- A leading cause of US death
- No line-item funding in federal budget to target
President Obama’s FY 2017 Budget Proposal released this week reflects priorities of $4.1 trillion in federal spending. Absent from the budget: line-item funding for the 3rd leading cause of death in the US and the #1 cause of preventable hospital death & #1 cause of maternal death: venous thromboembolism (VTE).
Definition: Venous thromboembolism (VTE) are blood clots which occur in a deep vein of the body. VTE includes deep vein thrombosis (DVT) and its potentially fatal complication of pulmonary embolism (PE).
Around 60 percent of VTE are associated with hospitalization–occurring during or within 90 days of a hospital stay. The Agency for Healthcare Research and Quality (AHRQ) says “venous thromboembolism—is the most common preventable cause of hospital death.”
For perspective, VTE kills more Americans annually than breast cancer, AIDS and motor vehicle accidents combined. It kills more than firearm homicides and stroke–things we hear much more often about.
Because most VTE are preventable, it has been identified as a national health priority by the Surgeon General’s 2008 Call to Action, the CDC , the CMS Partnership for Patients and Healthy People 2020, yet no direct line-item funding allocation specifically for VTE has been made to support these designations.
VTE is “a major health problem, exacting a significant human and economic toll on the Nation”.
“There are few public health problems as serious as DVT/PE, yet these diseases receive so little attention.”
“the status quo unacceptable”
“This Call to Action concludes that in order to impact the incidence and burden of DVT/PE, stakeholders need to come together to increase public awareness, support the development of evidence-based practices, and carry out the scientific research that can address the gaps in knowledge.”
The CDC is the federal agency responsible for protecting the public’s health through the prevention of disease. While the CDC’s FY 2017 Congressional budget justification includes $87 million by name for two other thrombotic conditions, heart disease and stroke, there is no line-item specifically for VTE, which by the CDC’s own mortality figures, kills more Americans annually than stroke.
While there is no line-item funding allocation for VTE as you find with other conditions, that is not to say there is not some effort to address VTE by the CDC within its budgetary constraints. Found within the CDC National Center on Birth Defects and Developmental Disabilities (NCBDDD) is a $4.5 million line-item titled “Public Health Approach to Blood Disorders”. It is from a portion of these funds and within this division that current CDC efforts to address VTE arise. Past efforts have included creating a Flickr album of patient stories and hosting a webinar for health care professionals. I was pleased to contribute to both these educational efforts. However, despite good intentions to do the most possible with the available resources, we must admit that these are relatively low-impact, virtual based efforts when held in comparison to the more interventional-type methodologies employed to address other preventable medical conditions. For comparison, take a look at the national, hands-on network of programs the CDC has implemented for stroke.
This problem with the current CDC approach to VTE is 2 fold:
- VTE is not a blood disorder. Thrombosis is a cardiovascular event. There are identifiable risk factors for VTE–such as hospitalization, immobility, cancer, long-distance travel, oral contraceptives, pregnancy, advanced age. So it doesn’t fit neatly within the mission scope and skill set of an administrative unit at CDC which primarily addresses conditions acquired at birth. To capitalize on existing expertise and tap economies of scale, it should be addressed by the same administrative unit as the other 2 major thrombosis-related conditions–heart disease and stroke–within the National Center for Chronic Disease Prevention and Health Promotion. VTE shares a similar clinical pathology and risk profile to these thrombotic conditions. Some of the same drugs (anticoagulants) are used for treatment. Heart attack and stroke are due to blood clots which occur in arteries; VTE from blood clots which occur in veins. Yet, all are blood clots. Why then should they be administratively targeted so differently?
- Because VTE is not mentioned by name, with a line-item expressly for it, funds in the ‘Public Health Approach to Blood Disorders’ line can easily be diverted and utilized on non-VTE educational activities, which has been seen in past years. The only way to ensure funds are utilized for VTE is for it to have its own, clearly named line-item allocation.
While we would like to ideally think that our public health agencies prioritize those medical conditions which pose the greatest threat to American’s morbidity and mortality, this is not the case. While there are effective strategies to prevent and treat VTE, which impacts 900,000 Americans annually, it is a largely ignored public health concern.
To target VTE, the President and Congress need to:
- Establish a task force (as has been done for other conditions) to review, consolidate and coordinate all US VTE efforts across federal agency stakeholders–CDC, CMS, AHRQ, NIH, FDA, HRSA, Veterans Affairs, Rural Health. Currently, efforts are siloed reflecting a lack of cross-agency collaboration.
- Make a clearly named VTE line-item funding allocation.
- Funds should carry the mandate that they can only be utilized for VTE, prohibiting the ability to divert funds towards other conditions.
- A clear line of reporting and accountability should be implemented with attached funds to ensure results.
- If it is determined that CDC should maintain responsibility for public health prevention of VTE, then a clearly named VTE line-item funding allocation must be made within the same CDC administrative unit that addresses other thrombotic conditions–the National Center for Chronic Disease Prevention and Health Promotion. If another agency is chosen, VTE should be paired with related thrombotic conditions to take advantage of existing expertise.
What can you do?
Congress will now propose their own budget in response to President Obama’s proposal. Please know I’m not a lobbyist so I don’t rightly know what to do. I am a VTE survivor who doesn’t want to see anyone else experience what I and my family have undergone. If you would also like to see a VTE line-item in this budget, my suggestion is to then contact your Representative, the House Budget Committee Chair Tom Price and/or House Speaker Paul Ryan. Share your patient story and encourage them to fund VTE like the health priority it should be with a clearly named line-item funding allocation. And share knowledge of VTE on social media–knowledge empowers, action transforms.
Additionally, to encourage VTE action in future years, ask of persons running for elected federal offices, “Do you support federally funded VTE education and research? If so, will you include a line-item specifically for VTE in your budget proposal?”
House Speaker Paul Ryan
Additional contact methods http://www.speaker.gov/contact
H-232 The Capitol
Washington, DC 20515
Phone: (202) 225-0600
Fax: (202) 225-5117
Congressman Tom Price, House Budget Committee Chair
Additional methods: https://tomprice.house.gov/contact-me
100 Cannon House Office Building
Washington DC 20515