Could New Legislation Help Clinicians Prevent Amputation?

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On June 21, Representative Donald J. Payne, Jr. (D-NJ), introduced the Amputation Reduction and Compassion (ARC) Act of 2023, which will be of particular interest to the podiatry, wound care, and diabetes communities. This bipartisan bill, if passed, supports a growing provider movement to prevent unnecessary amputations through Medicare and Medicaid coverage of early screening and detection, surveillance, testing, and treatment for peripheral arterial disease (PAD).
 
Today, 21 million Americans have or are at risk for PAD and an estimated 200,000 of them will need an amputation.¹ But, as clinicians know, these amputations could be prevented if PAD is screened and diagnosed early. PAD also places individuals at a higher risk for stroke, myocardial infarction, and other cardiovascular disease. Additionally, there are significant racial disparities across those suffering from unnecessary amputation²—what some have termed an “amputation epidemic” in communities of color.³ The ARC Act addresses a call to action from health care professionals by:

• Funding resources to develop and support educational initiatives to increase understanding of PAD in the public and in medical communities.
• Requiring the development of quality metrics among payers and facilities that can prevent amputations; and
• Providing access to amputation prevention services through the development of a voluntary pilot program, including through patient risk medication and management approaches, early screening and detection, ongoing surveillance, testing, and interventions for PAD and associated conditions. 

Payne, the legislation’s lead sponsor, has spoken candidly about his own battle with type 2 diabetes and PAD, providing a face to an often silent disease. He is the co-founder of the Congressional PAD Caucus and an active member of the Congressional Diabetes Caucus to raise awareness, support and develop legislation and elevate these diseases as federal government health care priorities.
 
Many individuals with PAD don’t even know they have it, and podiatric and wound care clinicians are in an ideal position to provide a positive impact. Without education and early interventions that can save limbs, we know that amputation can all too quickly be the outcome. Yet currently, Medicare and Medicaid plans do not cover preventative measures and technologies such as diabetic foot screenings and pressure-relieving shoewear and can be burdensome for patients to access. It seems, from a policy perspective, that payers would rather cover and pay for more costly surgical interventions—even amputation—as opposed to focusing on the prevention of these diseases, which disproportionately affect people of color.⁴
 
As such, we at the Alliance of Wound Care Stakeholders joined with more than 30 organizations to voice our support of this important piece of legislation. Co-signers of this joint letter include the American Diabetes Association, American Podiatric Medical Association, Amputee Coalition, Amputation Prevention Alliance, the Partnership to Advance Cardiovascular Health, and more.
 
This legislation still has a long road ahead. It has been introduced and considered by Congress in the past, but not moved forward into law. Perhaps 2023 will be the year the ARC Act is passed and enacted. One way to help that happen is to voice our support as clinicians. Send an email to your congressional representatives asking them to support the ARC Act. Share perspective on the value that broadly accessible and fully reimbursed PAD screening can have on preventing amputations, chronic non-healing wounds, ulcers, and infections.
 
Marcia Nusgart, RPh, is founder and CEO of the Alliance of Wound Care Stakeholders, the leading voice of wound care advocacy for the past 20 years. The Alliance unites leading wound care organizations and experts through advocacy and educational outreach in the regulatory, legislative and public arenas to advocate on public policy issues that may create barriers to patient access to treatments or care. With a key focus on coding, coverage and reimbursement, quality measures and wound care research, the Alliance elevates the visibility and united voice of wound care providers to regulators and policymakers.

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References
 
1. Yost M. The current U.S. prevalence of peripheral arterial disease. Vasc Dis Manage. 2023;20(4):E67-E73
2. Rizzo JA, Chen J, Kotlarz H, Ryan MP, Gunnarsson C. Racial disparities in amputation rates for the treatment of peripheral artery disease using the health care cost and utilization project database. Value Health. 2016; 19(3), A55-A56. doi:https://doi.org/10.1016/j.jval.2016.03.142
3. Presser L. The Black American Amputation Epidemic. Propublica.
4. Tan TW, Shih CD, Concha-Moore KC, et al. Disparities in outcomes of patients admitted with diabetic foot infections. PLoS One. 2019; 14(2):e0211481. https://doi.org/10.1371/journal.pone.0215532