Congress can save lives and strengthen Medicare by doubling down on health screening

A quiet epidemic of avoidable amputations is driving up health care costs and harming the quality of life for millions of Americans. A simple screening procedure can help prevent many of these surgeries, saving lives and money. Unfortunately, a lack of health insurance coverage and physician access causes many chronic illnesses to go undiagnosed until it is too late, eventually requiring amputation. One such illness is peripheral artery disease (PAD), a condition in which narrowed arteries reduce blood flow to the arms or legs. By passing the Amputation Reduction and Compassion (ARC) Act, H.R. 4261, Congress can take a major step toward ensuring that PAD screening is affordable and accessible for high-risk patients, which will help prevent avoidable amputations.

A lack of access to medical care is driving inequality and poor outcomes in our health care system. Rural Americans often must drive hours to see a physician, lower-income and uninsured patients struggle to afford testing and treatment, and preventative services can be scant. As a result of our imperfect health care system, many conditions such as PAD go undetected, driving up costs and hurting patients in the process. Roughly 70 percent of the estimated 20 million Americans suffering from PAD do not know they have the disease, resulting in far too many preventable amputations due to late diagnosis and treatment plans.

Preventable amputations disproportionally hurt rural and minority communities. Black Medicare beneficiaries are three times more likely to receive an amputation due to PAD than non-Black Medicare recipients. Recent cuts to Medicare payments, particularly for office-based specialty care, will exacerbate this situation by further reducing access to PAD screening for Black, Hispanic, Native American and rural Medicare beneficiaries.

Amputations are incredibly expensive and can have devasting impacts on patients’ quality of life. A single lower-limb amputation can cost over $100,000, an expense that is disproportionately borne by federal programs such as Medicare and Medicaid. Research shows that in 2015, Americans spent $11.3 billion on major amputations and $18.6 billion on minor amputations, which reflects just the direct inpatient and outpatient costs of the procedure. The substantial indirect and follow-up costs of amputation and other expenses from managing PAD are not included in that number. The total annual economic burden of PAD is estimated to be between $233-414 billion.

Amputation does not end the health concerns that come with PAD. Patients that undergo an amputation suffer permanent disability, along with a heightened risk for chronic pain and depression. Furthermore, between 52 percent -80 percent of patients who undergo a major amputation die within five years of the procedure due to comorbidities, including the impacts of previously untreated chronic illnesses like PAD.

Policy action on PAD will strengthen Medicare, improve health equity, and save taxpayer dollars. Congress can dramatically expand access to screening through a combination of passing the ARC Act and by implementing a sustainable Medicare reimbursement rate for the physicians who diagnose and treat PAD.

The ARC Act would help address PAD through two key actions. First, the ARC Act would establish an education program through the Department of Health and Human Services on recognizing PAD risks and symptoms, diagnosing PAD, and treating the disease. Second, the ARC Act expands Medicare and Medicaid coverage to include screening for PAD for high-risk patients. These targeted measures would not only expand awareness and treatment of PAD, but would lead to addressing PAD earlier in the disease progression, ultimately reducing the number of avoidable amputations that devastate lives and drive up costs.

Additionally, Congress should act to protect access to office-based specialists who perform PAD screening and revascularization – a minimally invasive procedure that can restore blood flow in patients suffering from PAD and avoid amputation. Successive cuts to Medicare reimbursements and a lack of inflation adjustment have forced many of these critical office-based care centers to close.

These two policies — enacting the ARC Act and safeguarding physician access — can serve as the foundation for eliminating preventable amputations moving forward.

America can do better than our current system for diagnosing and treating PAD, where health outcomes are often determined by race, region and socioeconomic status, among other factors. We have simple, commonsense screening procedures that will benefit patients suffering from PAD and taxpayers who cover the costs of expensive but avoidable amputations. Each year we delay, tens of thousands of Americans suffer the health, economic and quality of life impacts of preventable amputation.

Dr. Joaquin Cigarroa is a former Co-Chair of the Committee on Government Relations for the Society for Cardiovascular Angiography and Interventions (SCAI), and Chief of Cardiology and a Professor of Medicine at Oregon Health & Science University.