Bill Would Eliminate Cost-Sharing to Screen for Patients at Risk of PAD

October 24, 2020
Mary Caffrey
Mary Caffrey

The legislation follows an investigation that highlighted how minorities experience much higher rates of lower limb amputation than whites.

fThree members of the House of Representatives have introduced a bill to make it easier to find patients at risk of amputations, a move applauded by a network of healthcare providers and advocates called the CardioVascular Coalition.

U.S. Reps. Donald Payne Jr. D-N.J., Bobby Rush, D-Ill., and Ruben Gallego, D-Ariz., introduced the Amputation Reduction and Compassion (ARC) Act (H.R. 8615) on October 16, which would provide coverage for screening for peripheral artery disease (PAD) to at-risk beneficiaries in Medicare and Medicaid and eliminate cost-sharing, thus reducing barriers for patients.

The CardioVascular Coalition said in its statement that expanding coverage for PAD screening, such as the ankle-bracial test, would help prevent patients from progressing to the serious complications that cause lower limb amputation. Up to 20 million Americans have PAD but many do not realize it, and a disproportionate share of these patients are minorities. Each year 200,000 Americans have lower limb amputations due to PAD, putting them on a trajectory that puts them at risk of death within five years.

An investigation earlier this year by ProPublica found that an amputation epidemic is taking place in America’s Black population, in part because of misaligned financial incentives that reward surgeons for amputating a limb but do not pay certain physicians for screening or for the revascularization that would save it. The resulting lifetime of disability checks and lost wages are not taken into account.

Thus, the proposed legislation would also bar providers from turning to amputation without completing arterial testing, which can show if other interventions can be tried first that can salvage the limb. Finally, the bill would also create the PAD education program to teach health care professionals and the public about the condition and how they can prevent amputations; the program would be focused on at-risk minority populations who are far more likely to have non-traumatic amputation than whites. Dartmouth Atlas has found that Blacks with diabetes have an amputation risk four times higher than the national average; Native Americans are twice as likely to have an amputation, and the Hispanic population is 75% more likely than the general population to have an amputation.

“By expanding coverage for simple, non-invasive screening tests, we have the power to help thousands of Americans avoid unnecessary amputations every year,” Jeffrey Carr, MD, co-founder of the Outpatient Endovascular and Interventional Society and a member of the coalition, said in a statement. “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.”


The CardioVascular Coalition includes national groups representing physicians, caregivers, manufacturers, and advocacy groups that seek to reduce geographic disparities in access to care for PAD and other cardiovascular diseases.