Advocates Urge Heat Maps and Grassroots Campaigns to Improve PAD Care

LAS VEGAS, NV—Advocating on behalf of patients for better disease prevention, detection, treatment, and funding is key to tackling the amputation epidemic that disproportionately affects nonwhite Americans and those of lower socioeconomic status who have PAD, several speakers said here at a special VIVA 2024 session.

With more than 10 million Medicare patients impacted by the disease, it is a widespread but underrecognized problem, said Joshua A. Beckman, MD (UT Southwestern Medical Center, Dallas).

“I think public awareness is going to be key for our battle going forward,” he said. “If you want to recruit and take care of the public, the public actually has to be engaged. They have to know that there's a problem. They have to want to participate because they feel like it could be them or their family members.”

Beckman and others with the PAD Collaborative, which is comprised of 17 professional organizations including VIVA, have created an interactive “heat map” of the United States that provides data on rates of lower limb amputation both geographically and by Congressional district.

Beckman said the map offers some surprising insights on the importance of geography and how easy it is to dismiss major urban areas as being immune to poor care because they are in close proximity to excellent hospitals.

A good example is Los Angeles, where amputation rates are 10 times higher in the lowest-income neighborhoods than in the highest-income neighborhoods. Those data fit with what has become increasingly known about unnecessary lower limb amputations and death among the most vulnerable patients with PAD in southern and rural areas that were once largely places where enslaved people lived. While the state of Mississippi tops the heat map in terms of the highest concentration of amputations per 100,000 people across several of its Congressional districts, California is wedged between them with its 21st Congressional district— located in the San Joaquin Valley—having an amputation rate per 100,000 of 120.3 compared with a statewide average of 28.5.

I think public awareness is going to be key for our battle going forward. Joshua A. Beckman

From an applicability standpoint, Beckman suggested that the data in the heat map can be used to start conversations at the local level with elected officials to advocate for accountability and recognition of the problem.

“You can walk into your congressman or -woman's office,  and you can say, ‘In your district you have this many people getting amputations, what are you doing for us?’” he said.

To TCTMD, Beckman said while taking individual action based on the map is moving in the right direction, the process is iterative and will be further refined with time as people access and use the data.

“I think we have to figure out how to organize all of our efforts into a single larger effort,” he said. Specifically, working toward a repository for the feedback that people get from their representatives and others on the local level when they present them with data from the heat map could help “move the needle” even further, he added.

Preventing Further Funding Cuts and Fees

In her presentation in the same session, Margaret C. Tracci, MD, JD (UVA Health, Charlottesville, VA), said that in spite of the need to improve care and outcomes for patients with PAD, the field has been hit harder than almost any other sector of healthcare in terms of payments for services not keeping up with inflation.

“Medicare payment has fallen behind the cost of providing care. This has perhaps fallen most heavily on the shoulders of the dwindling number of people who are still in independent practice, but who in our field, particularly in PAD, are a critical part of the safety net for providing care for patients,” she said.

Further cuts will only drive increased spending while harming both access and quality of care, Tracci added. She encouraged physicians in the PAD space to write letters to Congress through their professional societies to advocate for fixing the Medicare payment for physician services and urge no further cuts or “nickel and dime” fees from insurers or their vendors for things like electronic funds transfers, with a particular emphasis on doing this before end-of-the-year budget packages are approved.

“It is urgent,” she said. “It stops the cuts and gives us not a full inflation adjustment, but half of the Medicare Economic Index. It's on the right track, it's temporary, but I think it really marks an acknowledgement that not keeping up with inflation is not sustainable.”