Members of the peripheral arterial disease (PAD) Task Force—including the Association of Black Cardiologists (ABC), CardioVascular Coalition, CLI Global Society, Preventative Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Interventional Radiology—recently commended introduction of the Amputation Reduction and Compassion (ARC) Act (HR 2631), legislation intended to reduce unnecessary amputations due to PAD.
The bill provides coverage of PAD screening for at-risk beneficiaries under the Medicare and Medicaid programmes without the imposition of cost-sharing requirements.
In order to encourage appropriate screening and early detection of dangerous complications, the ARC Act further disallows payment for non-emergent amputations—unless anatomic testing has been done in the three months prior to amputation. The legislation also provides resources for a PAD education programme to support, develop, and implement educational initiatives that inform healthcare professionals and the public about PAD—as well as methods to reduce amputations, particularly with respect to at-risk populations including racial and ethnic minorities.
“The ARC Act is a historic intervention destined to alter the cardiovascular health outcomes of at-risk PAD patients and address the virulent practice of PAD-related amputations,” Foluso Fakorede (Cardiovascular Solutions of Central Mississippi, Cleveland, USA), co-chair of the ABC PAD Initiative. “The ABC welcomes this bipartisan effort and implementation of policy action in hopes of achieving genuine health equity.”
“With the introduction of the ARC Act, and in recognition of National Minority Health Month, we have the opportunity to expand coverage for simple, non-invasive screening tests that will empower patients to take steps to manage their PAD before amputation becomes necessary,” said Jeffrey Carr (Tyler Cardiac and Endovascular Center, Tyler, USA), co-founder of the Outpatient Endovascular and Interventional Society (OEIS) and a member of the CardioVascular Coalition.
“The ARC Act constitutes an important step towards preventing unnecessary amputations related to PAD,” said Lola Coke (Rush University Medical Center, Chicago, USA), a cardiovascular clinical nurse specialist with the Preventive Cardiovascular Nurses Association. “By expanding coverage for screening tests and supporting public and provider education especially in high-risk patients like chronic smokers and diabetics, we have the opportunity to minimise the progression of the disease and save limbs for those diagnosed with PAD.“
“Approximately 20 million Americans have PAD and an estimated 200,000 of them—disproportionately from minority communities—suffer unnecessary amputations every year. The Society for Cardiovascular Angiography and Interventions (SCAI) supports this bill because we believe 200,000 is too many,” said Joaquin Cigarroa (Oregon Health & Science University, Portland, USA), SCAI Government Relations Committee chair.
“Patients deserve to know and have access to all treatment options. With non-invasive screenings, the ARC Act will empower patients to make informed decisions about their PAD treatment. The earlier we are able to catch and treat PAD, the more likely we are able to avoid amputations and preserve patients’ quality of life,” said SIR President Matthew S Johnson (Indiana University School of Medicine, Indianapolis, USA).
Minority populations in the USA are at disproportionately higher risk for amputations from PAD. According to data compiled by the Dartmouth Atlas of Health Care, Black Americans are over three times more likely than whites to experience a non-traumatic amputation as a result of diabetes, a common PAD risk factor. Similarly, Native Americans are more than twice as likely to be subjected to amputation, while Hispanics are up to 75% more likely to have an amputation.
The PAD Task Force, originally formed in 2018, came together to advance strategies to increase public awareness and robust screening to ensure non-amputation treatment measures through a multidisciplinary team care approach. The PAD Task Force notes that its concerns around PAD are not restricted to government programmes and urges private payers to also adopt policies to raise awareness about PAD, improve access to PAD screening, and disallow non-traumatic amputations without anatomical testing.
To learn more about the ARC Act, click here.