Prosthetic Categories

Medicare Cuts May Worsen the Amputation Crisis

    On Nov. 2, 2021, the Centers for Medicare & Medicaid Services (CMS) finalized the 2022 Hospital Outpatient Prospective Payment System and ASC Payment System. The new payment system will see a 23% payment cut to in-office revascularization services, undoubtedly limiting patient access to this limb-saving procedure.

     Medicare's 2022 cuts may worsen the amputation crisis in the US.

    Revascularization, performed either in the hospital or outpatient setting, involves removing plaque from a patient's arteries or inserting devices to keep the blood vessels open. Patients, especially those in hard-to-reach rural areas, often prefer to receive such services in independent doctor's offices because they are more convenient, less expensive, and closer to home than hospitals.

    Medical literature shows that the vast majority of non-traumatic amputations—about 85%—related to peripheral arterial disease (PAD) and critical limb ischemia (CLI) could be prevented if patients could access timely interventions, like revascularization.

    However, proper screening and vascular care are still out of reach for many Americans, especially those who live in rural areas or individuals who identify as non-white. The previous Medicare payment system was more beneficial for these high-risk populations as outpatient vascular services reduce the risk of amputation.    

    Vascular services removed from the ASC payable list include:

    • Distal revascularization and interval ligation (code 36838)

    • Percutaneous transluminal revascularization of or through coronary artery bypass graft (code C9604)

    • Percutaneous transluminal revascularization of or through coronary artery bypass graft (code C9605)

    • Percutaneous transluminal revascularization of chronic total occlusion (code C9607)

    • Percutaneous transluminal revascularization of chronic total occlusion (code C9608)

    • Endovenous femoral-popliteal arterial revascularization (code 0505T)

    Because of the cuts, the amputation crisis in America will get much worse. There are an estimated 200,000 amputations annually in the US due to PAD and CLI. More Americans need access to proper screening and revascularization services to prevent further amputations. This is going to be difficult from now on.

    Furthermore, healthcare experts predict a devastating real-world impact. This change would significantly strain outpatient providers, many of which are already burdened by the ongoing COVID-19 pandemic. If outpatient vascular care providers are forced to close, already vulnerable patients will have to travel a great distance to the nearest major hospital. But those who don't have the means won't receive the care they need to save their limbs and even possibly their lives.

    Access to quality, community-based vascular care is crucial. However, healthcare policymakers still reduced beneficiary access to ASCs despite having little to no clinical data on which to base it.