The ARC Act: Fighting Amputation Via Legislation

In October 2020, Representative Donald M. Payne Jr, Cofounder of the Peripheral Artery Disease (PAD) Caucus, introduced the Amputation Reduction and Compassion (ARC) Act. The bill proposes an expansion of Medicare and Medicaid coverage to include PAD screening and would prevent reimbursement for amputation without previous arterial testing, among other reforms. Also, the bill provides resources to support and develop educational initiatives to increase understanding of PAD in the public and in medical communities. Along with the bill, Rep. Payne drafted a letter to House and Senate leadership to urge leaders to block Medicare and Medicaid payment cuts to specialty providers. The bill was reintroduced in the United States House in April 2021. Endovascular Today spoke with Rep. Payne to learn more about the Act and the rationale behind it.

Rep. Payne, can you share what spurred you to become involved with the fight to reduce PAD-related amputation?

It is a very personal battle for me. As a diabetic, I have a higher risk of having a limb amputated for health reasons. My conversations with Dr. Foluso Fakorede inspired me to take a more active role in the prevention and treatment of PAD. He has worked with patients in the Mississippi Delta for years and told me about what he called an “amputation crisis” going on there.

Too many doctors in the area didn’t know much about PAD, so they missed warning signs for patients that could have led to treatments and prevented amputations. The problem for doctors is that many PAD patients don’t have a specific set of symptoms that could lead to a PAD diagnosis. There is no easy test for it, so you must combine specific symptoms with a patient’s history to understand their risk. Then, doctors can order a vascular screening and target PAD directly.

When I heard about that situation, I joined Dr. Fakorede’s crusade to fight PAD and created the ARC Act, which is a bill that allows Medicare, Medicaid, and private health insurance to cover PAD screening tests and develop educational programs to reduce amputations related to the disease. That way, more people can get screened and fewer people will lose their limbs.

Along with the ARC Act, what other initiatives does the PAD Caucus have planned?

We will be introducing another amputation reduction bill to create incentives for doctors and other medical professionals to learn the warning signs of PAD. Once they know the signs, they can choose vascular screenings before they decide to amputate a limb.

In addition, we want to host a series of briefings on PAD for congressional members and staff once it is safe to conduct in-person meetings. These briefings will educate them on PAD, why it is so difficult to detect for doctors, what we can do to prevent it, and how minorities have a higher risk for PAD than White Americans.

What is your message to physicians concerned about the potential for overtreatment and the involvement of legislation in physician decision-making?

I would say that there is no need for concern. This bill helps referring physicians because it teaches them about PAD and allows them to make a proper diagnosis and avoid unnecessary amputations.

What can interested physicians and the vascular community do to support legislation aimed at reducing amputation?

The most important thing you can do is create more awareness of the disease and my ARC Act. Contact your representatives to tell them about the ARC Act and encourage their support of it. Ask them to join the PAD Caucus and request their support of other legislation to reduce amputations nationwide.

Efforts to create awareness are important in your communities as well. Find and discuss PAD in local organizations, whether medical or social, to increase screenings and reduce amputations. If you are a medical professional, encourage your coworkers and colleagues to learn more about PAD and how to identify symptoms to reduce amputations. Finally, support patients with vascular disease to get screened for PAD and promote tests to verify a PAD diagnosis.

I am working in Congress to save lives and limbs from PAD. But, the work you do in your communities will create the awareness necessary to make my bills easier to pass. I might be the one in Congress, but I believe we are all in this fight together.