and reduces blood flow to the legs. This puts patients at a dramatically higher risk of suffering a stroke, heart attack or limb amputation.

Click here to read the full article on the Fierce Healthcare website.

CardioVascular Coalition Commends Lawmakers Leadership in Launching Peripheral Artery Disease (PAD) Caucus during September Awareness Month

Vascular care leaders stress importance of PAD education and intervention to reduce limb loss in America by asking lawmakers to join Congressional PAD Caucus

WASHINGTON – Today marks the start of Peripheral Artery Disease (PAD) Awareness Month and this September the CardioVascular Coalition (CVC), a leading group of providers, physicians, and manufacturers, commends lawmakers Donald M. Payne, Jr. (D-NJ-10) and Gus Bilirakis (R-FL-12) for launching the new Congressional PAD Caucus to educate Congress and communities about PAD while supporting legislative activities to improve PAD research, education, and treatment. The ultimate goal of the caucus is to advance policies to prevent non-traumatic amputation due to PAD and other related diseases.

With the launch of the PAD caucus this September, CVC also urges healthcare leaders, patient advocates and other stakeholders to take part in increasing PAD awareness by asking lawmakers to join the caucus to expand Congressional knowledge about this disease.

PAD is a life-threatening circulatory condition, which affects nearly 20 million Americans and an estimated 200,000 of them are disproportionately from minority communities. It is a chronic condition, which causes narrowing or blockage of the vessels that carry blood from the heart to the legs.  The primary cause of PAD is the buildup of plaque in the arteries. Estimates suggest that anywhere from 12 to 20 percent of individuals over the age of 60 are living with PAD.

If not properly diagnosed and managed, PAD can lead to non-traumatic lower limb amputations, which data show lead to lower quality of life and increased risk for death. Estimates suggest 54 percent of limb loss in the U.S. is the result of vascular disease, including PAD.

“As we recognize PAD Awareness Month, I am encouraged to see lawmakers dedicating attention to PAD and coalescing around solutions to address research, education, and treatment through the  PAD Caucus.  It is a needed first step in acknowledging PAD as a mounting health concern nationwide, and particularly among minority communities. We look forward to working with Congressmen Payne and Bilirakis and their colleagues to advance policy solutions to increase understanding of PAD to ultimately reduce preventable amputations,” said Jeffrey G. Carr, MD, FACC.

Underserved communities are at greatest risk for developing PAD.  African Americans, for example, are twice as likely to be diagnosed with PAD and up to 3 times more likely to have an amputation than white Americans. Hispanic Americans are 50 to 75 percent more likely to undergo an amputation and Native Americans are twice as likely to undergo an amputation than Caucasians.

“By launching the PAD Caucus, Congressmen Payne and Bilirakis are showing true leadership in the vascular community, emphasizing the need for increased awareness so that more at risk populations are prepared to recognize the symptoms to enable early diagnosis, which is the key to preventing limb loss,” Dr. Carr continued.

The CVC urges patients to be aware of symptoms, which include leg pain, numbness, tingling, or coldness in the lower legs or feet, and sores or infections of the feet or legs that heal slowly.  By being properly aware of this disease and the treatments available, patients can avoid limb loss.

To access more information about PAD Awareness Month, CLICK HERE.

To ask your lawmakers to join the PAD Caucus, CLICK HERE.

Join the conversation on Twitter at #PADAwareness.

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AL.com: People of color are most at risk for amputations. Time to close the gap.

As an African American doctor in Montgomery, I am dedicated to closing gaps in healthcare by making sure our communities are healthy, happy, and thriving. The yawning gap between health outcomes for whites and health outcomes for people of different racial and ethnic backgrounds is well documented. We know, for example, that African Americans under the age of 50 are more likely to suffer from heart disease, stroke, or diabetes.

One of the biggest disparities in health stems from complications due to peripheral artery disease (PAD), an all-too-common but easily-preventable chronic illness. PAD occurs when fatty deposits in a person’s arteries restrict the blood flow to the limbs. As a result, the patient experiences intense pain in the legs and eventual amputation, if left untreated.

Click here to see the full op-ed at AL.com. 

Kaiser Health News: Further Steps To Guard Against ‘Shameful’ Amputations

Thank you for drawing much-needed attention to disparities in unnecessary limb amputations for communities of color (“Diabetic Amputations A ‘Shameful Metric’ Of Inadequate Care,” May 1). While I applaud your article’s focus on diabetes, understanding related diseases like peripheral artery disease (PAD) is just as important.

As a limb salvage specialist in the Mississippi Delta, I know firsthand that African American patients with diabetes are over three times more likely to have their limbs surgically removed — with even higher rates in Mississippi. Sadly, a majority of the estimated 200,000 annual non-traumatic amputations —many stemming from PAD, a complication of diabetes –– can be avoided with the proper care.

Tragically, even though PAD is as serious as cancer, more than 90% of the amputees I have met have never had a diagnostic test for PAD or an appropriate vascular evaluation to salvage their limbs. Most have never even heard of PAD until it is too late.

To stop these troubling trends in my community, I created a team to aggressively screen, diagnose and treat each one of our 10,000 patients early and often. With no institutional or outside financial support, our practice was able to decrease PAD-related amputation rates in the region by 87.5%.

More must be done on the federal level to address America’s “amputation lottery.” The United States Preventive Services Task Force (USPSTF), for example, should change its recommendation for screening at-risk patients including racial and ethnic minorities and low socioeconomic populations who have a disproportionately higher prevalence of PAD and amputation rates. The current recommendation makes the USPSTF complicit in perpetuating current PAD-related amputation disparities in treatment and outcomes.

There also needs to be broad adoption of non-amputation treatment measures such as revascularization in all algorithms for wounds to heal properly before amputation is ever needed. Finally, policymakers should advance a comprehensive strategy that combines increased public awareness, robust screening and better access to multidisciplinary care for at-risk populations. Together, these steps could go far in reducing limb loss, especially among minority communities.

— Dr. Foluso Fakorede, co-chair of the PAD Initiative for the Association of Black Cardiologists and CEO of Cardiovascular Solutions of Central Mississippi, Cleveland, Miss.

Click here to see the article on the Kaiser Health News website. 

CardioVascular Coalition Urges Policymakers to Create Intragovernmental Workgroup on Amputation Reduction to Improve PAD Care for Minority Populations

The call for improved access to early detection and diagnostic screenings for peripheral artery disease in underserved areas underscored during National Minority Health Month

WASHINGTON – This National Minority Health Month, the Cardiovascular Coalition (CVC), a consortium of physicians, care providers, advocates, and manufacturers working to improve awareness, prevention and treatment of peripheral artery disease (PAD), urges policymakers to set up an Intragovernmental Workgroup on amputation reduction since minority communities are disproportionately affected by non-traumatic, non-emergent lower limb amputations resulting from PAD.

The CVC urges Congress to direct the Administration to convene an Intragovernmental Workgroup on amputation reduction, which should focus on increasing at-risk patients’ access to screening for PAD, which is the cause of 85 percent of the 200,000 non-traumatic limb amputations in the U.S. each year and disproportionally impacts people of color.

Minority communities are most at risk of developing PAD, a common complication of diabetes that occurs when fatty deposits in the arteries restrict the blood flow to the limbs, resulting in pain in the legs, poor healing of diabetic ulcers, gangrene, and eventual amputation. According to the American Diabetes Association,  African Americans are 1.7 times more likely than non-Hispanic whites to have diabetes. Data show African-American patients with diabetes are over three times more likely to have their limbs surgically removed than whites. Moreover, Native Americans in the west and Hispanics, are twice as likely and 75 percent more likely, respectively, to suffer from PAD as their Caucasian counterparts.

Further, according to projections from the American Heart Association, in the next two decades, minorities will have the highest rates of cardiovascular disease and PAD will become the new number one cardiovascular challenge due to the disproportionate prevalence of obesity and diabetes among the patient group, which both have the potential to change the health trajectory of minorities.

“It is imperative that policymakers recognize the often-overlooked PAD epidemic that causes far too many Americans—especially Americans of color—to lose their lives and their limbs,” said Dr. Foluso Fakorde, MD, a practicing interventional cardiologist and co-chair of the PAD Initiative for the Association of Black Cardiologists. “National Minority Health Month is the perfect time for policymakers to turn their attention to this growing crisis and work to increase access to early vascular screenings for the more than 30 million Americans living with diabetes and 84.1 million living with prediabetes who are at greatest risk of developing PAD and facing amputation.”

In addition to advocating for an intragovernmental workgroup, through its work with the PAD Task Force, the CVC is also calling on the Department of Health & Human Services to work with the U.S. Preventive Services Task Force (USPSTF) to develop screening protocols for at-risk patients.

Finally, the CVC calls for policies that require providers to document vascular evaluations in the 12 months prior to having patients undergo non-traumatic, non-emergent amputations. Failure to perform arterial testing should result in non-payment for the amputation by Medicare and private payors.

In addition to April being National Minority Health Month, it is also designated as Limb Loss Awareness Month.

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The Hill: Congress: Adopt solutions to end minority health disparities

As a physician on the frontlines of an overlooked epidemic, I’ve seen countless patients who have had no choice but to have their limbs surgically amputated because they didn’t have access to the clinical interventions that could have saved their legs.

No, I don’t work in a developing country. I’m a doctor in the Mississippi Delta.

Despite living in the world’s richest country—a nation that spends twice as much on health care as any other – many minority communities in the U.S. suffer disproportionately from chronic diseases that wreak havoc on lives and limbs.

Since April is National Minority Health Month, now is the perfect time to reflect on the inequities facing millions of Americans, as well as how we can collectively pave the path for building stronger, healthier communities.

Each year, roughly 200,000 Americans – about 548 each day – will have their limbs amputated because of non-traumatic causes like peripheral artery disease (PAD). Never heard of PAD before? Neither have many of my patients until it is too late.

Click here to see the full article on The Hill’s website. 

Vascular Care Leaders Underscore PAD Risks for Americans Living with Kidney Disease on World Kidney Day

Americans with CKD are at a higher risk than the general population of developing PAD

WASHINGTON – The CardioVascular Coalition (CVC), a coalition of cardiovascular and endovascular care providers, physicians, and manufacturers created to improve awareness, prevention, and intervention of vascular disease, is urging increased understanding for kidney health and related health conditions, including Peripheral Artery Disease (PAD), in recognition of World Kidney Day.

Chronic Kidney Disease (CKD) is the ninth leading cause of death in the United States affecting an estimated 26 million Americans. Research has shown that Americans with CKD are at a higher risk than the general population of developing PAD, which causes narrowing or blockage of the vessels that carry blood from the heart to the legs.  Studies have also shown patients with CKD are less likely to be provided recommended ‘optimal’ PAD care.

PAD is a circulatory condition affecting as many as 18 million Americans. Like CKD, PAD disproportionately impacts minority communities due to the higher prevalence of diabetes and other risk factors. If not properly managed, PAD can lead to non-traumatic lower limb amputations, which data show lead to lower quality of life, increased risk for death and higher healthcare costs.

“Public policies are needed to increase access to PAD diagnosis and intervention, particularly among older Americans dependent on Medicare to access care, and who are often living with multiple comorbidities common across this patient population including diabetes and hypertension,” said Dr. Neil Marwah of National Cardiovascular Partners. “Other important factors impacting both CKD and PAD patient groups are the racial disparities that exist, which show African Americans are at a measurably higher risk for both diseases conditions.”

In fact, data show in regions with larger populations of African Americans living with diabetes, the PAD-related amputation risks are as much as three to four times higher than the national average. Nationally, the amputation rate among African American Medicare patients is nearly three times higher than the rate among other beneficiaries.

The CardioVascular Coalition has been working with the PAD Task Force to advance a comprehensive strategy that combines increased public awareness and robust screening with non-amputation treatment measures and multidisciplinary care. The PAD Task Force has called on the Administration to convene an intragovernmental workgroup to develop a standardized model for amputation reduction. 

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CardioVascular Coalition Commends CMS for Appropriate Updates to Final Physician Fee Schedule Rule

PAD advocacy community, bipartisan lawmakers urged CMS to work with stakeholders to properly value revascularization services

WASHINGTON– The Cardiovascular Coalition (CVC), a coalition of physicians, care providers, advocates, and manufacturers dedicated to finding solutions designed to improve awareness and prevention of peripheral artery disease (PAD), commends the Centers for Medicare & Medicaid Services (CMS) for not finalizing an estimated 30 percent cut to revascularization reimbursement for the treatment of PAD in the Final 2019 Physician Fee Schedule (PFS) Rule.

“Maintaining adequate reimbursement for PAD interventions ensures continued access to high-quality and convenient care, improving clinical outcomes and increasing our ability to prevent avoidable amputations in patients diagnosed with PAD,” said Jeffrey Carr, MD, a member of the CVC and Founding President of the Outpatient Endovascular and Interventional Society (OEIS). “We applaud CMS for listening to the concerns of the physician community and working with stakeholders to appropriately value revascularization services in the Final Rule.We look forward to continuing our work with CMS and the Congress to ensure unnecessary limb amputation becomes a thing of the past.”

The CVC had previously warned inappropriately cutting reimbursement rates for performing revascularization procedures, which are vital for clearing patients’ arteries of dangerous clogs and preventing thousands of unnecessary amputations, could put patient access at risk. Data show as many as 200,000 non-traumatic amputations take place each year in the U.S.

The proposed cuts stemmed from CMS’ proposal to update equipment and supply pricing data in the Medicare Physician Fee Schedule database. The CVC expressed concerns with the accuracy of the data for revascularization codes as some of the inputs had no pricing data at all in the CMS database to support the rational for the cut.

The CVC further praised a bipartisan group of lawmakers – led by Congressman Erik Paulsen (R-MN) and Donald Payne (D-NJ) – for sending a letter to CMS cautioning against the proposed cuts to revascularization services. In addition to Congressmen Paulsen and Payne, Representatives Joyce Beatty (D-OH), Bonnie Watson Coleman (D-NJ), Carlos Curbelo (R-FL), Vicente Gonzalez (D-TX), Lynn Jenkins (R-KS), Mike Kelly (R-PA), Leonard Lance (R-NJ), Sheila Jackson Lee (D-TX), Kenny Marchant (R-TX), Luke Messer (R-IN), Gregory Meeks (D-NY), Tom Reed (R-NY), Tom Rice (R-SC), David Phil Roe, MD (R-TN), Peter Roskam (R-IL), Dennis Ross (R-FL), Bobby Rush (D-IL), Pete Sessions (R-TX), Glenn “G.T.” Thompson (R-PA), Fred Upton (R-MI) and Frederica Wilson (D-FL) signed the letter.

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American Journal of Managed Care: Increasing Awareness this National Diabetes Month Can Save Limbs and Lives

With the holiday season fast approaching, most Americans are looking forward to feasting with family and friends and taking a much-needed break from work.

However, for over 30 million Americans living with diabetes and 84.1 million living with prediabetes, the consumption of unhealthy food and long periods of inactivity during the holiday season can make symptoms worse.  Diabetes is a public health crisis, costing $327 billion dollars per year, according to the most recent analysis from the American Diabetes Association. As many as 1 in 3 U.S. adults could have diabetes by 2050 if current trends continue, according to a new analysis from the CDC.  Racial and ethnic minorities have a higher prevalence and greater burden compared with whites. Disparities in health and health care lead to higher rates of complications in minority populations.

November is National Diabetes Month and is the perfect time to promote awareness of diabetes and diabetes-related complications so that, through awareness, we can prevent the suffering diabetes causes to ourselves, our families and our friends.   It is important for everyone to be aware of this disease and its complications.

Click here to see the full article on the AJMC website.

MedPage Today: Healthcare is Justice for Underserved Communities

– Foluso Fakorede, MD, on tackling the epidemic of PAD among minorities

In 1966, Dr. Martin Luther King, Jr., observed: “Of all the forms of inequality, injustice in healthcare is the most shocking and inhumane.” Addressing the Medical Committee for Human Rights, he understood that the failure to adequately prevent and treat diseases in minority communities perpetuates the racism and inequity that he rallied against his whole life.

While rapid medical advancements and greater respect for civil rights have helped us make great strides over the last 5 decades, we still have a long way to go towards achieving justice in healthcare. The disparity in treatment of peripheral artery disease (PAD) is a most devastating example of this injustice. PAD is the most prevalent, debilitating, costly, and deadly pandemic that most Americans have never heard of. Which patients live and which patients die from PAD is often determined by race, income, insurance status and geographical location.

PAD can be prevented and treated in many patients. However, instead of identifying and treating this disease early, many patients undergo unnecessary amputations. These unnecessary amputations disproportionately plague minorities across the country. Compared with their white counterparts, data show Hispanics are 75% more likely to face amputations, while Native Americans in the West are more than twice as likely to be amputated, and African-American patients with diabetes are over three times more likely to have their limbs surgically removed — with even higher rates in Mississippi.

How is it that there are approximately 200,000 non-traumatic amputations each year in the United States when the majority of them can be avoided with proper care? Experience suggests that lingering disparities in healthcare stem from larger systemic inefficiencies.

For example, the state of Mississippi – where I practice – is the epicenter of the PAD epidemic. Mississippi has the lowest number of physicians per capita and is the country’s poorest state, with an average annual household income of $41,000. Sadly, the results are predictable: more than 90% of the amputees I have encountered in Mississippi have never had a diagnostic test for PAD or an appropriate vascular evaluation to salvage their limbs. PAD is as serious as cancer, yet its risks are vastly underappreciated. If screening for cancer has become routine, why is screening for PAD – which can reduce the probability of an amputation by 90% – so underutilized amongst vulnerable populations?

For the vast majority of PAD patients who remain undiagnosed and untreated, the outcomes are stark. Most amputees will require life-long caregiving assistance, usually from family members, resulting in lost wages and benefits since caregiving is practically a full-time job. In addition to this burden, there are unreimbursed costs for patients and their families with medical and nonmedical expenditures estimated to be $150,000 annually and nearly $800,000 over a lifetime. The tragic reality is that the cost of unnecessary amputations represents a tremendous burden on patients, families, the workforce, the Medicare system, and our national economy.

As a limb salvage specialist, I was so troubled by these trends that I moved to the Mississippi Delta 3 and 1/2 years ago to do my part. With no institutional support, no financial support, and no multi-disciplinary team in my immediate vicinity, I started my own private practice and founded the Cardiovascular Solutions of Central Mississippi. Our approach was to cultivate professional teams to go out into the community directly to increase educational awareness of the importance of screening, seeking a second opinion and having an angiogram prior to amputation.

Through this program, our team was able to decrease PAD-related amputation rates in the region by 87.5%. In the year prior to my arrival, the hospital I currently service – the only hospital serving Cleveland, Mississippi’s population of 12,500 – performed 56 major amputations and zero diagnostic tests for PAD. Last year, that same institution performed just seven amputations and almost 500 diagnostic tests for PAD.

How did our team at Cardiovascular Solutions of Central Mississippi accomplish this as a solo private practice? We assembled a great team of nurses, technicians, and medical assistants and increased our patient base from 128 in October 2015 to 10,000 individuals served in the Mississippi Delta region by September 2018. Our team comprehensively treated every one of our patients as family members. We utilized aggressive early screening, diagnosis and treatment of modifiable cardiovascular risk factors in patients who are at-risk and advocated for diagnostic testing before amputations. We promoted patient medical literacy and advocacy via a faith-based approach – building community navigators, educating the community about PAD and stressing the importance of prevention over cure. We also recognized the social determinants of health and discussed solutions with stakeholders on local and state levels.

These results can be realized elsewhere. I recently joined a group of PAD care providers in Washington, D.C., to call on the federal government to adopt a national strategy to reduce non-traumatic amputations through increased awareness of PAD, increased screenings for at-risk populations and improved access to multidisciplinary care.

As the number of Americans with PAD, obesity, and diabetes continues to skyrocket, it is essential to expand healthcare access to underserved communities across the country and address the health disparities that impact individuals of all ages. Trends show that risk factors for PAD are presenting in patients earlier in life, underscoring the need for solutions to halt the progression of PAD in our most at-risk populations. Just as the systems in our body work in harmony, so too should our healthcare system, our government, our schools, our churches. and community organizations to effect this change. Together, we can take the next step toward the justice Dr. King dreamed of.

Foluso Fakorede, MD, is a practicing cardiologist and CEO of Cardiovascular Solutions of Central Mississippi as well as co-chair of the PAD Initiative for the Association of Black Cardiologists.

Click here to see the original article on the MedPage Today website. 

CardioVascular Coalition Commends Bipartisan Lawmakers for Warning Against Proposed Cuts to Revascularization Services

CVC supports bipartisan group of lawmakers for signing letter to CMS opposing the proposed 30% cut in the CY 2019 Physician Fee Schedule Proposed Rule 

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 praised a bipartisan group of lawmakers for cautioning against proposed cuts to revascularization services used to prevent amputation in PAD patients.

In a letter submitted yesterday to Centers for Medicare & Medicaid (CMS) Administrator Seema Verma, 23 bipartisan lawmakers expressed concern that the CY 2019 Physician Fee Schedule (PFS) Proposed Rule would inappropriately cut reimbursement rates for performing revascularization procedures, which are vital for clearing patients’ arteries of dangerous clogs and significantly preventing thousands of unnecessary amputations. The Proposed Rule would slash payments for revascularization services performed in an office-setting by as much as 30 percent.

Yesterday’s letter, led by Congressman Erik Paulsen (R-MN) and Donald Payne (D-NJ), follows previous letters to CMS that emphasized the critical need to prevent unnecessary non-traumatic amputations from occurring. Revascularization services are critical for achieving this goal. Data show as many as 200,000 non-traumatic amputations take place each year in the U.S.

“In order to protect a critical tool in the arsenal against amputation, we urge you to work with stakeholders to properly value revascularization services in the 2019 PFS Final Rule as we expect that stakeholders will be submitting data on these missing inputs and other misvalued services,” the lawmakers wrote to Verma.

In addition to Congressmen Paulsen and Payne, Representatives Joyce Beatty (D-OH), Bonnie Watson Coleman (D-NJ), Carlos Curbelo (R-FL), Vicente Gonzalez (D-TX), Lynn Jenkins (R-KS), Mike Kelly (R-PA), Leonard Lance (R-NJ), Sheila Jackson Lee (D-TX), Kenny Marchant (R-TX), Luke Messer (R-IN), Gregory Meeks (D-NY), Tom Reed (R-NY), Tom Rice (R-SC), David Phil Roe, MD (R-TN), Peter Roskam (R-IL), Dennis Ross (R-FL), Bobby Rush (D-IL), Pete Sessions (R-TX), Glenn “G.T.” Thompson (R-PA), Fred Upton (R-MI) and Frederica Wilson (D-FL) also signed the letter.

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Morning Consult: 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.

Click here to see the original op-ed on the Morning Consult website.

CardioVascular Coalition Urges Congress to Support Limb Loss Prevention Initiatives During Peripheral Artery Disease (PAD) Awareness Month

PAD community emphasizes importance of protecting access to revascularization services to reduce amputations in Medicare patients

Washington, DC– Citing the pressing need to prevent unnecessary limb amputation in Medicare patients, the CardioVascular Coalition (CVC), a leading group of providers, physicians, and manufacturers, urged Congress to act to protect access to vital revascularization services during Peripheral Artery Disease (PAD) Awareness Month this September.

Noting that the 2019 Physician Fee Schedule (PFS) Proposed Rule cuts reimbursement for revascularization services by up to 30 percent or more, the CVC emphasized the key role Members of Congress play in calling on the Centers for Medicare & Medicaid Services (CMS) to not include these cuts in the final rule.

“As we recognize PAD Awareness Month, it is especially timely for our elected lawmakers to protect the estimated 18 million individuals who suffer from PAD across the country by doing all they can to protect revascularization services by blocking these proposed cuts,” stated Jeffrey Carr, MD, FACC. “These cuts stem from CMS’ proposal to update equipment and supply pricing data in the Medicare Physician Fee Schedule database. We have concerns with the accuracy of this data for revascularization codes as some of these inputs have no pricing data at all in the CMS database. It is time for Congress and CMS to come together to ensure that unnecessary limb amputation becomes a thing of the past.”

Nearly 20 percent of Americans over the age of 70 suffer from PAD – the hardening of arteries that causes narrowing or blockage of vessels that carry blood from the heart to the legs – which can lead to significant buildup of plaque in the arteries known as atherosclerosis. Minimally invasive revascularization can effectively prevent the need for limb amputation and, thereby, improve patients outcomes and reduce Medicare spending. It is incumbent on Congress to protect funding for this vital PAD treatment.

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 due to an increased prevalence of diabetes, obesity and other risk factors.

CVC noted that the lack of any listed price for supply inputs used in revascularization services means providers are not being reimbursed for the resource cost of those inputs. The time has come for all Members of Congress to urge CMS to properly value critical revascularization services.

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

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The Hill: Congress must act to protect vulnerable population from unnecessary limb loss

Most Americans consider limb amputation to be the result of a traumatic and non-avoidable event. But for the 18 million citizens who develop Peripheral Artery Disease (PAD), the possibility of a preventable limb amputation is a stark reality.

During my years of practice, I have seen many patients present with PAD – the hardening of arteries that causes narrowing or blockage of vessels that carry blood from the heart to the legs caused by buildup of plaque in the arteries, or atherosclerosis. As a chronic, life-threatening circulatory condition, PAD puts patients at greater risk of the development of critical limb ischemia (CLI), resulting in extreme pain in the legs or feet and risking complications such as wounds and sores or the ultimate amputation of the affected limb.

The amputation of a patient’s limb is not a decision any health care provider takes lightly. Individuals with PAD who have undergone amputation face higher rates of mortality, specifically amongst older Americans. After a major amputation, 48 percent of patients over the age of 65 die within the first year and 71 percent die within three years. Further, once a major leg amputation occurs, the Medicare costs in caring for these patients escalate significantly.

These outcomes could be reduced, and in some cases entirely prevented, through the increase of revascularization services. Revascularization is the process of restoring blood flow to the limb through minimally invasive surgical intervention. When implemented correctly, and in a timely manner, revascularization can ultimately prevent disease progression, ultimately saving a limb. Despite this seemingly obvious solution is a life-altering problem, studies have shown that as many as one third of late-state PAD patients do not receive arterial testing to determine if they are a candidate for this procedure.

This is where Congress has the opportunity, and arguably the responsibility, to step in to prevent avoidable amputations for those eligible for this critical medical intervention by stopping proposed cuts for revascularization procedures under Medicare. These cuts are included in the 2019 Physician Fee Schedule (PFS) Proposed Rule, which cuts up to 30 percent in reimbursement for revascularization codes.

Click here to read the full article on The Hill’s website.

New PAD Task Force Joins Lawmakers in Calling for Policies to Reduce Amputations for Patients with Peripheral Artery Disease

PAD Task Force urges lawmakers to support establishment of intragovernmental workgroup on amputation reduction and oppose proposed Medicare cuts to PAD treatments

WASHINGTON– Members of the newly formed PAD Task Force – including the Association of Black Cardiologists, CardioVascular CoalitionPreventative Cardiovascular Nurse Association and Society for Cardiovascular Angiography and Interventions– today commended Congressman Erik Paulsen (MN-3) and Congressman Donald Payne (NJ-10) for sponsoring a Capitol Hill briefing yesterday to raise awareness about the risks of peripheral artery disease (PAD) and the need for policies to reduce preventable amputations.

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 180,000 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.

“I applaud Congressmen Payne and Paulsen for sponsoring today’s briefing and offering us a platform to call attention to the devastating impact of PAD on communities across the country, particularly minority populations that disproportionately experience preventable amputations,” said Bryan Fisher, moderator of today’s briefing and a member of the CardioVascular Coalition. “As we recognize PAD Awareness Month this September, we are urging policymakers to work with us to advance a comprehensive strategy to combat PAD in the United States that includes increased screening for at-risk patients as well as access to multidisciplinary care and vascular evaluations.”

Earlier this year, 32 members of the U.S. House of Representatives sent a letter – lead by Congressmen Paulsen and Payne – urging the Department of Health and Human Services and the Veterans Health Administration to adopt a national strategy to reduce non-traumatic amputations through increased awareness of peripheral artery disease (PAD), increased screenings for at risk populations, and improved access to multidisciplinary care.

Speakers at yesterday’s briefing included representatives from the PAD Task Force, which was formed to collectively advance a comprehensive strategy that combines increased public awareness and robust screening with non-amputation treatment measures and multidisciplinary care. Specifically, the PAD Task Force is asking the Administration to convene an intragovernmental workgroup to develop a standardized model for amputation reduction and raise awareness on the issue.

“As a member of the PAD Task Force, The Society for Cardiovascular Angiography and Interventions looks forward to with working with others in the vascular care community to advocate for the creation of an intragovernmental workgroup on amputation reduction. It is past time for a meaningful solution to this complex problem, which can only be achieved through enhanced screening, vascular evaluations before amputation and an emphasis on multidisciplinary care,”  said Ehrin J. Armstrong, MD, MSc, MAS, FSCAI

The Administration has the capacity to take significant steps towards the total elimination of PAD-related non-traumatic amputations by convening an intragovernmental workgroup to develop a standardized model for amputation reduction, which can be modeled after existing programs including the Department of Veterans Affairs’ Preventing Amputations in Veterans Everywhere (PAVE) program.

Further, members of the PAD Task Force are asking lawmakers to urge the Centers for Medicare & Medicaid Services (CMS) to prevent cuts of 30 percent or more to revascularization procedures used to treat PAD included in the 2019 Physician Fee Schedule (PFS) Proposed Rule. Stakeholders are concerned the cuts stem from CMS’ proposal to update equipment and supply pricing data in the Medicare Physician Fee Schedule database based on inaccurate and incomplete data.

“We hope lawmakers in Congress will support the delivery of quality PAD care, oppose deep Medicare cuts to PAD treatments and advance the establishment of a standardized model for amputation reduction,” added Foluso Fakorede, MD, Association of Black Cardiologists’ PAD Initiative Co-chair and CEO, Cardiovascular Solutions of Central Mississippi. “Yesterday’s briefing is a positive step toward the development of a standard model for PAD care and amputation reduction that I hope will save limbs and save lives for individuals diagnosed with PAD.”

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Morning Consult: Let’s Make Unnecessary Amputations a Thing of the Past

Did you know that more than 185,000 Americans – enough to fill 2 1/2 football stadiums – lose a limb each year due to amputation? Did you also know that half of those amputations are the result of completely preventable vascular diseases like peripheral artery disease? Even though we’re well into the 21st century, tens of thousands of Americans experience completely unnecessary painful, devastating and life-altering amputations. This is a significant public health concern that demands the attention of the federal government.

PAD is typically caused when the arteries in a person’s legs become blocked by a build-up of plaque. Patients who smoke, are over the age of 60, or have a history of chronic conditions like diabetes or high blood pressure are most at risk. Though PAD can affect anyone, many of these risk factors are common in minority communities with studies showing that African-Americans and Hispanics with PAD are between two and four times more likely to undergo an amputation than white patients.

The toll of PAD-related limb loss is far reaching. Not only does it leave individuals permanently disabled, research shows that patients who have an amputation are at a significantly higher risk of needing a second one several years late. Furthermore, the lifetime cost of care for a person with limb loss can be as high as $500,000, taking an additional toll on family finances and taxpayer-funded public health programs alike.

We have the technology – and the capability – to identify and treat patients early on in their diseases progression. We also have the means to screen at-risk individuals and prescribe interventional treatment before PAD even develops. What’s missing is a commitment from the federal government to make non-traumatic amputations a thing of the past.

Thankfully, Congress is beginning to listen. A group of lawmakers, led by Congressmen Erik Paulsen (R-Minn.) and Donald Payne Jr. (D-N.J.) – recently sent letters to the Departments of Health and Human Services and Veteran’s Affairs urging the administration to adopt a national strategy for reducing PAD-related amputations through increased awareness, increased screening for at-risk populations, improved access to multidisciplinary care, and policies that ensure no one receives an amputation without first undergoing arterial testing.

Second, the administration must make screening for at-risk patients a priority. Despite recommendations from the American Heart Association and the American College of Cardiology that all patients who smoke, are over 65, or have been diagnosed with another type of vascular disease get screened, the U.S. Preventative Services Task Force does not recommend screening for the at-risk population. CMS should update these guidelines so potentially at-risk patients aren’t left unscreened.

Additionally, CMS must recognize that awareness is not always enough. There must be policies in place to ensure that patients are assessed for all other treatment options before they receive an amputation. According to a 2014 study, a third of late-stage PAD patients had no arterial testing in the year before their amputation to determine if they were a candidate for limb-saving procedures. Without testing, there is no way to know for sure whether an amputation is truly necessary.

And finally, more must be done to expand multidisciplinary care for at-risk patients. Though many Centers of Excellence across the country have been successful in driving their amputation rates to near zero, there are still too many patients who don’t live close enough to benefit.  The Administration should make it a priority to expand access to such care, especially in minority communities.

I applaud the bipartisan lawmakers in Congress who are calling for a robust, comprehensive, nationwide strategy to “sprint to zero” for non-traumatic amputations and encourage others to lend their voice to this effort. Only then can we save limbs – and lives. No patient should have to endure the pain and trauma that comes with losing a limb, especially if their amputation occurs unnecessarily.

Jeffrey Carr, MD, is a member of the CardioVascular Coalition’s Board of Directors and founding president of the Outpatient Endovascular and Interventional Society.

Click here to see the original article on the Morning Consult website.

Cardiovascular Care Community Applauds Lawmakers for Urging Administration to Make Unnecessary Amputations a Thing of the Past

Bipartisan group of lawmakers call for a national strategy to reduce non-traumatic amputations to zero

Washington – The CardioVascular Coalition (CVC) today applauded 32 members of the U.S. House of Representatives for urging the Department of Health and Human Services and the Veterans Health Administration to adopt a national strategy to reduce non-traumatic amputations through increased awareness of peripheral artery disease (PAD), increased screenings for at risk populations, and improved access to multidisciplinary care.

In the letter, which was sponsored by Representatives Erik Paulsen (R-MN) and Donald Payne, Jr. (D-NJ), the lawmakers ask the administration to provide Congress with information about any current or planned efforts by the federal government to reduce unnecessary non-traumatic amputations. The letter also calls on all relevant agencies to provide information about their regulatory authority to implement any such policy and asks whether any new statutory authority is needed.

“On behalf of the vascular care community, I would like to sincerely thank Representatives Paulsen, Payne, and their colleagues for working to make non-traumatic amputations a thing of the past,” said Jeffrey Carr, MD, a member of the CVC Board of Directors and Founding President of the Outpatient Endovascular and Interventional Society. “Thanks to their leadership, we are closer to advancing initiatives to address the alarming rate of limb loss in America, particularly in minority communities.”

Each year, nearly 185,000 Americans undergo an amputation, about half of which can be attributed to preventable vascular diseases such as PAD. Studies show that minority populations are significantly more impacted by the effects of PAD with amputation rates between two to four times higher than Caucasian Americans. Even more alarming is the fact that up to one-third of patients with late-state PAD never receive arterial testing to determine if they might be a candidate for limb-saving, revascularization surgery.

“This is a significant public health concern that deserves a response from the federal government,” Carr continued. “We already have the capabilities to identify and treat PAD before it progresses to the point of amputation. We just need a national strategy to get the right treatment to the right people at the right time. With lawmakers, we’re calling on the Administration to make PAD awareness and prevention a national priority.”

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AJMC: “Sprint to Zero“: A Strategy to Address High Rates of Nontraumatic Amputations in Minority Communities

By Jeffrey Carr, MD, FACC, FSCAI

CMS can take steps to raise awareness, including a specific quality measure, to ensure that testing occurs prior to nontraumatic amputation.

EVERY DAY, APPROXIMATELY 500 Americans lose a limb and join millions of others who will struggle with a lifetime of high medical bills, disability, and significant barriers to participating in their communities.The greatest risk factor for developing this condition—which is completely preventable if caught early—is diabetes, the prevalence of which is at an all-time high.

Within the Medicare program, African Americans living with diabetes are nearly 3 times as likely to experience limb loss as other beneficiaries; the disparity is even worse in certain regions, such as the rural Southeast.3 Meanwhile, Hispanics are between 50% and 75% more likely than whites to undergo an amputation,4 and studies have shown that Native
Americans—especially those living in rural Western regions—are substantially more likely to receive a diagnosis of diabetes and undergo an amputation than their white counterparts.5

The good news is that we already have the capability to identify and treat vascular diseases before they progress to the point of amputation. And we have the technical know-how to bring the right care to the right people. What’s missing is a comprehensive, national strategy that integrates public awareness, increased screening and arterial testing for those determined to be at risk, and improved multidisciplinary care with new patient safety measures.

Increased Awareness
With as many as 18 million Americans at risk for limb loss due to peripheral artery disease (PAD)6 and the unprecedented prevalence of diabetes, we clearly need more effective public awareness.2 This applies to patients, who should receive better education about the risks of PAD, as well as providers, who should have better incentives to perform standard arterial testing on at-risk patients. In this regard, CMS should take cues from the previously successful Fistula First Breakthrough Initiative, which significantly increased the  percentage of patients with end-stage renal disease receiving fistulas by setting standards for the entire field.7Implementing a similar amputation reduction initiative, with a specific focus on providers in minority communities, could raise the benchmark across the whole spectrum of cardiovascular care providers.

Screening for At-Risk Populations
Based on the US Preventive Services Task Force assigned grade of I, or insufficient evidence, there is great room for improvement in PAD screening the general US population and in identifying disease in asymptomatic, at-risk populations. Despite guidelines issued by the American College of Cardiology and American Heart Association that recommend screening of at-risk patients—those who are over age 65, have a history of diabetes, smoking, and/or PAD, or have received a diagnosis of other vascular disease8—we know that screenings are not taking place among these patient groups, therefore increasing the likelihood for advanced disease and limb loss.

No Amputation Without Arterial Testing
But awareness is not enough if arterial testing remains underutilized. According to a 2014 study, more than 30% of patients who underwent a nontraumatic amputation had no arterial testing the prior year to evaluate whether they would be a potential candidate for revascularization or another intervention.9 Providers should make screening mandatory for all at-risk patients, and no amputation should occur unless a patient receives an invasive angiogram or other arterial vascular evaluation first. A 2011 analysis of more than a million Medicare patients with critical limb ischemia (CLI) found that this practice reduced the odds of amputation among patients with CLI by 90%.10 At some centers—particularly The Surgical
Clinic in Nashville, Tennessee, and Martin Memorial Hospital in Stuart, Florida—an angiogram before an amputation is routine. Both centers saw significant declines in their nontraumatic amputation rates since implementing this requirement.11,12

Improved Quality Measures and Multidisciplinary Care
Many facilities remain out of reach for patients living in underserved communities, which have populations that are disproportionately African American, Hispanic, and Native American. Reaching these communities requires that care be improved in other settings and that CMS promote policies to encourage more providers to coordinate care.

Quality measures for facilities that accept Medicare are also improving. As recently as this year, CMS approved 2 new cardiovascular-related measures as Qualified Clinical Data Registries (QCDRs), which will track the rates of noninvasive vascular testing prior to revascularization for patients with CLI or who have claudication. Because they are applicable
to all specialties that provide revascularization care, these measures are expected to give investigators greater insight into the decision-making process that precedes an amputation.

However, there is room for CMS to go further. The CardioVascular Coalition’s most recent Quality Measures Working Group recommends that CMS implement an additional measure to track use of a patient safety survey prior to undergoing a nontraumatic amputation. Facilities would be required to go through a Safe Surgery Checklist with patients before proceeding with an amputation and report the results as part of Medicare’s QCDR program.

Better measures like these have the potential to improve care quality and save money. Research shows that patients who avoid amputation have a higher quality of life afterward and experience fewer adverse effects associated with limb loss—such as depression and disability.13 And, according to an analysis by Avalere Health, cutting the number of Medicare patients with major amputations in half could save the program $2 billion over 10 years.14 could save the program $2 billion over 10 years.14

When considering all these factors, it is clear that opportunities exist for improving how both PAD and CLI are screened, diagnosed, and treated among the Medicare population, particularly minorities who are at greatest risk. The progress made in the field of vascular care indicates that there is no good reason any amputation should occur when limb preservation is a possibility. This is why the CardioVascular Coalition is calling for a national Sprint to Zero initiative that seeks to eliminate senseless amputations through increased awareness, higher screening rates, and the use of a multidisciplinary approach that will ensure no amputation is performed on a patient without arterial testing.

Morning Consult: Policy Reforms Needed to Address Most Traumatic Impacts of Diabetes

According to the American Diabetes Association, more than 30 million Americans today are living with diabetes. With a new diagnosis every 21 seconds, it’s a disease that’s forcing growing numbers of Americans to contend with a variety of significant health challenges. Uncontrolled, it can rob patients of their vision, kidneys and even their lives. In 2014, diabetes was the nation’s seventh leading cause of death.

Yet, even as millions of Americans learn to address – and hopefully avoid – some of diabetes’ most common complications, one of the most traumatic remains a dangerously silent threat, particularly for minority populations.

Diabetes is a major risk factor for Peripheral Artery Disease – a narrowing of the arteries feeding the body’s lower extremities, which causes pain, poor mobility, tissue death and life-threatening infections. Each year, tens of thousands of disproportionately African American patients undergo lower-limb amputations as a result of diabetes and PAD. According to recent research, regions across the country with larger populations of African Americans living with diabetes see amputation risks as much as three to four times higher than the national average.

Our initiative, Standing TALL, specifically aims to increase understanding about the startling racial disparities that exist among American amputees because far too many minority Americans experience limb removal when amputation could have been prevented.

It’s a trend that’s devastating both for vulnerable patients and our health care system. Nationally, the amputation rate among African American Medicare patients was nearly three times higher than the rate among other beneficiaries (5.6 per 1,000 vs. 2.0 per 1,000). The costs of these amputations to the U.S. health care system reach an estimated at $10.6 billion annually – with Medicare being the largest payer, covering an estimated 66 percent.

While health care providers, advocates and researchers have made enormous strides when it comes to diabetes education, treatment and even prevention, there is still a tremendous dearth of progress related to stopping the associated causes of PAD and amputations. It’s a shortfall largely attributable to lack of knowledge – both on the part of patients and their providers.

It’s estimated that as many as 18 million Americans unknowingly live with peripheral artery disease, unaware of the potentially significant implication of leg pain and the need for early screening and intervention. And even when patients do seek expert consultation and receive a PAD diagnosis, there is significant variation in whether a clinician chooses amputation versus limb-saving revascularization therapy.

Whenever options exist to help patients avoid amputation, it’s incumbent upon health care providers to use their knowledge and expertise to try to save the limb. Increased screening is, indeed, one of the best places to start. Today, although the U.S. Preventive Services Task Force cites insufficient evidence for PAD screening for the general population, guidelines issued by the American College of Cardiology and American Heart Association disagree: both groups recommend screening of at-risk patients (those over age 65, have a history of diabetes, smoking, and/or PAD; or have been diagnosed with other vascular disease).

Increased screening, along with the establishment of best practices for PAD patients facing amputation are long overdue. For example, there is still no intragovernmental federal health policy to ensure patients are assessed for non-amputation treatment options before they suffer limb loss. Instituting such a policy, which would require arterial testing – could push adoption of quality measures, guidelines and appropriate payment incentives to ensure patients receive appropriate arterial evaluation prior to costly amputations.

Working together, policymakers and the health care system have the power to reduce amputations, which are tragic, particularly when you consider that many are completely avoidable.  Increased awareness, screenings and multidisciplinary care – like centers of excellence across the country that have been effective in driving amputation rates down to near zero – will get us there.

We must, however, put muscle behind this effort, starting now.  As we round out National Diabetes Month, it’s important to advance initiatives that ensure PAD and limb loss don’t remain silent, avoidable and largely unknown consequences for patients with diabetes.

Jeffrey Carr is an interventional cardiologist and endovascular specialist, as well as the founding and immediate past president of the Outpatient Endovascular and Interventional Society, a multispecialty medical society, and the physician lead for the CardioVascular Coalition, a group dedicated to raising awareness for PAD and advocating for national health care policy and amputation prevention.

CardioVascular Coalition Urges Adoption of National Strategy to Address Unnecessary Amputations During Peripheral Artery Disease (PAD) Awareness Month

Vascular care leaders call for policies to prevent amputation without arterial testing, increase PAD awareness, support screening for at-risk populations and promote multidisciplinary care

WASHINGTON – The CardioVascular Coalition (CVC), a leading group of community-based cardiovascular and endovascular care providers, physicians, and manufacturers created to advance community-based solutions designed to improve awareness, prevention, and intervention of vascular disease, is urging healthcare leaders, policymakers, patient advocates and other stakeholders to join them in recognizing September as Peripheral Artery Disease (PAD) Awareness Month, a time designated to increasing awareness about the disease and calling attention to the need for a national initiative to reduce preventable PAD-related lower limb amputations.

PAD is a life-threatening circulatory condition, which affects as many as 18 million Americans, many of whom are at risk for non-traumatic amputation if their condition is left undiagnosed and untreated.  In fact, data suggest as many as 180,000 amputations are performed in the US each year, including 43,000 Medicare patients, which increases healthcare costs, harms patient quality of life and significantly increases patient mortality.

“As a public health crisis, PAD not only results in tens of thousands of preventable amputations, it also disproportionately impacts ethnic and racial minorities and costs taxpayers billions in additional spending,” said Jeffrey G. Carr, MD, FACC, FSCAI, an Interventional Cardiologist and Endovascular Specialist and the physician lead on the CardioVascular Coalition. “It is time for policy makers, healthcare professionals and the beneficiary communities to come together to adopt a national strategy that successfully increases understanding of this disease, improves patient access to clinically-appropriate interventional care and prevents amputation when a patient’s limb can be spared.”

Specifically, the CVC looks forward to working with both the Congress and the Administration to advance an initiative that will successfully lead to amputation reduction across the US, particularly among the Medicare population.  Four key tenets of such an initiative should include:

  • No amputation without arterial testing
  • Multi-disciplinary approach
  • PAD awareness programs
  • PAD screening for at-risk beneficiaries

Significant racial and geographic disparities in PAD-related amputation rates suggest that there is great opportunity for reducing amputation among these populations. African, Hispanic and Native Americans are two to four times more likely to undergo a lower-limb amputation due to PAD because of increased prevalence of diabetes, obesity and other risk factors as well as reduced access to screening and interventional procedures.

While not every patient experiences symptoms of PAD, the CVC urges patients to be aware of the symptoms, which include leg pain, numbness, tingling, or coldness in the lower legs or feet, and sores of infections of the feet or legs that heal slowly.

To access more information about PAD Awareness Month activities, visit cardiovascularcoalition.org/pad-awareness-month/.  Join the conversation on Twitter at #PADAwareness.

The Hill: We need a new strategy for tackling peripheral artery disease

It is simply unacceptable that in 2017, so many Americans undergo a non-traumatic limb amputation each year. Yet, as we recognize Peripheral Artery Disease (PAD) Awareness Month this September, estimates suggest between 160,000 and 180,000 Americans lose one of their limbs every year — about half of which are attributable to preventable vascular diseases. This figure includes 43,000 Medicare beneficiaries, according to Avalere.

This must change. As a public health crisis, PAD not only results in tens of thousands of preventable amputations, it also disproportionately impacts ethnic and racial minorities and costs taxpayers billions in additional spending.

PAD is caused when the arteries that carry blood from the heart to the limbs become blocked by plaque buildup. Typically, patients who smoke, are older than 65, or have a history of high blood pressure, diabetes, or high cholesterol are at an increased risk of developing PAD. Many of these risk factors are more common in African Americans, Native Americans and Hispanics, which makes them two to four times more likely as whites to develop PAD. Disparities also exist among Americans living in rural areas as well as those with lower incomes.

Compounding these issues is the fact that lifetime care for a person with limb loss can average as much as $500,000. Studies also show that patients who receive a first amputation are at an elevated risk of having to undergo another amputation and a significantly increased risk for mortality.

Fortunately, we already have the technology to identify and treat PAD before it progresses to a point where an amputation is required. We just need a comprehensive strategy to get the right treatment to the right people. If we are going to get serious about reducing limb loss from PAD, the US must adopt a new strategy that integrates increased public awareness and robust screening with non-amputation treatment measures and multidisciplinary care.

First, we must raise awareness about PAD. While as many as 18 million Americans are estimated to be living with the disease, many are completely unaware of the risks and thus may not seek care until it’s too late. Policymakers should consider what more we can do to ensure that there is a dedicated awareness effort to encourage doctors to make patient education a priority.

Second, more could be done to increase PAD screening for those already identified to be at risk. The American College of Cardiology and the American Heart Association recommend that all patients who smoke, are over 65, or have a history of diabetes or another vascular disease be screened for PAD. CMS should work to implement these screening guidelines so that no at risk patient is left unscreened. Earlier in the PAD disease progression, less invasive options such as medical therapy or even supervised exercise therapy can be helpful once the disease has been identified.

Third, policies should ensure that patients who are later in their disease progression are assessed for other treatment options before they undergo an amputation. We know techniques such as minimally-invasive revascularization can be used to clean clogged arteries in the legs and avoid amputation all together. However, studies show that as many as one third of late-stage PAD patients never receive arterial testing to evaluate whether they may be a candidate for this procedure.

Finally, there must be a strong effort to expand multidisciplinary care for at-risk patients. Hospitals and treatment centers that have adopted comprehensive amputation prevention programs have been successful in driving amputation rates to near zero. At the same time, however, the evidence shows that certain specialties are much more prone to amputate than revascularize. As a result, policymakers should consider ways to encourage multidisciplinary care to ensure the option to save a patient’s limb is considered.

The price of developing PAD should not be limb loss, especially when the technologies exist to identify these patients and save their limbs. This September, I hope that policymakers, providers and patients will take a moment to better understand PAD. Only then can we work together to save lives and limbs, and make non-traumatic amputations a thing of the past.

Jeffrey Carr, MD is an interventional cardiologist and endovascular specialist. He is the founding and immediate past president of the Outpatient Endovascular and Interventional Society, a multispecialty medical society. He is also the physician lead for the CardioVascular Coalition, a group dedicated to raising awareness for PAD and advocating for national health care policy and amputation prevention.

Click here to see the original article on The Hill’s website.

Nephrology News: How kidney disease, peripheral artery disease, and amputation intersect

As the ninth leading cause of death in the United States, and a condition that affects an estimated 26 million Americans, chronic kidney disease is a growing health epidemic that creeps in silently, but can quickly manifest in deafening ways. While kidney disease is widely recognized and understood by patients, it’s equally as important to focus on related disease conditions.

Perhaps one of the most devastating impacts of CKD—and one we don’t hear about nearly enough—are complications associated with CKD and cardiovascular disease, particularly peripheral artery disease (PAD) and resulting limb amputation. Leading factors for both CKD and PAD are hypertension and diabetes, underscoring the multiple health risks patients face when diagnosed with these chronic conditions.

Research has further shown that Americans with CKD are at a higher risk than the general population of developing PAD, which causes narrowing or blockage of the vessels that carry blood from the heart to the legs. Poor circulation not only causes excruciating pain, but can lead to tissue death and complex, untreatable ulcers.

Vascular disease—including PAD—is now responsible for 80% of all amputations. Undergoing an amputation due to advanced PAD is both physically and emotionally devastating. It can be a source of lifelong pain, impact a patient’s quality of life, and the ability to work and function independently. Amputations also bring enormous costs to the health care system—an estimated $10.6 billion annually.

But the news for CKD patients with PAD isn’t all bad. Current technologies are available that can help reverse some of the most devastating symptoms. Outpatient interventions like angiography, revascularization (which restores critical blood flow to affected limbs), and atherectomy (a minimally invasive endovascular technique that removes plaque from blood vessels), have helped decrease the incidence of major amputations by 75%.

The benefits of this type of care can be nothing short of life-changing. With access to a PAD specialist and appropriate intervention, patients can enjoy reduced pain, enhanced mobility, improved quality of life, and a better outlook overall. In fact, the mortality rate for those who avoid amputation drops to just 16–24% compared to 48-71% for those who undergo an amputation.

This data underscores the need for public policies that increase access to PAD diagnosis and intervention, particularly among older Americans dependent on Medicare to access care, and who are often living with multiple comorbidities common across this population, including diabetes and hypertension. Other important factors impacting both CKD and PAD patient groups are the racial disparities that exist, which show African and Hispanic Americans are at a measurably higher risk for both diseases conditions.

For CKD patients diagnosed with PAD, the critical importance of appropriate and timely clinical intervention cannot be overstated. Unfortunately, there are a host of challenges affecting this population, including delayed vascular specialist referral, and slow PAD treatment initiation. Furthermore, studies have shown that patients with CKD are less likely to be provided recommended “optimal” PAD care.

Combatting the silent devastation that comes with CKD means educating Americans about their risk factors and working to provide the very best care possible to help avoid CKD’s most serious complications. Better access to PAD treatment to ensure limb preservation is central to this effort.

Click here to see the original article on the Nephrology News website.

Morning Consult: Stand Together Against Limb Loss

Progress is not a myth. Over the past few decades — and even just the past few years — our nation’s health care system has evolved. More people than ever have access to health care and better treatments. However, one major problem continues to boil under the surface and hinder health outcomes: racial inequity.

There are many things to be said on this topic. But, instead, I will focus only on my area of medical expertise: limb loss due to pre-existing medical conditions. This is because large-scale change must start small. And when it comes to staving off life-altering amputation, there are some very practical ways that advocates and policymakers alike can make a difference.

The prevalence of limb loss is a significant burden on our nation’s health system with an estimated 500 Americans undergoing amputation each day. It’s also an inconceivable struggle, pushing patients to the brink both physically and psychologically.

However, not all Americans are affected equally; amputations are significantly more prominent among minority groups. African-Americans, for instance, are up to 400 percent more likely to have an amputation than their white counterparts. Similarly, Hispanic Americans are up to 75 percent more susceptible to limb loss than Caucasians. The scale of limb loss is particularly tragic because the condition is largely preventable. In fact, it’s now estimated that nearly 60 percent of amputations triggered by diabetes — one of the most prominent drivers of limb loss in minority populations — could have been evaded given proper attention.

Taken together, these numbers suggest something quite powerful. That is, despite innovative procedures and technologies designed specifically to prevent limb loss, minority populations are simply not reaping the benefits. And, as a result, they are needlessly losing limbs at an alarming rate.

It’s precisely for this reason that a new national awareness campaign to combat limb loss disparities has emerged here in the United States. Its name is Standing Tall Against Limb Loss (Standing TALL), and its mission is expanded access to clinically appropriate care, especially for minority groups. I’m proud support the Standing TALL initiative, as an advocate who is acutely aware that limb preservation fundamentally improves lives. But I’m also very conscious of the challenges ahead.

If I’ve learned anything during my five years of practicing medicine, it’s that limb loss is incredibly complex. Amputations not only derive from injury; they are commonly triggered by a range of pre-existing conditions. To reduce limb loss, we must strengthen understanding among the most at-risk populations while simultaneously improving access to interventional treatments across the care continuum.

One primary focus is peripheral artery disease — a life-threatening circulatory condition where arteries are narrowed, reducing blood flow to limbs. Crucially, PAD is exacerbated by diabetes, chronic hypertension, and renal disease, all of which are most prevalent in minority populations.

Despite being at greater risk of PAD, however, non-white Americans typically have inadequate access to interventional treatments, which can sure up blood flow and stave off limb loss from the start. The implication of this is clear: both patients and caretakers need to know more about vascular disease. And politicians must ensure that limb preservation procedures are available to all Americans, no matter where they live or how much money they make.

This will require the collaboration of many stakeholders. Thus, Standing TALL aims to coalesce patient advocacy, disease, minority, faith-based, veteran and professional organizations. I am confident that such unity — which expands outside the medical profession — can leverage broad-based knowledge into better health outcomes and slowly but surely alleviate racial disparities.

I am incredibly proud to be taking part in the National Minority Quality Forum’s Health Braintrust event this week with the Congressional Black Caucus, which aims to address African American and minority health disparities on Capitol Hill and create legislative and policy solutions to reduce health disparities and promote good health outcomes in multicultural communities. Coordinated efforts by health care professionals and lawmakers are necessary to ignite change for minority communities unfairly facing fewer health care options.

In the end, our Standing TALL campaign rests on a few basic principles. First, no one should experience limb loss unnecessarily. And second, Americans of all backgrounds should be treated equally for limb-threatening conditions and have access to limb preservation procedures. These are things we can all agree on. So now let’s turn understanding into action and ensure limb preservation is prioritized among clinicians and policy makers alike. 

Bryan T. Fisher is a recipient of the National Minority Quality Forum’s 40 Under 40 Leaders in Health and the co-director of Limb Preservation at Centennial Medical Center and is an endovascular surgeon at the Surgical Clinic in Nashville, Tenn.

Click here to see the original article on the Morning Consult website.