LETTER FROM THE PRESIDENT

By Dr. Marlin Schul, AVLS President 2019-2020

It has been an honor and privilege to serve the Society over the past two years. In my wildest dreams, I could not have imagined the organization I have known for 16 years to have evolved into such an active society. In no particular order, I will share some highlights of the AVLS and where we are going as we transition executive leadership. I am grateful for my time leading this Society. I look forward to maintaining my involvement in various committees and as Chairman of the Foundation for Venous & Lymphatic Disease.

MEMBER SERVICES

Name Change to Fit the Scope of Practice and Description of our Membership – We have learned that swollen legs do not always have a reflux cause of the problem. Early data from the AVLS PRO Venous Registry estimates that no less than 3% of all visits have a lymphatic component as their primary problem. More and more providers have incorporated services for the lymphedema in their practices. In fact, of the American Vein & Lymphatic Society (AVLS) educational offerings, those involving lymphedema are consistently the most popular sessions. A True Shift in Mission Has Taken Flight, Built on Pillars of Advocacy, Research, and Education – As Mark Meissner said at the time, “We have always delivered on education, and expansion to the other areas adds value if we can do it right.” Indeed, advocacy is vital to every specialty, and the approach is not as easy as saying “we are advocates.”

I’ll spell out details in the areas below, but THIS SOCIETY IS RELEVANT due to our commitment to advocacy and research. myAVLS Community (MAC) Became Reality – Members connecting with members is always a goal. How can we build more awareness of the process and share interesting cases? How can members learn more about a specific condition or educational offering? The MAC allows providers to post videos, ask other members about compelling cases, and get real-time feedback. Although in its infancy, we anticipate Ultrasound Sections, Lymphedema Sections, Advocacy Sections, etc. The board’s vision of finding more ways to connect members through the myAVLS Community is accomplishing its intent, and I encourage you to become engaged and share any feedback you may have. AVLS moved Annual Congress from November – The AVLS meeting calendar shifted to early or mid-October as the target dates for the foreseeable future. This timing offers better access for our members, avoiding the time crunch in November, increasing the accessibility for our members to our annual Congress, and navigating the Thanksgiving holiday during a traditionally busy time of the year.

ADVOCACY

The Advocacy Department quickly develops structure and takes wins! - Indeed, with a full-time director in Robert White, and decades of experience in the Healthcare Policy Committee (HCP) with Dr. Stephen Daugherty as chair, the AVLS has become relevant to patients, providers, other specialty societies, industry, and payers. AVLS has an active Healthcare Advocacy Advisory Committee (HAC) led by Dr. Chris Pittman, that battles many issues each year focused on patient access to care, appropriate reimbursement, and standards of care, e.g., preventing abuses. » HAC Chair – Chris Pittman, MD (AVLS

AMA Delegate & CAC Member FCSO) » Vice-Chair – Vineet Mishra, MD (AVLS

AMA Alternate Delegate) » John Blebea, MD (AVLS RUC Advisor) » Trip Todd, MD (AVLS RUC Alternative

Advisor) » Satish Vayuvegula, MD (AVLS CPT

Advisor) » Michael Graves, MD (AVLS CPT Alternate

Advisor & CAC Member NOVITAS) » Stephen Daughtery, MD (AVLS HPC Chair & CAC Member Palmetto) » Ken Nguyen, MD (AVLS Rep. to IAC Vein

Center Board) » Carl Fastabend, MD (AVLS Rep. to IAC

Vein Center Board) » Another (20) volunteer members of this committee offer thorough coverage of our national policy issues. The efforts of the advocacy committees have arguably led to greater access to care versus where we were two years ago. We identified through the 21st Century Cares Act that Medicare Contractors had an obligation to meet with societies when a coverage or policy issue was a concern. Through the course of multiple face-to-face meetings with medical directors of government and commercial payers have enhanced access to care in nearly every market. The payers care about data. Leveraging the Improving Wisely data by Medicare Contractor (MAC) and multiple recent manuscripts that run parallel regarding utilization trends opened the door to the more reasonable policy than we have seen in years. Ambulatory Phlebectomy Task Force was developed – The 30% drop and repricing of CPT37765 & 37766 caused a ripple in our Society and would have been worse had YOUR Society not taken action to support practice expense. This task force, led by Drs. John Blebea and Ken Harper, is actively identifying opportunities that could lead to reclassifying phlebectomy codes by region(s). Our Society is increasingly being looked to for leadership in advocacy and asked by carriers for guidance on policy. There are many wins you will hear about, and the wins will keep on stacking as long as we maintain the focus on patients and access to care for those in need.

RESEARCH

AVLS PRO Venous Registry transitions from PRO 1.0 to PRO 2.0 - The AVLS has the largest vein registry hosting quality of life outcomes for superficial venous disease than any other database at this time. Utilization standards found in Crawford, Baber, and the Improving Wisely project have a high correlation with the data in AVLS PRO. Over the past two years, we have been transitioning to the PRO 2.0 platform to aid in data extraction and to expand the registry to include deep and pelvic venous disease in addition to the superficial disease of PRO 1.0, and to allow providers more robust comparisons of their performance with the aggregate. The Improving Wisely Project provided data that could be broken down by Medicare

Contractor (MAC) and shared with medical directors about their respective regions. This activity demonstrated an opportunity for MACs to rein in policy where needed and enhance access to care and treatment options elsewhere. The second iteration of the Improving Wisely project is forthcoming with the leadership of Dr. Margaret Mann. Stay tuned as we see if trends have changed over the past two years. AVLS PRO Registry Writing Groups are working in parallel - One recent and critical manuscript regarding the Anterior Accessory Great Saphenous Vein (AAGSV) manuscript has helped change policy to covering treatment for this anatomy. It came solely based on data from the registry. There are many more projects coming as we have writing groups seek to address well established and new treatments and respective outcomes using the registry alone. Guidelines Efforts are continuing – Dr. Mark Meissner has led multiple multisocietal efforts, including the C2 disease guidelines, chronic venous obstruction, lymphedema, and pelvic vein reflux, and the Society has begun a new effort targeting lymphedema. A landmark article will soon be published as the guide to classifying pelvic vein incompetence.

EDUCATION

Sclerotherapy Immersive Course (Virtual Reality) – Using a virtual reality headset, participants feel like they are in the room as Dr. Margaret Mann demonstrates her technique for small vein sclerotherapy. The course extensively covers large and small vein sclerotherapy. The AVLS education portal will share VR headsets and ship the devices and content directly to the address provided. Reviews of this program have been a hit, confirming that this type of education done at the student’s time is truly cutting edge. YOUR

Society has many additional modules under development, offering even more options for our members. • 2020 Annual Congress is 100% Virtual! –

COVID-19 has changed everyone’s usual way of doing things. The same is true as there is no face-to-face meeting in Washington,

DC. What has changed is the content delivery, where we’ll have both livestreamed opportunities and additional access to recorded versions through the end of the year. A total of 80.75 hours of CME are possible, and the “Live & Interactive” portion we have come to expect in our Annual

Congress will continue to be a significant part of the livestreamed sessions. • AVLS wins the host role for the 2023 World

UIP Meeting in Miami Beach, Florida! –

Looking ahead, your Society has committed to hosting the 2023 International meeting, along with our continental partners in North

America (Canadian Society of Phlebology,

American Venous Forum, and the Mexican

Academy of Phlebology & Lymphology). The

UIP meeting has traditionally been a wellattended scientific meeting, and Miami is accessible to everyone. Place this on your schedule! This Society relies upon its members for sustainability, and we take that very seriously. The executive leadership, volunteer advisory committees, and HQ Staff consistently look for ways to build value in membership to the AVLS. No matter where you look, the Society has delivered in every pillar despite COVID-19 challenges. We cannot do these activities without members and feedback to guide our actions. In closing, I am pleased to report that YOUR executive leadership and HQ staff are primed to take the Society to greater heights over the coming years. I encourage you to get involved! Find a place to serve as our committees’ work can accomplish so much to advance our mission and to improve the future of our field, our practice, and, most importantly, our patients!