PRESIDENT’S LETTER

By Dr. Mark Meissner

Here we are at the AVLS Annual Congress in Denver, Colorado, on October 7 – 10, 2021. I want to especially thank all of you that made it a point to attend this year’s meeting in person amidst all of the chaos that continues regarding the pandemic. This is an opportunity to renew old friendships, advance your knowledge of venous and lymphatic disease, and become involved in your society’s activities. I do not want to overlook those of you who chose to attend this year’s Congress virtually. One positive out of the pandemic has been the advancement of technology that enables the AVLS to offer access to the Congress through livestream and on-demand, meaning you never have to miss out on the Congress again!

Although the ongoing pandemic has made it impossible for us to meet in person over the past 18 months, it has been a very busy year for the American Vein & Lymphatic Society, with many important achievements by our standing committees and task forces. These have included the publication on a new classification system for pelvic venous disorders, the SVP classification (https://www. myavls.org/svp-classification.html) as well as again partnering with Johns Hopkins University to produce a follow-up study to the Improving Wisely project. As the PRO Venous Registry completes migration to a new platform, we anticipate the completion of several scientific projects over the next few months, and the publication of updated guidelines for the management of C2 chronic venous disease (in collaboration with the Society for Vascular Surgery and American Venous Forum) later this year. Several new task forces have also been established to codify the AVLS conflict of interest policy for board members, evaluate coding and payment models for phlebectomy, and evaluate potential pathways to establishing venous and lymphatic medicine as a recognized subspecialty.

The collaborative multidisciplinary membership of the American Vein & Lymphatic Society makes it unique among medical societies. Our members, representing multiple disciplines and a variety of practice settings, learn from each other and collectively advance the field of venous and lymphatic medicine. Unfortunately, these special aspects of our society have been challenged over the past year, and the AVLS has developed an active response to them. Foremost among these have been ongoing e orts to establish venous and lymphatic medicine as a recognized specialty and to stop the devastating impact that proposed changes to the Medicare Physician Fee Schedule (MPFS) will have on our member’s practices and our society.

Although the American Board of Venous and Lymphatic Medicine (ABVLM) was created in 2007, progress towards recognition by the American Board of Medical Specialties (ABMS) has been slow. Fortunately, our e orts have been recently stimulated by an independent request for the American Board of Surgery to create a focused practice designation (FDP) for general and vascular surgeons. In response, the AVLS has created a task force under the leadership of Drs. Jeff Schoonover and Zoe Deol with the goals of moving towards ABMS recognition of Venous and Lymphatic Medicine and attaining Accreditation Council for Graduate Medical Education (ACGME) recognition of the ABVLM fellowship programs. The task force has already had several productive calls with ABMS and ACGME administrative staff. This likely will be a multi-year process, but progress is being made towards the recognition our membership deserves.

The AVLS Healthcare Policy committee has developed a robust response to the proposed changes in the 2022 Medicare Physician Fee Schedule. As all should be aware through our membership communications, implementing the Proposed Rule would result in a 20% weighted average reimbursement decrease in nine of the most commonly used venous codes. Overall, it is estimated that venous and lymphatic specialists would suffer a 12% decrease in payment across all services between 2021 and 2022. Such dramatic cuts would affect most of our members in office-based practice and threaten the viability of their practices as well as patient access to timely care. Our actions include commissioning two studies evaluating the impact of the proposed rule on our members and their patients by respected third-party analysts, drafting a robust response to CMS, and partnering with the United Specialists for Patient Access (USPA) to educate and encourage a congressional response should implementation of the Proposed Rule move forward. Unfortunately, the response to this critical situation is costly and lies outside of the usual AVLS budget. However, given the dire consequences that this would have for our members, their practices, and their patients, as well as the multidisciplinary and inclusive nature of our society, the AVLS has initiated an aggressive campaign (STOP CMS’22) to urgently address both the current issue as well future threats to the field of venous and lymphatic medicine. Since 2018, reimbursement for six commonly used venous codes has declined by over 20%, and this progressive erosion will undoubtedly continue. Fighting public policy is a process that involves many small fights and the ability to rapidly respond to such threats quickly. Our initial goal is to prevent the proposed CMS cuts for venous and lymphatic medicine from taking effect on January 1st, 2022, with a long-term goal of preserving equitable venous and lymphatic code valuation and coverage for all eligible patients. Although the Healthcare Policy Committee is doing an outstanding job of responding to the current crisis, we need all of our members to become involved. The thing that I would personally ask of each of our members.

Inform – Become informed about how the Proposed Rule will directly impact your patients and practice and what the AVLS is doing to protect your future through the STOP CMS'22 campaign.

Invest – Become an AVLS Physician Advocate and donate the equivalent of the reimbursement for one venous ablation - $1200 (although donations in any amount would be greatly appreciated). Donations can be made through the AVLS website at www.myavls.org/cms22

Involve – Take up the cause, volunteer to engage your peers as Physician Advocates and challenge them to donate to the cause and contact their legislators. Engage your members of Congress and convey your concerns for the future of your patients. Inform your Medicare patients and ask them to contact their legislators.

Our goal is to raise over $300,000 to fund both this e ort and the ongoing reimbursement threats to venous and lymphatic medicine. Your contributions to this important e ort will be specifically recognized at our Annual Congress.

I look forward to seeing each of you at Congress. In addition to the outstanding educational program developed under the direction of Dr. Robert Worthington-Kirsch and his committee, we can anticipate further discussion of the AVLS advocacy efforts and initial discussions about the next phases in the development of our society.