Sep 12, 2018
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 condiion, 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.