myAVLS - Reaching the New Horizon

AVLS 2022

36th Annual Congress October 13-16, 2022 • New Orleans Register at www.avlscongress.org

Veins & A that Jazz

TABLE OF CONTENTS IT WAS ALL YOU

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REACHING THE NEW HORIZON

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LOOKING FORWARD WITH GREAT EXPECTATION

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GROWING THE SOCIETY BY MEMBERS, FOR MEMBERS

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AVLS ADVOCACY2022 AND BEYOND: FAIR PAYMENT IS KEY TO OUR FUTURE

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WHY RESEARCH MATTERS: UPDATING AND CREATING GUIDELINES

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WHO IS THE AVLS PRO VENOUS REGISTRY?

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ANALYZING PHLEBECTOMY ZONES

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PURSUING NEW RESEARCH

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BUILDING ON THE FOUNDATION OF THE PAST

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EVOLVING ANNUAL CONGRESS REFLECTS SOCIETY’S GROWTH

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ABVLM ON PATH TO SUB-SPECIALTY

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LET’S TALK ABOUT IT

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It Was All You

By Marlin Schul, MD, FAVLS Chairman of Foundation for Venous & Lymphatic Disease

On behalf of the Foundation for Venous & Lymphatic Disease (FVLD) Board of Directors, I would like to welcome you to our fourth Executive Leadership Summit (ELS)! We are extremely excited to celebrate our various New Horizon strategic plan and captial campaign achievements from the past five years. Even more so, we have “Great Expectations” for what lies ahead.

One of the highlights for the Foundation is hosting the Executive Leadership Summit, and this year is no different. When we can bring the caliber of leadership in our field together in a single place with a single objective, it is a powerful opportunity to change the world. Your participation in the ELS is an opportunity to help craft the strategy and implement the tactics necessary to ensure a brighter future for all of us caring for patients with venous and lymphatic disease.

Thank you!

I also would like to take a moment and thank everyone that has not only made this ELS possible but also made every accomplishment of the New Horizon strategy possible through your generous contributions. Without your investment, we would not be able to celebrate all our achievements over the past five years.

Thank you!

The Foundation was created over 15 years ago and has raised more than $13 million to invest in a variety of initiatives, all centered on the pursuit of recognition for venous and lymphatic medicine as a standalone medical specialty. We have come a long way to making this dream a reality. While we have accomplished much, there is still more to do.

Now, we find ourselves on the 20-yard line looking to make the final push to protect our specialty for generations to come with the ultimate goal of ensuring accessible quality care for those who suffer from venous and lymphatic disease.

On behalf of the entire Board of the Foundation for Venous & Lymphatic Disease, I am excited that we remain committed to our mutual cause to invest in Advocacy, Research, and Education, and to impact patient care and awareness of venous and lymphatic medicine.

With Great Expectations!

Marlin Schul

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REACHING THE NEW HORIZON Mark Meissner, MD, FAVLS • AVLS President

Margaret Thatcher is credited for the statement, “Plan your work for today and every day, then work your plan.”

This profound statement is applicable in all facets of business and life. The AVLS adopted this approach to our Society decades ago and structured our leadership and staff to ensure that, although changes occur, the goals and objectives of the Society remain steady. The AVLS leadership and staff are to be good stewards of the long-range plan rather than change our agenda every few years. The AVLS is truly unique among medical societies in this regard, and this mindset has contributed to our success.

In 2015 at the 2nd Executive Leadership Summit (ELS), we came together and agreed upon a variety of objectives and initiatives that ultimately became our 5-year Strategic Plan known as “New Horizons.”

The Society built this plan on the background of previous strategies dating from 2003 when the Society decided to pursue specialty recognition for venous & lymphatic medicine.

Since then, everything the Society has done and accomplished can be tied back to this core objective.

Investments in research, owning our patient data with the PRO Venous Registry and producing evidence-based guidelines;

While we are grateful for our accomplishments, it is time to plan for the next five years, again building upon what we started so many years ago.

The Board of Directors for the AVLS and FVLD started their strategic planning process in October of 2021 at the 35th Annual Congress in Denver, CO. Since then, much has been done to determine our plans going forward.

a full-time advocacy director and successfully advocating with payers and policymakers on behalf of the field and our patients; and our core focus on education all fulfill the purpose of “improving patient access to quality venous & lymphatic care.” This idea reaches its pinnacle with the concept of Board Certification and recognition by the American Board of Medical Specialties (ABMS).

Over the past five years, with the New Horizon plan’s success, we are closer than ever to reaching this goal. Thanks to all that have contributed countless hours in volunteer service to the Society and Foundation, especially all that have made financial contributions to the cause. Without you, we would not be where we are today.

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Many of you from our membership and corporate leadership participated in the FVLD feasibility study to provide input into the goals and objectives of our next strategic vision. The thoughts and directions derived from this background work will be presented at the 2022 ELS in Chicago, and we will begin to chart the plan going forward and what will be required to achieve success.

With your commitment, we will be able to achieve great and mighty things to further benefit our patients by providing access to the highest quality care!

Please know your input is always welcome and always appreciated. We hope you will help us celebrate our successes, but more so, we look forward to working alongside you as we strive for the “Great Expectations,” which lay ahead!

SPECIAL THANKS TO THE

AND ITS DONORS FOR SUPPORTING THE

NEW HORIZON AND HOSTING THE

EXECUTIVE LEADERSHIP SUMMIT

L king Forward with Great Expectation

Dean J Bender • Executive Director American Vein & Lymphatic Society Foundation for Venous & Lymphatic Disease

Welcome to the fourth Executive Leadership Summit (ELS) of the FVLD! It was almost exactly seven years ago at the ELS II that the leadership from the American College of Phlebology (ACP) and the executive leadership of our corporate partners gathered here in Chicago to layout our strategic vision and plan for the future of the College and how

we could work together to shape the future of this field.

Serving as Treasurer on the Board of Directors for the ACP Foundation, I recall the excitement of everyone as we challenged ourselves to expand the scope of the College to better meet the needs of our specialty through Research and Advocacy while maintaining its excellence in Education.

Following the ELS II, the College began a transitional process that saw the retirement of our Executive Director of 26 years, Bruce Sanders. Bruce’s retirement allowed me to transition from a long-time active member of the ACP and corporate executive to a full-time employee of the College as your Executive Director in July of 2017.

With great excitement and enthusiasm, I joined the ACP. Having been a part of developing the new strategic vision, I was a part of executing that vision alongside the friends and colleagues I had come to know well over the years.

We quickly finalized the five-year strategic plan that began to take shape in 2015 and chose to entitle the plan “New Horizons” (2017-2022).

Immediately, the Foundation launched a new capital campaign to develop the funding to support the goals and objectives we set for ourselves.

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This edition of the MyAVLS Magazine highlights many of the various achievements of the Society for you. I hope when you stop and reflect on all we have achieved over the past five years, you realize the impact that you, as a member of this Society, have made to advance the future of our field!

All the many things we achieved concerning Advocacy, Research, and Education are summarized best in our name change to the American Vein & Lymphatic Society in 2019. The name change exemplified our membership’s commitment to a dedicated medical specialty in venous and lymphatic medicine embracing the full responsibilities of advancing the field to provide the highest quality patient care for generations to come.

The need to Advocate on behalf of the specialty, invest in Research, and Educate the diversity of our membership more accurately defined us as a Society. We ARE: the American Vein & Lymphatic Society.

In addition to changing our name and brand, the Society demonstrated our commitment to our plan by investing in two new key staff positions, a Director of Research and a Director of HealthCare Policy and Advocacy. We also relocated

the corporate offices of the Society to Chicago in 2018, placing us in the center of more than 65 medical associations, including the offices of the AMA, and enabling us to attract some of the finest societal professionals available:

ROBERT WHITE

Director of HealthCare Policy and Advocacy

JOYCE KING

Director of Continuing Medical Education

EMILY HORNUNG

Membership Coordinator

AMANDA GODWIN

SARAH SABET

Director of Marketing and Communications

Marketing Coordinator

AMY PFAFFENBACH

BETTY SANCHEZ

Director of Meetings and Events

Director of Finance

MICHAEL THOMPSON Director of Research

BRIAN JONES

Director of Membership

JOHN MANGOLD

Managing Director of Development & Corporate Relations

Know that you have an open invitation to swing by your offices when passing through Chicago.

Spend time with your staff and learn more about how they serve our members daily to advance our mission and vision.

The past five years as your Executive Director have been challenging and exciting as we have achieved so much in pursing the New Horizon! And now, it is with Great Expectation that we look forward to the next five years and what we will be able to achieve together!

At your service, Dean

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Growing the Society

by Members, for Members

By Zoe Deol, MD, FACS

2019

During the last five years, AVLS has evolved its structure, leadership, and resources to adapt to our ever-changing times and position the organization for success in the future. These changes, some planned, some in response to mitigating circumstances, allowed AVLS to expand its reach, recruit new members, and engage existing members. Through the development of successful leadership, decisionmaking, and programming, we have gained the necessary momentum that will bring success.

1460

2020 1525

2021 1580

2022 1630

From 2020 to 2022, we have seen an increase in female membership from 26% to 32%, Vascular Surgeons rising from 20% to 29%, Family/ General Practice members increasing from 14% to 18%, and an overall increase in residents/ fellows from 17 to 236 total members.

MEMBERSHIP TRENDS AVLS’s success is dependent on its membership.

Each year offers not only the challenge of retaining members but also recruiting new ones. Recruitment efforts have focused heavily on non-member attendee conversions from Annual Congress, AVLS live courses, and general promotions to our various prospect lists. Over the last five years, membership recruitment expanded through outlets and new programming, including new outreach efforts through outside society conferences, ads in external vein publications, and new lead retrieval through online educational offerings.

Beginning in January 2022, AVLS launched a quarterly member referral program highlighting a new incentive each quarter. These incentives include gift cards, renewal discounts, Annual Congress discounts, AVLS store products, special raffles, and non-AVLS merchandise. This program is promoted via email and social media and includes highlighting new members in the Member Connection newsletter. Refer a member at www.myavls.org/refer.

LEADERSHIP STRUCTURE

While member retention slowed due to COVID-19, AVLS continues to grow its membership by meeting or surpassing our annual recruitment numbers for the past three years.

Through a series of Committee restructuring decisions led by the Member Standing Committee, AVLS increased production and efficiency of its Membership volunteers. In 2021, the Membership Recruitment, Membership 9

Retention, and International Advisory Committees merged into the Membership Advisory Committee. This committee aims to advise and support the AVLS with development and implementation of programs and policies to recruit new and retain existing members.

This committee created the International Member Recruitment Initiative to assist AVLS in translating social media posts and Annual Congress web pages. The initiative promotes new members from outside of the US and inclusivity, encouraging those different nationalities within the US to feel more included in AVLS. The Membership Advisory Committee also updated AVLS’s academic and experiential Fellowship pathways to broaden requirements for recognizing members for their substantial commitment and contribution to the specialty of venous & lymphatic disease treatment and care. Fellows show their commitment to the field through a combination of volunteerism, authored publications, education, years of practice, leadership, and any other quality or behavior which leads to the advancement of venous & lymphatic care.

Similar to how AVLS recognizes Physician Fellows, we have developed a “Laureate” status with academic and experience pathways to acknowledge outstanding vascular technologist, advanced practice provider, nurse, and therapist members who meet a specific set of guidelines, similar to how AVLS recognizes Physician Fellows. The AVLS Board has approved proposals for Advanced Practice Providers and Vascular Technologists. A proposal for Nurses and Lymphedema Therapists is currently in development.

AVLS also introduced a new Mentorship Task Force in 2022. This group is responsible for making recommendations for AVLS’s Mentorship Program, including promoting the program, developing functions and guidelines, and matching mentors with mentees. The Mentorship Program debuted as a part of the 2021 Annual Congress. It was designed to facilitate a member’s professional growth by allowing them to tap into the experience and resources of well-established venous and lymphatic care physicians and health

professionals. Upon successful completion, AVLS launched a year-long mentorship campaign beginning in 2021, expanding beyond Annual Congress.

In 2019, AVLS added a new volunteer group, the Lymphatic & Integumentary Rehabilitation (LIR) Specialty Section. The LIR Specialty Section was designed to comprehensively and holistically address patient management issues, associated complications, and contributing factors that lead to lymphatic, integumentary, and functional impairments related to lymphedema. Lymphatic pathophysiology requires a team approach to maximize patient outcomes and knowledge and appreciation of the inter-relationship of the body systems for prehabilitation, rehabilitation, restoration, and maintenance to improve quality of life. Even in its infancy, this group has conducted some of AVLS’s most popular webinars and Annual Congress content with LIR webinars averaging 229 registrants compared to the overall webinar average of 169 registrants.

NEW BENEFITS & RESOURCES In 2019, The Mel Rosenblatt Distinguished Service Award was created to recognize exemplary service by an individual in the field of venous & lymphatic medicine. This award honors individuals whose service substantially contributes to realizing the mission and vision of the American Vein & Lymphatic Society in such a manner as to significantly impact the field and our patients while inspiring those around them to act.

AVLS launched a series of free webinars in 2020, ranging from practice resources to assist during the COVID-19 pandemic to CME offerings on Lymphedema, Venous Stenting, and more. Each webinar produced non-member prospects for future membership recruitment.

AVLS continues to gain positive returns on attendees and new members through its series of complimentary webinars. Each webinar attracted non-member prospects for future membership recruitment. In 2021, AVLS held eight webinars (non-Congress) with a total of 2,160 registrants, 1,399 of which were unique users.

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In 2020, AVLS began offering Organizational Membership for venous and lymphatic medical practices. Through the agreement, we offer organizations the opportunity to have their physicians and allied health staff join at a discounted rate, which includes complimentary live and online educational credits. Indiana Vein Specialists joined as the first organizational member, with 12 allied health professionals and two physician members. Four more organizations have enjoyed Organizational Members program benefits.

appointments. AVLS continues to reach out to members with unclaimed profiles to encourage participation.

AVLS introduced its first virtual reality educational offering in 2020, Immersive Sclerotherapy: VR 360. This was an excellent opportunity to obtain CME credit from the comfort of your own home. In 2020, we achieved 42 registrations, and the feedback from the registrants has been overwhelmingly positive with 80% of respondants saying they would participate in another VR course. In 2022, AVLS updated its Sclerotherapy course with a second edition and added Introduction to Venous Insufficiency.

AVLS launched a new member portal in 2021. This project was implemented with the members in mind, with the primary goal of streamlining navigation and creating a more user-friendly atmosphere. The new portal features include profile management, online member engagement, and a new membership storefront. Since its launch in 2021, 85% of members have logged in to their profiles to update their information. We have also seen a direct correlation between member logins and multiple YM transactions, with 70% of logins paying their dues, 98% registering for courses and webinars, and 8% purchasing merchandise.

My AVLS Community (MAC) launched in 2020 as an online outlet for member communication and networking. The goal was to provide a space for members to ask questions and discuss topics with each other. In this space, members can start discussion threads, respond to others, connect with members through direct messaging, and upload or download resources that will help improve the care provided to patients. This members-only community has increased member engagement while also allowing segmented groups within AVLS a place to communicate with each other, for example, committees, task forces, sections, etc.

The AVLS ePass was created in 2022 to make online learning more accessible. This annual subscription to our eLibrary (recorded content and webinars) grants access to recorded AVLS webinars and short courses to view at your convenience. Seven recorded webinars and virtual courses are currently available in the ePass catalog. The subscription will expand to no less than 20 recorded sessions and a minimum of 100 hours. Most ePass courses are eligible for 1.0 AMA PRA Category 1 Credit(s)™.

As new courses are added, ePass holders automatically receive access. The full online educational catalog is available at www.myavls. org/online-edu

In 2020, AVLS partnered with Vitadox.com to help our members reach new patients for vascular and lymphatic system-related symptoms, conditions, and treatment options.

AVLS members were given a June 30 deadline to claim their profile to ensure they can showcase expertise, highlight medical services, and share success stories while establishing credibility, improving their online reputation, attracting new patients, and booking 11

Understand

CEAP & SVP

Improve your understanding & application of venous classification systems

SVP REVIEW VENOUS CLASSIFICATION WITH REAL PATIENT CASES LEARN AT HOME WITH THE DIGITAL WORKBOOK PRACTICE APPLYING VENOUS CLASSIFICATION SYSTEMS EARN UP TO 4.5 HOURS CME

ORDER FOR CEAP OR SVP CLASSIFICATION SYSTEMS, OR BUNDLE AND SAVE! VISIT: WWW.MYAVLS.ORG/WORKBOOKS OR SCAN THE CODE The Venous Classification Digital Workbooks are a joint project from the American Vein & Lymphatic Society and the American Venous Forum.

The American Vein & Lymphatic Society (AVLS) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

CEAP Classification Workbook The American Vein & Lymphatic Society (AVLS) designates this internet enduring activity for 2.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

SVP Classification Workbook The American Vein & Lymphatic Society (AVLS) designates this internet enduring activity for 2.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

AVLS ADVOCACY 2022 AND BEYOND: FAIR PAYMENT IS KEY TO OUR FUTURE

By Stephen Daugherty, MD, FACS, FAVLS, RVT, RPhS

The COVID-19 Public Health Emergency in March 2020 caused many AVLS members to suspend operations. By June 2020, most vein care offices started to serve patients once again. This rapid adaptation to a changing reality is part of our culture as venous and lymphatic clinicians and serves as an organizing principle for our Advocacy activities.

The American College of Phlebology (ACP), now the AVLS, functioned as an educational organization from its inception. The ACP tackled advocacy issues in a limited way, but in 2017, this changed. A Board level committee was formed to formally address advocacy issues.

In 2018, the HealthCare Policy and Advocacy Committee (HPAC), and a subcommittee, the HealthCare Advocacy Advisory Committee (HAC), was formed to expand participation by committee members. A full-time staff position was created in 2018 to serve members and give this issue the attention it deserved.

OUR 3 CORE OBJECTIVES OF ADVOCACY: • Patient Access to Quality Care • Fair Reimbursement & Coverage from Payers • Support Research and Guidelines The AVLS sought and received financial support from the Foundation to hire Robert White as

support staff and fund participation in important meetings with payers, governmental, and regulatory agencies.

The HPAC is composed of members of the Robert White, AVLS Board of Director of Advocacy Directors who set advocacy policy and are accountable to the full Board of Directors. The HAC works to implement policy through members committed to at least three years on the committee for the sake of continuity. The HAC, including the members of the HPAC, meets by conference call monthly to review input from membership as teams work on specific assigned projects or interests.

Beginning with the Annual Congress in November 2019, the HAC holds monthly conference calls with the American Venous Forum (AVF) leadership in a collaborative effort to align our shared advocacy efforts and expand our combined influence in medicine.

The HAC includes our representatives who serve multiple-year terms to whom we refer to as “Senators” because of the importance of the service and the value of building long-term relationships with other organizations.

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These positions include: • American Medical Association House of Delegates » Vineet Mishra, MD, FAVLS, FAAD, Delegate

• American Medical Association CPT Editorial Panel Advisor » Satish Vayavegula, MD, MS, FAVLS » Michael Graves, MD, Alternate Advisor

• American Medical Association ResourceBased Relative Value Update Committee (RUC) » John Blebea, MD, MBA, FACS » Marlin Schul, MD, MBA, RVT, FAVLS, DABVLM

• Medicare Carrier Advisory Committees » Chris Pittman, MD, FAVLS, FACR—First Coast Services » Stephen Daugherty, MD, FACS, FAVLS, RVT, RPhS—Palmetto » Michael Graves, MD—Novitas

• Intersocietal Accreditation Commission—Vein Center Division, Board of Directors » Ken Nguyen, DO » Carl Fastabend, MD

HOW DO WE ADVOCATE? AVLS Advocacy Insider (Monthly) We digitally publish the Advocacy Insider to the membership to provide a monthly review of new topics of interest. While not comprehensive, the intent is to make members aware of critical issues alongside contact information, so they can reach out to learn more.

The American Medical Association (AMA) As a professional medical society devoted to the care of venous disorders, the AVLS has representation at the AMA House of Delegates (HOD), the AMA CPT Editorial Panel (CPT Panel), and the Resource-Based Relative Value Update Committee (RUC). The AMA HOD is the AMA policy-making body where decisions are made that affect medicine, and we engage in relationships to influence our effectiveness in our other AMA endeavors. Each of our

AVLS Members meet with Rep. Pelosi and Rep. Davis

AVLS “Senators” serves a multiple-year term in their role that require several days out of their practice at least two-to-three times per year.

The AMA CPT Editorial Panel writes and revises descriptions of medical services under the close supervision of CMS. The existence of a code and an accurate, detailed description of the service is essential for correct payment for the professional services and supplies necessary to perform each specific service. The RUC assigns value to the physician’s work and other expenses, including supplies necessary to perform the procedures described for each CPT code, under CMS supervision with CMS veto power. An accurate description of the service from the CPT Panel and accurate assessment of the physician’s work and practice expenses from the RUC are essential to appropriate and fair payment for old and new technologies. We are working to build our influence at the CPT Panel and the RUC. The AMA and most major United States medical societies are working to educate Congress and CMS about the serious adverse effects of the BUDGET NEUTRAL Federal law. This law severely limits payment for office-based care 14

with no provision for increased costs of care, including inflation, more Medicare beneficiaries, increased complexity of care, and increasingly complex office procedures. The AVLS views Congressional action to account for these issues as a critical priority.

Intersocietal Accreditation Commission—Vein Center Division (IAC-VC) The IAC-VC was formed in 2012 as an initiative from the AVLS due to mounting concern about low-quality and possibly unsafe practices in vein clinics. Two representatives on the IACVC Board of Directors represent the AVLS. Several other AVLS Board of Directors members also serve on the IAC—VC Division board representing other societies. The IAC—VC Division has engaged in efforts to convince payers to require IAC—VC Division accreditation as a condition for payment for vein treatment.

This effort is controversial and not supported by the AVLS board. The AVLS holds that there are several different pathways to attest to quality work and credentialing.

In the summer of 2021, CMS announced a change in its office-based payment formula that is already impacting office-based specialists in 2022. Termed the “Clinical Labor Update,” this new CMS policy cuts practice expenses for a range of office-based procedures. We are actively working on multiple fronts to rectify this policy and convince

STOP CMS22: AVLS members make unprecedented donations to Make our Voice Heard and roll-back Clinical Labor update!

At 2021 AVLS Congress, a special appeal was made to members to donate and fund a wide range of quick reaction Advocacy services.

Members donated over $100,000, which was committed for use in Capitol Hill outreach and data analysis services. We are actively deploying these funds and making strategic investments right now to influence and enact positive changes for 2023.

Centers for Medicare and Medicaid Services (CMS) CMS views the patient as a consumer and providers as accountable entities with payment for outcomes and prevention of illness and complications. CMS policy announcements come almost daily, but some of the more critical activities and policies that we continue to monitor for action as appropriate include:

Bold action to advocate to stop cuts to office payment As a professional society where officebased members are the majority, CMS’s 2021 announcement of the Clinical Labor Update policy mobilized the Society to enact all efforts to protect patient access to care and ensure future fair reimbursement.

AVLS volunteers Dr. James Albert and Dr. Lornell Hansen stepped forward to lead an effort to mobilize fundraising, enabling the AVLS to commit to multiple projects to get our message out. The CMS22 campaign raised well over $100,000, which the Society invested in data analysis and Capitol Hill outreach efforts. This effort is carrying over to 2022 and beyond, and AVLS is committed to ongoing work for a result that will benefit our patients and the long-term viability of office-based care.

• Merit-based incentive payments (MIPs) • Alternative payment models (APMs) • Physician-Focused Payment Model Technical Advisory Committee (PTAC) • Revision of Evaluation and Management codes • Annual July draft physician fee schedule regulations and valuations • Annual November final physician fee schedule regulations and valuations • Four-year phase-in of office-based supply costs determined by a private contractor with obvious gross errors • Recently announced targeting of the thermal ablation codes for Recovery Audit Contractors (RACs) 15

in a peer-reviewed journal. AVLS surveyed our membership regarding the impact of the CMS cuts on their practices and their likely responses, such as retirement or shifting sites-of-service. This data is being published to educate CMS and Congress regarding the severity of the problem.

Venous Policy Navigator: In partnership with the AVF, AVLS offers members a monthly insurance medical policy tracking service focused on vein care. This tool allows offices to quickly stay on top of multiple payers in their region or state.

Press conference with Dr. Reddy, AVLS Member and Rep. Danny Davis

Medicare Administrative Contractors:

Congress to implement a hold-harmless approach to the Clinical Labor Update.

Novitas/First Coast: In late December 2020, these Medicare Administrative Contractors (MAC) announced their final LCDs for vein care and venous stent coverage. Capping almost two years of interactions and personal communications with Carrier Medical Directors, the final policies represented a broad expansion of allowable vein care technologies and an option for prompt treatment in cases of advanced venous disease.

KEY ADVOCACY ACTIONS AND ISSUES ON OUR RADAR In July of 2021, when CMS proposed changes to the office-based payment formula, it became apparent these changes could have a long-term impact on access to care, especially officebased vein care. The Healthcare Policy and Advocacy Committee undertook numerous projects to inform and guide our response.

Site of service and payment incentives: Michael Richards, MD, PhD, and Jonathan Seward, MS, analyzed claims and produced a detailed report showing that even modest cuts in office-based payment likely will lead to a reallocation of services to the more costly hospital outpatient setting. These site-of-service shifts are quite steep and will cost Medicare more for the same services. AVLS used this data in our 2021 proposed rule Comment letter to CMS, and Dr. Richards summarized the research in a presentation at the AVLS 2021 Annual Congress in Denver, CO. Impact on AVLS members: Using our member NPI data to approximate if a specialty of venous & lymphatic medicine existed, we engaged a leading research firm to approximate the impact of the CMS cuts from 2022 to 2025.

Because of the Clinical Labor update, officebased reimbursement cuts to key CPT codes used by our members were among the steepest in medicine. This data is now being analyzed for possible manuscript publication

Palmetto GBA: In April of 2022, this regional carrier implemented a new LCD for vein care. In conjunction with the American Venous Forum and the Society for Vascular Surgery, AVLS provided written comments and made verbal comments on the draft LCD. Overall, while the new LCD has many features which support effective patient care, AVLS has some suggestions and comments, which we have sent to Palmetto as a joint letter with the AVF and the Society for Vascular Surgery.

Venous Stenting: The AVLS has been engaged since 2015 with MACs regarding venous stenting policy. The AVLS urged the withdrawal of a poorly written draft LCD in 2016 and 2017. The AVLS, AVF, and OEIS actively engaged Novitas Solutions in 2018 as it developed a new LCD regarding venous stenting. Based on comments from the AVLS and other stakeholders, new LCDs for venous stenting are now in effect in some jurisdictions that we feel are fair and reasonable. Further review of venous stent medical policies is underway, and there remains 16

considerable variation in coverage between MACs jurisdictions.

group interacts with Congress on office-based reimbursement and physician payment issues.

We worked with political consultants to learn and participate in the legislative and regulatory process as advocates for patients and clinicians.

Phlebectomy Task Force: To better define clinical patterns and possible treatment zones, the AVLS rolled out an easy-to-use application to collect data. This first-of-its-kind tool is instrumental in better delineating patterns of care and typical treatments to inform our future reimbursement strategy.

AVLS is also a member of the Alliance for Wound Care Stakeholders. The Alliance advocates to CMS and Capitol Hill on matters regarding wound care, access to care, new technologies, and payment.

Venous & Lymphatic Medicine Specialty Workgroup: This group seeks to develop a specialty board with membership in the American Board of Medical Specialties to properly recognize the unique knowledge and skill sets that existing boards do not recognize.

One key component of this process is that physicians with many different primary specialty certifications are skilled contributors to the specialty, and they must be included in this process. In the long term, the development of fellowships is an essential element of specialty recognition and patient care.

THE FUTURE The HPAC and HAC will continue working on the active issues referenced above and will add to the list as new issues develop. Our top priority is urging Congressional action to remedy the Clinical Labor Update for 2023 and ensuing years to reform Federal payment for care constrained by budget-neutral legislative mandates.

We hope to increase advocacy to payers regarding medical policy problems and issues regarding access to care, such as refusal by payers to cover care based solely upon a primary physician’s specialty. Payer acceptance of ABVLM certification is a critical step.

Finally, we are exploring how venous and lymphatic practices may be able to function in “fee-for-value” models, which soon will become more common.

Capitol Hill and Washington DC: Though not historically a focus or part of our Society, the AVLS pivoted in 2021 and developed a Federal outreach capacity. Several AVLS members stepped up and made personal overtures to their legislators. The AVLS also joined as an Executive member of a group called United Specialists for Patient Access. This advocacy

HEALTHCARE POLICY & ADVOCACY COMMITTEE MEMBERS • Stephen Daugherty, Chairman • Chris Pittman, Vice-Chairman • Mark Meissner, AVLS President

• Marlin Schul • Steve Elias

• John Blebea • Vineet Mishra

HEALTHCARE ADVOCACY COMMITTEE MEMBERS • • • • • • • • •

Chris Pittman, Chairman Vineet Mishra, Vice-Chairman Marlin Schul Stephen Daugherty Steve Elias John Blebea Mark Meissner Satish Vayuvegula Khahn “Ken” Nguyen

• • • • • • • • •

Margaret Mann Lornell Hansen Robert Worthington-Kirsch Zoe Deol James Albert Michael Graves Francis Lee Thomas Wright James St. George

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• • • • • • • •

Carl Fastabend Robert Tahara Theresa Soto Ken Harper Michael Di Iorio Ali Wazni Marcus Stanbro Dev Batra

C O R P O R AT E Thank you to our

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INDIVIDUAL New Horizon Donors! forMel GOLD

DONOR

Scot Dube

Cynthia Asbjornsen Carl Black Catherine Burdge Yung-Wei Chi Alan Crowther Stephen F. Daugherty Mark D. Forrestal Kathleen Gibson Margaret Mann Vineet Mishra Diana Neuhardt Kenneth Todd Joseph Ty Bell Robert Worthington-Kirsch

Gordon Gibbs

SILVER

Eric Heil

Thomas Alosco John Blebea Jeff Braxton Anthony Comerota Zoe Deol David Draughn Serigo Gianesini Amanda Godwin Michael Graves Evan Harris Neil M. Khilnani Terrance Krysinski Daniel Monahan Nick Morrison Tyler Palmer Betty Sanchez Saudra Spruiell Julianne Stoughton Dominic Tolitano Darren Wennen

Michael Aikens Lisa Amantangelo Luis Barajas Michael Cornwall Stephanie Dentoni Lance Dillon Suzie Ehmann Chris Freed Mark Joseph Garcia Aditya Gupta Todd Hansen Mohamed Hassan Marresa Houle Fernando Illescas Lowell Kabnick Laura Kelsey Seema Kumar Duc Le Thomas Leaton William Marston Mark Meissner Khanh Nguyen Michelle Nguyen Bonnie Pauza-Miller Neal Reynolds Anuj Shah LouAnn Smith Lawrence Starin Sean Stewart Sonja Stiller-Martin Ronald Winokur Thomas Wright Steve Zimmet

CHAIRMAN James Albert Dean Bender Felicite Daftuar Terri Harper James Heinz Sanjiv Lakhanpal Brad Moseley The Mel Rosenblatt Family

DIAMOND

Chris Pittman AJ Riviezzo Marlin W. Schul

RUBY Jeffery P. Schoonover Satish Vayuvegula

EMERALD Glenn Anderson Paul Cheatum Michael Di Iorio Liza Eden Giammaria Steve M. Elias Joseph Jenkins Joseph Zygmunt, Jr.

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Why Research Matters: Updating and Creating Guidelines As the AVLS conducts research, the goal is to understand venous and lymphatic disease and improve venous and lymphatic medicine for all patients. Throughout the past five years, several guidelines committees convened to update or write new guidelines including for C2, Pelvic Varices, and Lymphedema.

C2 GUIDELINES The American Vein and Lymphatic Society (AVLS), The Society for Vascular Surgery (SVS) and the American Venous Forum (AVF) joined to update the 2011 SVS/AVF clinical practice guidelines and provide new evidence-based recommendations on critical issues affecting the care of patients with varicose veins. Each recommendation is based on a recent, independent systematic review and meta-analysis of the diagnostic tests and treatments options for patients with lower extremity varicose veins. The guidelines include evidence-based recommendations on the evaluation of CEAP (Clinical Class, Etiology, Anatomy, Pathology) Class 2 varicose vein patients with duplex scanning and other diagnostic tests, on open surgical treatment versus endovenous ablation techniques, on thermal versus non-thermal ablations of the superficial truncal veins, on the management of incompetent perforating veins in CEAP Class 2 disease, and on the concomitant vs staged treatment of varicose tributaries in patients who undergo ablation of incompetent superficial truncal veins.

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Who is the AVLS PRO Venous Registry?

By Marlin Schul, MD, MBA, RVT, FAVLS, DABVLM

The AVLS PRO Venous Registry has grown exponentially. In 2021, we saw an increase in the number of patients and procedures. This growth is largely due to the compounding of data by existing AVLS providers. Currently nearly 200 providers are in our Registry. We need as many AVLS members contributing data as possible.

The research generated from the Registry goes beyond interesting articles to read in our Journal.

The data contributed by our members and the resulting research conducted will support and defend our field of practice against the continuing efforts of CMS and other payers to reduce payments – or even decide that there isn’t enough evidence supporting the health outcomes of treating pre-ulcer disease to justify any payments.

Total Records in the Database

Q1 2021

Q1 2022

Patients

180,573

276,611

Chemical Ablation

205,955

270,767

Conservative Therapy

9,271

187,616

Cyanoacrylate

4,097

7,741

Endovenous Laser Ablation

31,356

41,856

Mechanochemical Ablation

6

22

Radio Frequency Ablation

111,028

161,918

240,520

299,771

3,541

49,154

Sclerotherapy Surgery (Phlebectomy)

To learn more about becoming an AVLS PRO Venous Registry data provider, please contact Michael Thompson, Director of Research: mthompson@myavls.org

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PRO 2.0 VENOUS REGISTRY To set up your office as a part of the AVLS PRO Venous Registry, please contact Michael Thompson at: registry@myavls.org or at: 510-470-9377.

For more information visit: www.veinstats.org

Analyzing Phlebectomy Zones It has been suggested that treatment efforts and re-imbursement for phlebectomy procedures would be better based on pathophysiology and anatomic location rather than simply on the number of phlebectomies performed, as is presently the case. Optimal classification and zone location, however, has not yet been defined. Proposed anatomic zones on the leg varies from 3 to 32. Although more zones would provide greater specificity, fewer zones would be easier to define and more likely to be utilized by physicians.

To help answer this question, a smart phone app has been developed to collect needed clinical data. In this app, clinicians have entered in which of 14 anatomic zone locations phlebectomies have been performed:

1 - UPPER THIGH - MEDIAL 2 - UPPER THIGH - ANTERIOR - LATERAL 3 - UPPER THIGH - POSTERIOR 4 - LOWER THIGH - MEDIAL 5 - LOWER THIGH - ANTERIOR- LATERAL 6 - LOWER THIGH – POSTERIOR 7 – KNEE

8 - UPPER CALF - MEDIAL 9 - UPPER CALF - ANTERIOR - LATERAL 10 - UPPER CALF - POSTERIOR 11 - LOWER CALF - MEDIAL 12 - LOWER CALF - ANTERIOR – LATERAL 13 - LOWER CALF - POSTERIOR 14 - FOOT

AVLS Research Committee members John Blebea MD and Ken Harper MD have spearheaded this effort and are now analyzing the data from the more than 1,000 clinical cases that have already been entered in the app.

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PURSUING NEW RESEARCH As a part of the New Horizon Strategic Campaign, the AVLS formed committees to pursue new research projects and grants relevant to venous and lymphatic medicine.

Many of these new studies use data from the PRO Venous Registry.

Phlebectomy Outcomes Study Utilizing the thousands of data points on phlebectomy procedures from the AVLS PRO Venous Registry, Drs. John Blebea and Ken Harper are studying and comparing groups that initially underwent only phlebectomy, simultaneous phlebectomy, and venous ablation (laser and RFA) and groups that initially had only venous ablation. Examining both indications and clinical outcomes, they wish to better define optimal strategies for the use of phlebectomy and its contribution to patients who require combination therapy.

Venous Leg Ulcer Abstract

and ONLY deep vein pathology. An additional 278 patients presented with an absence of venous pathology yet an ulcer on the legs. In all, the VLU patients with superficial pathology presented at an average age of 65, proportionally more males vs. females.

Those with mixed pathology demonstrated significantly younger ages.

This manuscript is forthcoming, and we must ask ourselves, how can we disrupt the barriers to care so that those in need of our services have access to care? There is still much to do.

The Anterior Saphenous Vein Last year an initiative was created by AVLS and AVF to demonstrate the importance of the anterior accessory of the great saphenous vein (GSV). Several scheduled meetings took place to determine the important issues and develop a plan to enhance our understanding and clarify all issues regarding this vein.

All the anatomic and clinical work was collected, As the 2018 EVRA trial demonstrated that early and our group of experts, Alberto Caggiati, intervention accelerates venous leg ulcer (VLU) Nicos Labropoulos, Mark Meissner, Antonios healing and is proven cost-effective, has there Gasparis, Edward Boyle, and Suat Doganci, really been a shift in care for those most in need removed the word accessory and proposed of intervention? There remain structural barriers a new name: Anterior Saphenous Vein (ASV). in place for many markets where no change in This was done to indicate that ASV has its own referral patterns has occurred. The following distinct anatomy and pathology, producing paragraph offers insight into nearly 2,000 leg signs and symptoms similar to those seen ulcers entering vein practices pulled for analysis by the GSV. from the AVLS PRO 2.0 Registry.

ASV starts from the dorsum of the foot and Data pulled for analysis included demographic variables, disease severity scoring, and duplex findings at presentation. To no one’s surprise, 83% had a superficial venous component (79% superficial ONLY, while the remainder had mixed superficial and deep vein pathology.

1.9% presented with post-thrombotic syndrome

continues all the way to the thigh and groin area having connections with the GSV at various levels. It also often replaces the GSV in the thigh, and it is the main vein for drainage in the anterior and medial parts of the subcutaneous tissues.

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image: FREEPIK.COM

Often the ASV has reflux on its own or together with the GSV, and thus it is very important to diagnose the exact pattern of the disease and plan the treatment. Other anatomic aspects of tributaries, lympho-venous networks, and connections with different veins will be described.

We are preparing two separate papers. The first will demonstrate the clinical anatomy of the ASV and its complex and relevant pathophysiologic and therapeutic implications.

The second paper is focused on the clinical presentation of patients with ASV reflux and the different patterns of the disease. It will also provide robust evidence against the claims of health insurances that inappropriately do not cover payment for procedures on this vein.

Clinical Research - Pelvic Varices (Pelvic Venous Disorders) It has been estimated that almost 40% of all women will experience chronic pelvic pain during their lifetime and that 15% of all women between the ages of 18-50 experience chronic pelvic pain (CPP), accounting for 20% of outpatient gynecology appointments.

Although more than 30 billion dollars are expended in the United States due to loss of work, family responsibility, and relationships caused by CPP, no cause is identified in up to 30% of patients. It is postulated that pelvic venous disorders (PeVD) account for 16-31% of cases of chronic pelvic pain, second only to endometriosis in prevalence.

PeVD are also responsible for lower limb and vulvar varicose veins, left flank pain and hematuria, and lower limb pain and swelling without varicose veins. PeVD can lead to symptoms and signs as a result of the resultant pelvic venous hypertension caused by reflux of one or more gonadal or internal iliac veins as well as by obstruction of an iliac or the left renal vein. Consequently, PeVD can also be responsible for lower limb and vulvar varicose veins, left flank pain and hematuria, and lower limb pain and swelling without varicose veins.

The current literature on outcomes for treatment of PeVD has limited acceptance by physicians and payers, resulting in poor access to treatment for patients and continued suffering from CPP. One of the largest limitations is the lack of a randomized trial of intervention proving efficacy.

This project is planning to demonstrate change following treatment based on current real-world inclusion criteria for Ovarian Vein Embolization (OVE) by performing a randomized controlled trial of venography versus venography and embolization with adequate tracking of quality-of-life changes for six months following an intervention.

In addition to validating OVE as a treatment option for patients with venous origin CPP, this will provide an assessment of the venous system in this unique patient population. This will also demonstrate change in the validated qualityof-life metrics as well as novel disease-specific quality-of-life tools that are in development.

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AVLS Immersive Education

STEP INTO AN EXPERT’S CLINIC WITHOUT LEAVING THE COMFORT OF HOME 360° Virtual Reality allows you to watch as experts perform procedures with you in the procedure room next to them.

Two New Courses!

• Sclerotherapy Immersive Course 2.0 • Introduction to Venous Insufficiency

Future Courses

• Ultrasonography • Deep Venous Disease • And more

Learn more at www.myavls.org/immersive

Learn More at www.avlscongress.org/abstract

BUILDING ON THE FOUNDATION OF THE PAST

By Margaret Mann, MD, FAAD, FAVLS and Steve Elias, MD, FACS, FAVLS, DABVLM • Co-Chairs of the Education Committee

Education remains one of the top career-enhancing assets the AVLS offers. The AVLS has positioned itself as the premier association for health professionals dedicated to diagnosing and treating venous and lymphatic disease. Our educational goal continues to enhance the resources we offer our members.

The AVLS has brought forth new learning experiences and enhanced our previous offerings. Our past efforts have focused on the quality of courses and webinars offered. This year, we expanded our vision to ensure access and availability to a broader selection of educational opportunities for our members and non-members alike.

THE LAUNCH OF AVLS’S VIRTUAL REALITY EDUCATIONAL COURSE One of the highlights of the educational program was the introduction of AVLS’s virtual reality course – Immersive Sclerotherapy, VR 360, launched in May 2020. Virtual reality education was an opportunity for professionals to obtain CME credits in the safety of their homes or offices.

According to overwhelming positive post-course surveys, the rollout of this course in this format was a success. The original course achieved forty-two registrations.

In 2022, we expanded the program with the Intro to Venous Insufficiency and updated the Immersive Sclerotherapy course. Thermal Ablation and Ultrasound courses are currently in development and will launch in November 2022.

ADAPTING REGIONAL COURSES TO CHANGING TIMES Before 2020, the AVLS hosted a robust regional calendar of one-day courses across the country.

While the format and delivery of the courses changed due to the pandemic, new technology and educational methods adapted during this time will continue to enhance our programs for years to come.

In the evolving world of education, AVLS must continue to meet new education delivery standards.

Hybrid courses will remain a part of the AVLS educational curriculum.

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The RPhS Review Course with Virtual Mock Exam offering began in March 2021 and continues to enroll attendees upwards of 30 + registrants per session offering. RPhS attendees have full access to over thirteen chapters of prerecorded didactics in preparation for the Mock Exam including close to 4 hours of rigorous interactive exam questions.

Our success continues with the Venous & Lymphatic Medicine Review Course (VLM) OnDemand with In-person Livestream Mock Exam to prepare participants to sit for the ABVLM Certification Examination or improve their expertise. Previously a two-day, in-person-only course known as the Phlebology Review Course, now participants receive a compilation of 10 hours of medical education content on-demand, alongside a live, full day of experienced faculty reviewing, discussing, and coaching during the intense mock exam.

ROLLOUT OF WEBINAR PROGRAM In 2020, the COVID-19 pandemic upended the medical world. AVLS Members needed prompt information about how this affected vein practices. In response, the Society launched a free series of webinars as a part of the “Apart, Together” operation. Webinar topics included employment practices, telemedicine implementation, financial effects, marketing, and more.

The webinars attracted 1,149 registrants and produced non-member prospects for future membership recruitment.

Following the initial success of the “Apart, Together” webinar program, the AVLS continued to offer webinars on topics beyond the pandemic. We are hosting webinars about every other month, and subjects include

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medical education like lymphedema and pelvic venous disease.

To continue offering comprehensive, innovative education for practitioners who treat or anticipate treating patients with venous and lymphatic disease, we have identified several objectives to enhance the program. Those objectives are: 1. Increasing education across the full spectrum of practitioner experience.

2. Expanding methods of educational delivery.

3. Increasing the variety and accessibility of educational opportunities.

4. Increasing collaboration with other organizations to provide education and resources.

IMPROVING OUR UNDERSTANDING OF VENOUS CLASSIFICATION SYSTEMS In May 2021, an international group spearheaded by the AVLS published the Symptoms-Varicies-Pathophysiology (SVP) classification of pelvic venous disorders. With this new venous classification system, there was a need to provide education for physicians to begin classifying their patients.

Learning to implement a classification system requires more than just reading or lectures. It requires practice. The Venous Classification Workbooks were the creative solution to provide this education. The Venous Classification digital workbooks present real patients to evaluate and simulate real patient diagnoses. Clinical cases range from basic to advanced classifications. Participants receive immediate feedback about their classification selection and the opportunity to improve their skills.

BEYOND AVLS EDUCATION – ADDING JOINT PROVIDERSHIP The AVLS has recently expanded its role in venous and lymphatic medical education by working with other educational providers to accredit their continuing medical education (CME) offerings. Working as Joint Provider allows the AVLS to expand venous and lymphatic medical education to include more quality, accredited CME. Since beginning our Joint Providership, AVLS has provided continuing medical education for three conferences within the medical industry: Miami Vales, Strandness Symposium, and Pacific Northwest Endovascular (PNEC) with Behind the Scenes Medical Education (BTCME).

In addition, we continue to collaborate with a host of other agencies to provide CME – collaborations include the CEAP Venous Classification Workbook with the American Venous Forum (AVF) and introductory webinars with Wilson Farris Consulting LLC. Over the next year, our goals are to broaden our offerings in new and innovative educational methods and topics. We have implemented a subscriber base annual subscription to the AVLS eLibrary, which grants members access to recorded AVLS webinars and short courses to view at their convenience. As we add to the monthly catalog, subscribers will automatically receive access as an ePass holder.

We recognize the advantage of rolling out more premier courses/webinars play in the ongoing development of our members.

As the SVP Venous Classification Workbook came together, there was an opportunity to partner with the American Venous Forum and expand the program to include a CEAP (Clinical-Etiology-Anatomical-Pathophysiology) Venous Workbook.

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Evolving Annual Congress Reflects Society’s Growth

By Margaret Mann, MD, FAVLS • Co-Chairman Education Standing Committee

W

e are approaching the 36th Annual Congress of the American Vein & Lymphatic Society in New Orleans on October 13-16. I am amazed as I consider our Annual Congress’s transformation in just a few short years.

never miss a lecture occurring in one room while participating in a session elsewhere. There were undoubtedly some perks to a virtual congress.

Nevertheless, I hope that I am the “one and only” Chair to ever reside over a 100% virtual Congress of the AVLS!

I was privileged to serve our Society and the field in general as the 34th Congress Chair in October 2020. During this unprecedented COVID pandemic,

we pivoted from an in-person event planned for Washington, DC, to a 100% virtual Congress. Thanks to the foresight of our leadership and the herculean effort of our volunteers and Society staff, we made an amazing transition in a matter of a few months.

We managed to keep the complete Congress program intact and even created a few social events to preserve the spirit and camaraderie, which defines our AVLS Congress.

The final 2020 program had 658 participants logging in from the comfort of their homes or offices worldwide to watch our real-time broadcasting. For the first time, attendees had the opportunity with on-demand session recording to earn over 72 hours of CME and

The AVLS Congress is such a comprehensive endeavor providing continuing education across all facets of venous and lymphatic medicine to all walks of life in our field. There really is “Something for Everyone!”

Physicians can learn the latest advancements in treating superficial, deep, and pelvic venous disease and how to incorporate the treatment and management of Lymphedema or leg ulcers in their practice. Attendees can learn and interact with the leading minds in our field from the US and the world. Additionally, our program continues to be inclusive of learning opportunities for our Nurse, Sonographer, and Therapist members and attendees, recognizing 30

the holistic approach to treating and caring for our patients suffering from venous and lymphatic disease.

Now, thanks to the investments the AVLS made to achieve a fully virtual Congress in 2020, we have adapted to a hybrid format for future Congresses. Every attendee can avail themselves of every educational offering of the annual Congress, whether they attend in person or virtually. Our annual Congress went from a three-to-four-day event every October to a three-month experience.

I mentioned earlier I hope that I am the “one and only” Chair to preside over an entirely virtual Congress. I bring that up in closing as a reminder that there is so much more to an AVLS Annual Congress than just the lectures and presentations. So much of our learning experience comes when we interact with our peers from all around the country and world discussing various opportunities and challenges in the hallways, over lunch, dinner, or at the coffee pots during breaks.

In addition, there is so much we learn from the corporate participants and their teams. All this is lost when we participate remotely. And so, I encourage you to join us all in New Orleans this October, where we will all be able to celebrate

the successes of the AVLS over the past five years, reconnect with old relationships, and begin developing new relationships that can alter our lives.

Dr. Chris Pittman has tagged this year’s Congress with “Veins & All that Jazz” to remind us that the Annual Congress of the AVLS is truly an event with something for everyone. There will be plenty of excellent education in the sessions or the latest in research at the “Space Forum” on Thursday evening, and the chance to engage with each other by exploring the city of New Orleans during the Foundation’s “Congress Expedition”, running (or walking) along the Mississippi River at the “Fun Run for Mel” or to celebrating on Bourbon Street Saturday night.

As we look to the future, it is exciting that the International Union of Phlebology selected us to host their 20th World Congress on September 13-17, 2023, in Miami Beach, Florida. We are looking to bring together over 2,000 medical professionals from around the globe to share the latest advancements in venous and lymphatic medicine. We will cohost the 2023 UIP World Congress with the American Venous Forum, the Canadian Society of Phlebology, and the Mexican Academy of Phlebology and Lymphology.

FUTURE AVLS ANNUAL CONGRESS EVENTS 2023 Miami Beach, FL (UIP World Congress)

UIP2023 Connecting the Continent... Welcoming the World

2024 Chicago, IL 2025 Washington, DC 2026 Denver, CO 2027 Orlando, FL

The AVLS is truly a Society of individuals who have committed their life’s work to caring for those with venous and lymphatic disease. I cannot think of a better group of people to develop lifelong relationships with that all share my passion for being a better doctor and a better person by giving back to those that I have the opportunity to serve through the Society.

Thank you, Margaret 31

LEARN ON YOUR TIME

ePASS

One-year subscription to AVLS Online Education including: • A Comprehensive Overview of Lymphedema • Understanding the Glycocalyx • Compare and Contrast US & European Lipedema Consensus Learn more at www.myavls.org/epass

Immersive Education Experience in-person education from the comfort of your home with VR:360 technology. The VR:360 labs allow you to stand next to our physician experts while they perform procedures in-clinic.

• Sclerotherapy 2.0 • Introduction to Venous Insufficiency Learn more at www.myavls.org/immersive

Venous Classification Workbooks Learn and practice CEAP and SVP classifications with real patient case studies. The digital workbooks help you apply classifications to your own patients.

Learn more at www.myavls.org/workbooks

ABVLM ON PATH TO SUB-SPECIALTY Neil Khilnani, MD, FSIR, FAVLS President of the ABVLM

In 2008, the American Board of Phlebology recognized our first class of diplomates. Here we are today with 913 diplomates of what is now known as the American Board of Venous & Lymphatic Medicine (ABVLM). What an accomplishment! The ABVLM is grateful for the dedication and commitment of those physicians who have shown their commitment to providing the highest quality of venous and lymphatic care for their patients.

As we all know, sitting for a certification exam and receiving a diploma is not the end of a vibrant medical specialty. It also takes ownership of our training and education.

Currently, the ABVLM, with the generous financial support of the Foundation for Venous & Lymphatic Disease (FVLD), has established four programs across the country, averaging a total of seven fellows per year. Since the inception of the VLM fellowship program by the late Dr. John Bergan at La Jolla Vein Institute, we have seen over 20 fellows graduate. I want to thank the current programs and their directors for their investment and commitment to the study of venous & lymphatic medicine: • Center for Vein Restoration VLM Fellowships (4) – Peter Pappas, MD • ProMedica/Jobst Vascular Institute VLM Fellowship - John Fish III, MD • Prisma Health System VLM Fellowship – Marcus Stanbro, DO

• Massachusetts General Hospital/Harvard Medical School VLM Fellowship – Julianne Stoughton, MD In addition to the continuing medical education provided by the AVLS, the ABVLM has developed a Maintenance of Certification (MOC) program that operates on a month-to-month basis utilizing the latest in digital educational technology from SelfStudy Inc. This MOC program replaces the traditional MOC exam every ten years.

While we have accomplished a great deal over the past 14 years since our first class of diplomates, there is still much to do to achieve our goal as a sub-specialty recognized by the American Board of Medical Specialties. Many of you reading this article are affiliated with institutions where a VLM Fellowship Program could be developed and thrive. If you are interested in learning more, please reach out to our team at the ABVLM at www.abvlm.org.

In closing and on behalf of the Board of Directors of the ABVLM, I want to thank all the members of the AVLS, the diplomates of the ABVLM, and especially the donors to the FVLD that have made the creation of the ABVLM a reality for supporting this effort over the years. Together, we are looking forward with great expectation to the day we achieve the recognition that the specialty of venous and lymphatic deserves to elevate patient care to even higher levels.

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Let’s Talk about It

Advancing Society Communication to Reach the New Horizon

By Vineet Mishra, MD, FAAD, FAVLS

Communication is essential for any healthy relationship. For the AVLS, improving the conversation amongst members and leadership was imperative to accomplishing the objectives of the New Horizon Strategic Plan. To facilitate member connections, the AVLS enhanced the digital newsletters, created the myAVLS magazine, launched the MAC, and redesigned the website.

The Society’s primary means of informing members is its digital newsletters. Previously, VeinLine was sent twice a month as a conglomeration of all updates from the Society and the field of venous and lymphatic medicine.

As the Society grew and our updates grew more varied, many news items were getting lost in the mix. To combat this, in 2019, we decided to segment the newsletter into four weekly editions, Advocacy Insider, Research Review, Learning Matters, and Member Connection.

Each newsletter reflected a tenet of the New Horizon Strategic Campaign.

With segmented newsletters, members can filter their news to topics significant to them.

Additionally, we can share Society news and items from across the field of venous and lymphatic medicine relevant to each subject.

For instance, Member Connection can now highlight a Member of the Month, introducing members to each other in more depth. The Research Review can share the latest relevant

articles published in the past month across the field of venous and lymphatic medicine.

Sometimes, however, the conversation needs to go deeper than email can provide. The myAVLS magazine, born out of the Daily Congress newspapers, offers space for long-form articles and an in-depth look at topics and projects the Society is tackling.

The long-form approach of the magazine offers context for the news blurbs sent by email throughout the year. Articles grant a glimpse into the minds of AVLS leadership, explaining their goal and hopes for the continued growth and success of the Society.

MyAVLS magazine began in 2019 with its first edition announcing the name change of the American College of Phlebology to the American Vein & Lymphatic Society. The magazine is published twice a year, with a spring edition distributed digitally and a fall edition distributed physically to Annual Congress attendees and digitally to all members.

While newsletters and a magazine provide various ways to engage with the Society, all good conversations have two sides. To facilitate member communication amongst members and the leadership, the AVLS launched the MAC, My AVLS Community. The MAC is an online discussion forum exclusively for AVLS members.

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Previously, member networking and discussions were limited to in-person meetings. With an online forum, members can continue those conversations once they are back home and begin new dialogues at any time throughout the year.

The MAC launched in early 2020, right as the world headed into shelter-in-place. Unable to gather in person, the MAC created a space to ask questions and figure out how to handle all the changes from the pandemic. Since then, the MAC has continued to grow with new discussions covering topics from treatment options, best practices, research discussions, and practice management.

New technology and means of communication are exciting, but most individuals’ primary point of engagement with the AVLS is our website.

When the Society changed its name in 2019, the website needed to be updated. However, we did not stop at just refreshing the branding but restructured the entire site and how different audiences engage.

The website needs to serve our members with quick and easy access to all our online content.

To facilitate these interactions, we created www. myavls.org as a member dashboard complete

with buttons for anything and everything a member may want to access, all available within one click.

The new homepage provided our members with navigational speed, but what about prospective members who may not know what they are looking for yet? These individuals still needed a more traditional website experience that would promote browsing. To that end, we created www.veinandlymph.org. This homepage is more SEO targeted and allows new visitors to explore who we are and what we offer.

By presenting two different faces of the Society with varying homepages, the AVLS was able to adjust the online experience by audience.

Today both pages receive equal traffic, with the myavls.org homepage just outpacing the veinandlymph.org homepage.

Without healthy communication, the Society would have been limited in achieving the New Horizon Strategic Plan and establishing who we “ARE” in Advocacy, Research, and Education.

Conversations are always two-directional, and we want to engage and hear from you about your preferred method of communication and where we should go next.

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Catch you down in New Orleans!

AVLS 36th Annual Congress October 13-16, 2022 Hyatt Regency New Orleans & at Home www.avlscongress.org

UIP 2023 World Congress & AVLS 37th Annual Congress Connecting the Continent, Welcoming the World September 17-21, 2023 • Miami Beach Convention Center