Comment on CMS-2026-2344-0002
Devin ZarkowskySupportIndividual
Summary: The commenter, a medical practitioner, advocates for the preservation and restoration of independent medical practices in local communities. They argue that procedures like PAD limb preservation should be available in ambulatory settings to improve access and reduce costs for underserved patients.
The decline of independent medical practices is not just a rural problem. It is a community problem. Across the country, independent medical practices, often the backbone of care for working-class, elderly, and underserved patients, are disappearing. Over the last decade, the share of physicians in independent practice has dropped dramatically. When those practices close, patients drive farther, pay more, and often receive care in higher-cost settings that were never meant to replace local medicine. Nowadays, Peripheral Arterial Disease (PAD) limb preservation care happens in the office or ambulatory surgery center setting with excellent safety and efficacy. Portable ultrasounds, mobile X-ray equipment, as well as minimally invasive devices allow blocked arteries to be diagnosed and reopened under local anesthetic. These procedures, among other vascular, general, ENT, plastic, and orthopedic surgeries should be available within the communities where patients live. Supporting procedural migration back to the communities that need them will go a long way to restoring the community's fabric in medically-underserved areas, like Fallbrook, CA where I practice, around the United States.