April 18, 2016 — The American College of Radiology (ACR), as a member of a coalition of leading medical societies, provided peripheral arterial disease (PAD) treatment recommendations to the Medicare Evidence Development Coverage Advisory Committee (MEDCAC). In addition, the coalition called for continued research in how to provide the best care for U.S. seniors with lower extremity PAD.
“Identifying quality healthcare and impacting the treatment of a disease that affects millions of Americans are critical,” said Anne C. Roberts, M.D., FACR, ACR vice president and co-author of the multisociety response to the MEDCAC panel, convened by the Centers for Medicare & Medicaid Services (CMS).
PAD (or hardening of the leg arteries) is a common condition affecting 8–12 million Americans over 60 that causes significant patient difficulty and may be a signal of future heart attack and stroke. The MEDCAC panel examined the scientific evidence of existing PAD interventions that aim to improve health outcomes in the Medicare population and addressed areas where evidence gaps exist. MEDCAC panel members advise CMS about the extent to which it may wish to use existing evidence as the basis for any future determinations about Medicare coverage.
“The coalition believes that disparities in amputation, revascularization and access to PAD medical care should be recognized and eliminated,” said Roberts. Specifically, the medical groups note:
- Proven therapies, such as supervised exercise therapy, should be offered to all Medicare patients with intermittent claudication (painful cramping in the leg or hip that occurs when walking or exercising and typically disappears when an individual stops the activity);
- Revascularization (redirecting blood flow via endovascular or surgical treatment) is appropriate for patients who have intermittent claudication that is lifestyle-limiting despite a non-invasive treatment approach;
- Revascularization for patients with critical limb ischemia (CLI) should be encouraged and reimbursed according to quality of care and outcomes literature. The groups endorse the development of CLI teams for optimal care; and
- Systematic collection of reliable data regarding management of all patients with PAD will enhance the understanding of outcomes and help define appropriate care for the future.
The coalition’s response, “Vascular Specialist Response to Medicare Evidence Development Coverage Advisory Committee (MEDCAC) Panel on Peripheral Artery Disease of the Lower Extremities,” will be published in the Journal of the American College of Radiology (JACR).
Besides the ACR, the original article is endorsed by the Society of Interventional Radiology (SIR), Society for Cardiovascular Angiography and Interventions (SCAI), Society for Vascular Medicine (SVM) and Vascular Interventional Advances (VIVA). The response will also be published in SCAI and SVM journals.
For more information: www.jacr.org
April 17, 2024 
