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October 26, 2020

New Amputation Reduction and Compassion Act Bill Aims to Reduce Lower Limb Amputations, Improve PAD Care

October 26, 2020—United States Representative Donald Payne, Jr. (D-NJ) recently took actions aimed at reducing lower limb amputations nationwide and addressing racial disparities in peripheral artery disease (PAD) care with the introduction of The Amputation Reduction and Compassion (ARC) Act (H.R. 8615).

Among other reforms, the bill proposes an expansion of Medicare and Medicaid coverage to include PAD screening and would prevent reimbursement for amputation without previous arterial testing.

As noted by the CardioVascular Coalition (CVC), providing adequate health care for vulnerable individuals is essential, particularly those most at risk for PAD. The CVC noted: “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 undergo amputation, and Hispanic Americans are up to 75% more likely to have an amputation.”

The ARC Act aims to fill the policy gap that contributes to these inequities 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, stated CVC.

In an October 22 announcement, CVC advised that provisions of the ARC Act would achieve the following:

  • Provide coverage of PAD screening for at-risk beneficiaries under the Medicare and Medicaid programs without the imposition of cost-sharing requirements.

  • Expand coverage for PAD screening such as the ankle-brachial index test for at-risk beneficiaries, thereby preventing vulnerable individuals from developing serious complications from PAD, which can lead to lower limb amputation.

  • Prohibit the use of amputation without the completion of arterial testing to determine if alternative interventions could be applied.

  • Establish a PAD education program to support, develop, and implement educational initiatives that inform health care professionals and the public about the existence of PAD and methods to reduce amputations, particularly with respect to at-risk populations, such as racial and ethnic minorities who are more likely to face nontraumatic amputation than whites.

These efforts come in the wake of a May 17 report published by ProPublica. “The Black Amputation Epidemic” by Lizzie Presser focused on the clinical treatment and advocacy efforts of Foluso Fakorede, MD, in the Mississippi Delta to examine unnecessary amputations and racial disparities that have resulted in Black Americans being three times more likely to undergo diabetic amputations than others. The ProPublica article also focused on how patients often undergo diabetic amputations without previous arterial testing.

On August 27 in ProPublica, Presser reported on new initiatives of the American Diabetes Association to prevent unnecessary amputations as part of a campaign to reduce racial disparities in diabetes care. She reported on the ARC bill on October 19.

In the announcement of the bill, Rep. Payne stated, “I took these actions to protect Americans who could lose a limb to a preventable disease. PAD is treatable, if we catch it early. Medicare and Medicaid treat our most vulnerable citizens. We need to allow these two critical programs to support medical professionals and patients and not cut critical funding that could cause Americans to lose their limbs.” Rep. Payne is co-sponsoring the ARC Act with Representatives Bobby Rush (D-IL), Ruben Gallego (D-AZ), Eddie Bernice Johnson (D-TX), Lisa Blunt Rochester (D-DE), and Bennie Thompson (D-MS).

The CardioVascular Coalition (CVC) applauded Representative Donald Payne, Jr. (D-NJ) “[f]or his exemplary leadership and commitment to addressing the inequities and health disparities in the healthcare system by introducing The Amputation Reduction and Compassion (ARC) Act (H.R. 8615).”

According to CVC, the ARC Act demonstrates Rep. Payne’s continued dedication to creating an equitable healthcare system, which began when he cofounded the Congressional PAD Caucus with Rep. Gus Bilirakis (R-FL) in April 2019. The PAD Caucus, which currently has 35 bipartisan members, seeks to educate Congress about PAD while supporting legislative activities to improve PAD research, education, and treatment.

Jeffrey Carr, MD, Cofounder of the Outpatient Endovascular and Interventional Society and a member of the CVC, commented in the October 22 CVC announcement, “By expanding coverage for simple, noninvasive screening tests, we have the power to help thousands of Americans avoid unnecessary amputations every year. 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.” Dr. Carr added, “We look forward to working collaboratively with Reps. Payne, Rush, and Gallego, and advocates across our profession to build support for this propatient legislation, which is a giant step forward for the patients we serve and others at risk for PAD.”

On September 3, at the start of PAD Awareness Month, CVC announced that it was urging Congress to support policies to improve PAD screening, diagnoses, and treatment to reduce lower limb amputations. Specifically, CVC asked Congress to advance legislation to block planned Medicare and Medicaid payment cuts to specialty providers in 2021. In an October 16 letter to the House and Senate, Rep. Payne also urged leaders to prevent these Medicare cuts.

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