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Unless Congress Acts, Ongoing Clinical Labor Cuts Will Worsen Amputation Epidemic

Dec 9, 2022

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

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

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

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

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

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

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

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

I’m calling on Congress to use its power to stop ongoing clinical labor cuts in the 2023 Medicare Physician Fee Schedule final rule. It is crucial to giving patients the appropriate medical care they need to prevent needless amputations, particularly in underserved areas.Paul J. Gagne MD, FACS, RVT, is board-certified vascular surgeon, fellow of the Society of Vascular Surgery, and director of the Vascular Breakthroughs.

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