PHLEBECTOMY TASK FORCE: Harnessing data to advocate for access to care (by ensuring sustainable payment) John Blebea, MD, MBA, FACS Kenneth Harper, MD, FACS, RPVI, RPhS
Dr. John Blebea
Dr. Kenneth Harper
As AVLS members are too well aware, officebased payment for many of the core vein procedures that we can offer our symptomatic patients has been in steady decline for over a decade. As part of the Medicare Part B Physician Fee Schedule, when the ResourceBased Relative Value System was introduced almost 30 years ago, Medicare payment rates set the bar for payment in the United States. Over the past 18 months, a group of AVLS members has been working to infuse payment methodology with clinical and data-driven insights. The work has not been simple and has much to accomplish, but the effort stands so far as a work-in-progress on harnessing data to support appropriate payment changes.
phlebectomies to assess their responses regarding the two CPT codes describing the procedure. These survey results were collated and summarized, and a multi-specialty group of physician volunteers presented the data to the RBRVS Update Committee or RUC Panel. Since 1992, the RUC is the venue where specialties present their data and share their expertise about what RVUs they recommend to each CPT typically performed by that specialty. The two codes surveyed for ambulatory phlebectomy Çare 37765 (10-20 incisions) and 37766 (more than 20 incisions). There is no code for less than ten incisions. As a result of the April 2018 RUC meeting, CMS agreed with the RUC recommendations. Payment for the two phlebectomy codes (37765 & 37766) was adjusted for 2020 and dropped by about 31% effective January 1, 2020. The global period for both codes has also been reduced from 90 days to 10 days.
SETTING THE SCENE In early 2018, specialty societies (e.g., AVLS, Vascular Surgery, Interventional Radiology) surveyed physicians who frequently perform
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