Earlier this month, the New York Times reported on a concerning trend – unnecessary atherectomies are putting patients at an increased risk of amputation. The procedure, used to treat peripheral artery disease, deploys metal blades to remove plaque from artery walls. Its use has nearly doubled in Medicare patients over the last decade, and a significant portion of this volume has shifted to outpatient settings, namely vascular clinics.
These clinics have been dubbed the “wild west” of healthcare, with some vascular surgeons, interventional radiologists and interventional cardiologists opting for atherectomies almost immediately, even though best-practice clinical research recommends a front-line approach of lifestyle modification and/or medication before surgical intervention. There are a whole host of other claims including shady partnerships between clinics and device manufacturers that I won’t get into here. The article’s findings were troubling, to say the least, and I imagine health plans are going to be taking a closer look at how they are managing vascular procedures as an output.
I see it all the time in my role at TurningPoint and as a practicing cardiologist – even the most well-respected cardiac programs have trouble following best-practice guidelines. A critical component of TurningPoint’s cardiac program is to ensure the clinical safety of the patient first and foremost – while also safeguarding against fraud, waste, and abuse. We see providers frequently requesting peripheral interventions, like atherectomy, with documented critical limb ischemia or rest pain without any supporting evidence.
More and more, we are seeing that without proper medication adherence and appropriate lifestyle modification, cardiac patients have an increased chance of mortality – from either abandoning treatment altogether or unnecessarily undergoing procedures, like the ones outlined in the Times article. In addition, we see providers treating isolated infrapopliteal vessels for patients with claudication which is not advised by societal guidelines.
If these patients do undergo vascular interventions, like atherectomy, it’s even more important that they get the proper medication after these surgeries and treatments. A study found that patients who weren’t given the recommend medications (also known as Guideline Directed Medical Therapy), like Statins, Antiplatelet, and ACE Inhibitors, had a 24% higher risk of death within one year after the procedure. That’s why it’s so critical to treat the whole patient and consider clinical best-practice guidelines, especially with an aging population.
We know that patients are becoming more acute, the NIH estimates that by the year 2050, the number of people aged 50 and older with one chronic, complex condition is expected to rise by 99.5%. It is critical for the healthcare system to better manage the risk factors contributing to poor outcomes in cardiac patients: smoking, diabetes, obesity, high cholesterol, sedentary lifestyle, poor diet, and sleep apnea. Overtreating with procedures is a real danger in cardiac programs.
TurningPoint is uniquely positioned to help health plans, employers, providers and patients avoid unnecessary and harmful procedures like unnecessary atherectomies and stent placements. It is my clinical opinion that unless there is evidence of limb necrosis (dead tissue in the limb) or pain at rest, any surgical intervention on the arteries should be reserved to situations when ALL else is excluded. That’s why we’re here – to make sure the right patient gets the right treatment at the right time.
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