Deerfield, IL (PRWEB) February 03, 2015
The Society for Vascular Medicine (http://www.vascularmed.org) read with disappointment the New York Times article, “Medicare Payments Surge for Stents to Unblock Blood Vessels in Limbs,” noting a series of inaccuracies that limit the discussion of this very important topic.
First, through the Choosing Wisely initiative (http://www.choosingwisely.org), the Society for Vascular Medicine does not warn that people typically do not need invasive treatment for peripheral artery disease (PAD). Our recommendation states, “[providers should] Refrain from percutaneous or surgical revascularization of peripheral artery stenosis in patients without claudication or critical limb ischemia,” warning against inappropriate use in patients who do not have leg symptoms.
Second, the article decries the surge in vascular procedures, focusing on peripheral artery interventions. However, as the figure in the article clearly shows, artery interventions have been relatively stable since 2006. As noted in the figure, vein interventions have more than doubled over this time period, but warrant scant attention in this article.
Third, the article underestimates significantly the prevalence of PAD in the United States. The best estimates suggests that 1 in 5 men and 1 in 6 women has peripheral artery disease in the Medicare population (patients 65 years or older) (http://www.ncbi.nlm.nih.gov/pubmed/14709362). This misconception prevents physicians and patients from getting life saving care: patients with PAD have a significantly increased risk of cardiovascular death.
Fourth, and perhaps most importantly, the article notes twice that most PAD patients can be treated with exercise alone. Unfortunately, despite extensive clinical evidence that exercise training improves leg symptoms for patients with PAD and is cost effective compared to intervention, Medicare does not cover supervised exercise programs for PAD as it does for heart and lung disease. The prescription for exercise without supervision has been shown to fail time and again. Unfortunately, because of the lack of Medicare coverage for supervised exercise therapy, most PAD patients do not have access to the safest and most cost effective therapies for this disease. The failure of Medicare to pay for inexpensive, effective exercise therapy, while being willing to pay for expensive interventional therapy, warrants further discussion.
The Society for Vascular Medicine strongly endorses the appropriate use of therapies to improve the quality and length of life for patients with vascular disease. We decry inappropriate use of any therapy and have an ongoing commitment to improving the lives of our patients, as well as better understanding of vascular disease. We believe that there is both overuse and underuse of medical and invasive therapies, but the misinterpretation of information only hinders progress towards improving the lives of our patients.
For more information contact SVM Executive Director Lee Ann Clark at lclark(at)vascularmed(dot)org or call 847-480-2961, Ext. 220.
The Society for Vascular Medicine is a professional organization founded in 1989 to improve the integration of vascular biological advances into medical practice, and to maintain high standards of clinical vascular medicine. The Society is distinguished by its emphasis on clinical approaches to vascular disorders. Learn more at http://www.vascularmed.org.