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FEBRUARY/MARCH 2013

VEINTHERAPYNEWS.COM

Bipartisan efforts grow to repeal medical device tax By Larry Storer Despite efforts to repeal the 2.3 percent Medical Device Excise Tax (MDET), the new tax designed to raise $29 billion to help pay the cost of Obamacare, went into effect Jan. 1. Efforts are already afoot to repeal the MDET. Conservative estimates are that Obamacare will cost nearly $1 trillion over the next decade. To sell this plan to a country that is already closing in on an $18 trillion debt, the government required a plan. The MDET and a number of other taxes and fees on the medical community will raise $107 billion.

Another $716 billion or so would be realized by reducing Medicare reimbursement payments to doctors, hospital services, home health services, skilled nursing services, hospice services and improvements to Medicare processes and other Medicare reforms. For some this is a “savings from Medicare” while others call it “cuts from Medicare.” Regardless of party affiliation, many experts think Obamacare will collapse under its own weight within a few years. However, the Administration believes that the 32 million new people who participate in Obamacare will offset the cost of reform.

THE MDET

Internal Revenue Service Code Section 4191(b)(1) “provides that, in general, a taxable medical device is any device, as defined in section 201(h) of the Federal Food, Drug and Cosmetic Act (FFDCA) (codified as amended at 21 U.S.C. 301 et seq. (2006)) that is intended for humans.” Section 501 of the code applies the medical device tax only to commercial sales and importation of medical devices. The IRS DEVICE TAX

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MED-Fibers develops new fibers: radial tip, Easy Flex Glide Fiber The MED-Fibers Inc. a multi-specialty Laser Fiber Manufacturer that has a state-of-the-art production facility in Chandler, Ariz., has developed two new fibers for the vein industry. The Med-Fibers team has more than 50 years of fiber optic experience. In the past several months, it has developed the radial tip fiber and the Easy Flex Glide Fiber, which can be used in various medical applications including vein and urology procedures. Owner Armin Kaus said the fiber is designed for easy navigation through ureteroscopes, arteries, veins and other anatomical structures without tissue perforations. “We have chosen Total Vein Systems based in Houston to be the exclusive distributor for the vein and vascular market due to its’ excellent marketing and customer base,” Kaus said. VT N HEAR MORE: 888-868-8346

Dr. Kristina Sanchez (left) believes in involving the family from the initial comprehensive lower extremity reflux ultrasound exam to the last follow-up visit.

The entire family plays a role in vein care By Kristina Sanchez, MD New patients often enter our clinic seeking answers and solutions to problems with their legs. It’s not always “new” symptoms, sometimes the appointment is finally made after living

with symptomatic venous insufficiency for most of their adult life. It’s also common that a concerned spouse or other knowledgeable family member convinces their loved one to

seek help – or at least, answers. Certain symptoms may be more bothersome to a spouse, often something as simple as nighttime leg restlessness. Other symptoms can be more significant, such as physical limitations in daily activities secondary to leg pain. Depending on the patient, it can be helpful for family members to provide an extra set of ears and eyes to gather information and ask questions during the clinic visit and consultation.

INSIDE THIS ISSUE ClosureFast passes 6 5-year test Social media in medicine 10 Sigvaris adds to men’s socks

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VeinViewer gets Image Capture

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FAMILY, A DIAGNOSTIC TOOL Family members can add helpful information VEIN CARE

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Disclaimer and Liability Statement: The information contained in this publication, including text, graphics and images, is for informational purposes only, and is not intended to be a substitute for professional medical advice. Publications & Communications Incorporated (PCI), Publications and Communications LP, and Vein Therapy News, via its Editors, Publisher, Editorial Board members, or staff, accept no responsibility for any injury or damage to persons or property occasioned through the implementation of any ideas or use of any product described herein. In consideration that great care is taken by the Publisher, Editors, staff, and Editorial Board to insure all information is accurate, we recommend each reader seek independent verification of all product or drug usage, surgical techniques and clinical processes prior to their use or implementation. The opinions expressed in this publication and all related marketing or sales material of this publication are those of the authors and are not attributable to the publication, Publisher, Editor, staff, Editorial Board, advertisers, or sponsors. References made in articles may indicate uses of medical equipment or medical procedures, or of drugs at dosages, for periods of time, and in combinations not included in the current prescribing information. Inclusion of advertising material in this publication, or in reproduction of articles and pages, or in supplemental materials, does not constitute any representation or guarantee by Publications & Communications Incorporated (PCI), Publications and Communications LP, and Vein Therapy News, via its Editors, Publisher, Editorial Board members, or staff, of the quality of such products, or of the claims made by the manufacturers. Trademarks are used in an editorial fashion with no intent to infringe. Reproduction in whole or in part of this publication is strictly prohibited.

Reader Services SUBSCRIPTIONS To subscribe or to purchase back issues of the magazine, please call 800-678-9724 ext. 344 or e-mail Beth Chorba at bethc@pcinews.com. For more information, please visit www.veintherapynews.com and click on the Subscribe link. ADVERTISING INFORMATION If you are interested in advertising in Vein Therapy News magazine, online or in our Marketplace, please contact our account executive: Gary Pittman, Jr., 512-637-0373, garypjr@pcinews.com EDITORIAL SUBMISSIONS Doctors, nurses, clinics, managers, vendors, patients, professors and others are encouraged to submit abstracts, white papers, writings, and ideas for editorial consideration. If you have a paper or story idea to submit, please e-mail larrys@pcinews.com UPCOMING EVENTS AND PRESS RELEASES Vein Therapy News would like to hear about your organization’s upcoming event, product launch, or announcement. Please e-mail press releases or event listings at least two months in advance to larrys@pcinews.com

VEIN THERAPY News

Volume 6, Number 2

Editor Larry Storer larrys@pcinews.com t Art Director Lisa Gouveia Advertising Executives Gary Pittman, Jr. 512-637-0373 garypjr@pcinews.com Dennis Carter 512-637-0371 dennisc@pcinews.com Accounting Beth Chorba bethc@pcinews.com Web and Network Manager Joel Nosal joeln@pcinews.com President Gary L. Pittman garyp@pcinews.com Publications & Communications, Inc. 13552 Highway 183 N, Suite A Austin, TX 78750 tGBY Vein Therapy News is published bimonthly by Publications & Communications, Inc., Gary L. Pittman, President, 13552 Highway 183 N., Suite A, Austin, TX 787250 512-250-9023. Subscriptions are available for $45 per year. Payment must accompany orders. Copyright 2013 by Publications & Communications Inc. All rights reserved. Reproduction in any form without written consent from the publisher is strictly prohibited. Postmaster: Send changes to Vein Therapy News Circulation Department, 13552 Highway 183 N., Suite A, Austin, TX 78750 ADVERTISING

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February / March 2013

NEWS

1 Paying for health care reform

Despite efforts to repeal the 2.3 percent Medical Device Excise Tax (MDET), the new tax designed to raise $29 billion to help pay part of the cost of Obamacare, went into effect Jan. 1. Efforts are already afoot to repeal the MDET.

6 American Venous Forum

The American Venous Forum’s 25th Annual Meeting will take place Feb. 25 to March 2 in Phoenix, Ariz., at the Wigwam Resort. This meeting will bring together experts in the field of venous and lymphatic health to participate in cutting edge, high-quality scientific presentations of the latest, most relevant research and information. A number of vendors will exhibit during the Forum.

SECOND LOOK 1 A family affair

Dr. Kristina Sanchez, MD, believes that patients are more successful if they have family involved at every step of treatment from the initial consult to the followup procedures. Often the most objective report of patient history can come from a spouse or a child who has seen the problems first hand.

18 The “fiscal cliff� was nothing

The debacle that we witnessed in Washington at the end of the year about the “fiscal cliff� negotiations is small potatoes compared to the brewing catastrophe that is the Affordable Care Act (ACA). This article reviews the ACA, the costs, its effect on physicians and why many believe that it will collapse under its own weight.

28 This calls for your super powers

Docs 4 Patient Care is working to put the power that was legislated away by bureaucrats back into the hands of medical professionals. Please join now and seize your super power!

THE PRACTICE

14 Measuring patient satisfaction

A provision in the healthcare reform bill promises to bring significance and urgency to measuring patient satisfaction. However, the benefits of these surveys extend far beyond meeting emerging government mandates, and some practices are already using them to make operational improvements.

VTN Report Business Side of Medicine Second Look Product News

4 14 18 29

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NEWS

THE VTN REPORT GETTING IT RIGHT In the article “Multispecialty Care In the Vein Practice Provides Advantage in Diagnosis” by Timothy Cawifield, MD, of the Rocky Mountain Vein Institute in the December/January issue, Dr. Cawifield would like to correct two errors. UÊÊ˜Ê VˆÌˆ˜}Ê Ì…iÊ V>ÃiÊ œvÊ >Ê ÇӇÞi>À‡œ`Ê “>iÊ «>̈i˜ÌÊ Ü…œÊ complained of two months of severe bilateral lower extremity cramping that was unremitting at night, the article stated the patient had informed the doctor he was taking Renofibrate. It should have read fenofibrate. UÊÊ˜Ê VˆÌˆ˜}Ê >˜œÌ…iÀÊ V>ÃiÊ œvÊ >Ê xx‡Þi>À‡œ`Ê “>iÊ ÜˆÌ…Ê ÃiÛiÀiÊ hyperpigmentation of both lower extremities progressing over the last six months, the article stated that his lower extremities were otherwise symptomatic. It should have stated that his lower extremities were otherwise asymptomatic.

AMESWALKER.COM AND MEDI PARTNER AGAIN IN 2013 AmesWalker.com is again partnering with Mediven (Medi) in 2013 to offer its premier line of compression hosiery, socks and medical braces. Products available include: Mediven Comfort, Mediven for Men, Mediven Sheer and Soft Stockings, Mediven Motion, Mediven Plus, Mediven Forte, Mediven Travel Stockings (15-20 mmHg), Mediven Ulcer Kit and Mediven accessories.For complete information, see www. ameswalker.com/medmedhossty.html

VEGAS COSMETIC SURGERY SYMPOSIUM REGISTERING FOR JUNE 26-30 MEETING The Vegas Cosmetic Surgery and Aesthetic Dermatology Symposium will be conducted June 26-30 at the Bellagio Resort Hotel in Las Vegas. The show is presented by the Multi-Specialty Foundation for Aesthetic Surgical Excellence, this year under the direction of S. Randolph Waldman, MD. Registration is underway. The purpose and mission of the Multi-Specialty Foundation for Aesthetic Surgical Excellence, a not-for-profit educational foundation, is to foster a spirit of cooperation and understanding between four specialties that are primarily involved in the science, practice and teaching of facial aesthetic surgery. The educational faculty includes experts from the fields of oculoplastic surgery, dermatology, facial plastic surgery and plastic surgery. READ MORE: www.multispecialtyfoundation. com/pdf/Final_Mailer_v3_online.pdf

COVIDIEN BUYS CV INGENUITY TO DEVELOP P.A.D. TECHNOLOGY Significant numbers of peripheral vascular and vascular accCovidien, a global provider of healthcare products and parent company of VNUS Medical, completed the acquisition of CV Ingenuity Jan. 11. The financial terms were not disclosed, but Covidien will increase R&D spending by $20 million in the second half of fiscal 2013, and much of that cash will go into polishing up CV’s rapid-release balloon for a regulatory debut. CV Ingenuity, based in Fremont, Calif., is focused on improving patient outcomes in the treatment of peripheral arterial disease (P.A.D.) by providing solutions to relieve vascular obstructions, inhibit restenosis and allow natural vessel

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healing. The company’s core technology, while still in the investigational phase, is a drug-coated balloon platform with a proprietary, tunable, rapid-release system. READ MORE: www.covidien.com

MEDICAL DEVICE SUMMIT SET Navigating the current volatility of the health care industry, medical device manufacturers will gather for the 4th Annual Medical Devices Summit Feb. 28-March 1 at the Boston Marriott Long Wharf in Boston. Two days of panels, presentations and networking opportunities with high-level individuals from across the industry will cover updates to the 510(k); legislation regarding such issues as electronic health records and the America Invents Act; the human factors in device design; regulatory concerns internationally, and strategies for bringing products to markets outside of the United States; integrating process excellence into design control; and getting information specific to attendee needs by offering choices from two tracks focusing on premarket and post-market issues. READ MORE: www.opalevents.org/p/62/ medical-devices-summit?gclid=CKGJr9Ck3rQC FWaoPAodvXkAMA

USC ADDS TWO APLIO 500 ULTRASOUNDS, ONE VIAMO To stay competitive using the most cutting-edge technology, the Keck Medical Center of the University of Southern California (USC) installed two Aplio 500 ultrasound systems and a Viamo ultrasound system from Toshiba America Medical Systems Inc. at its Keck Hospital of USC in Los Angeles. USC will use the Aplio 500 and Viamo systems for general exams. Aplio 500 offers picture-perfect imaging with advanced visualization capabilities, including Fly Thru. Toshiba’s Fly Thru is an industry-first technology using 4D ultrasound to “fly through” interiors of ducts and vessels for better exploration of lesions and masses, and to assist in planning interventional procedures. Additionally, Aplio 500 comes standard with enhanced workflow tools and ergonomics, including the iStyle+ Productivity Suite. The Viamo is a laptop ultrasound system with advanced imaging capabilities not available on hand-carried systems. Equipped with the performance of Toshiba’s larger, cart-based systems, Viamo delivers image quality and penetration (up to 40cm) from the operating room to a patient’s bedside. READ MORE: www.medical.toshiba.com

KLAS RECOGNIZES 3M AS 2012 MEDICAL RECORDS CODING LEADER For the fifth consecutive year, independent health care research firm KLAS, has ranked 3M Codefinder Software as the top software product in the Medical Records Coding category of its annual healthcare vendor survey. This year’s “2012 Top 20 Best in KLAS Awards: Software & Professional Services” report also recognizes 3M Health Information Systems as one of the top three highest-performing health care software vendors based on 25 separate performance measures, including product quality, implementation, and service and support.1 Used by more than 5,000 hospitals worldwide, 3M Codefinder Software manages the complex rules, guidelines and terminology of medical coding. The software is complete with ICD-10-CM and ICD-10-PCS coding content and tools to help coders prepare for the transition to ICD-10. These

tools include document insufficiency flagging, translation, and double and dual coding. The U.S. Department of Health and Human Services has set October 2014 as the start date for the new ICD-10 national coding standard. READ MORE: http://solutions.3m.com/ w ps/por ta l /3 M /en _ U S/ Hea lt h - I n for m at ion Systems/?WT.mc_id=www.3Mhis.com

HOUSTON ANESTHESIA FIRMS PARTNER U.S. Anesthesia Partners (USAP), an anesthesia-focused physician services organization backed by Welsh, Carson, Anderson & Stowe (WCAS), and Greater Houston Anesthesiology P.A. (GHA), has signed a definitive agreement to enter into a partnership through which GHA will serve as USAP’s cornerstone affiliated practice. As part of the transaction, USAP will also acquire the assets of GHA that provide practice management and business support services. Founded in 1996, GHA is one of the largest single-market private practice anesthesia groups in the country, employing more than 400 anesthesia providers who perform approximately 250,000 cases annually in all areas of anesthesiology, including cardiovascular, neurosurgery, obstetrics, orthopedics, pediatrics, transplant and acute and chronic pain management. GHA is the primary anesthesia provider for over 40 medical facilities in Houston and Austin, Texas. READ MORE: www.welshcarson.com

NAVY, ARMY CHOOSE DELL FOR UNIFIED CLINICAL ARCHIVING Dell was chosen by the U.S. Navy Medical Logistics Command and the U.S. Army Integrated Clinical Systems PMO, along with its partners BRIT Systems and Acuo Technologies, to implement Dell’s Unified Clinical Archive (UCA) solution. This was a task order assigned as a part of the Digital Imaging Network Picture Archiving Communications System III (DINPACS III) contract. The award was granted to the Brit Systems team that included both Dell and Acuo. As a part of this $45 million task order, Dell and its partners will help the Army and Navy share picture archiving and communications systems (PACS) images between military bases and branches worldwide through an archive that will simplify the access and sharing of medical images for 49 hospitals. Dell’s UCA solution enables hospitals to simplify the management and sharing of medical images between disparate PACS used in radiology, cardiology, neurosurgery, endoscopy, mammography, digital pathology and a variety of other clinical specialties, and manage imaging data in patient care. READ MORE: www.dell.com

RADIATION STABILIZATION SOLUTIONS SETTLES WITH VARIAN MEDICAL Radiation Stabilization Solutions LLC, an Acacia Research Corp. subsidiary, has entered into a settlement agreement with Varian Medical Systems Inc. resolving litigation that was pending in the United States District Court for the Northern District of Illinois. Acacia Research Corporation’s subsidiaries partner with inventors and patent owners, license the patents to corporate users, and share the revenue. Acacia subsidiaries control 250 patent portfolios valued at more than $750 million, covering technologies used in a variety of industries. READ MORE: www.acaciaresearchgroup.com or www.acaciaresearch.com

February / March 2013

VEIN THERAPY News


Available for your patients online at www.AmesWalker.com


NEWS

AVF organizes special 25th annual meeting By Larry Storer The American Venous Forum’s 25th Annual Meeting will take place Feb. 25 to March 2 in Phoenix, Ariz., at the Wigwam Resort. This meeting will bring together leaders from around the world in the field of venous and lymphatic health for cutting edge, high-quality scientific presentations of the latest, most relevant research and information. A number of vendors will exhibit during the meeting. This year the Sumner Venous Summit, from 8 a.m. to noon on Feb. 27, will be a presentation of seven interactive cases related to common aspects of venous and lymphatic disease management, chaired by AVF President-Elect Peter Henke, MD. Each speaker will present a case, ask the audience management questions, and then provide a brief review of the evidence. Questions will be presented via the audience response system as a post test for the AMA PRA Category 1 Credits and MOC Part 2 Credits. The cases include: 1) IVC filter use and management, presented by John Rectenwald, MD Ă“ÂŽĂŠ /ˆLˆ>Â?ĂŠ 6/ʓ>˜>}i“iÂ˜ĂŒ]ĂŠÂŤĂ€iĂƒiÂ˜ĂŒi`ĂŠLÞÊ Â?˜>ĂŠ>ĂƒĂ•`>]ĂŠ ĂŠ ĂŽÂŽĂŠ ÂœÂ“ÂŤÂ?iĂ?ĂŠÂ˜ÂœÂ˜Â‡ 6/ĂŠĂƒĂžĂƒĂŒi“Ê`ÂˆĂƒi>ĂƒiĂŠĂ€iÂľĂ•ÂˆĂ€ÂˆÂ˜}ĂŠÂˆÂ˜ĂŒiÀÛiÂ˜ĂŒÂˆÂœÂ˜]ĂŠ presented by Antonios Gasparis, MD

4) Complex superficial venous disease requiring intervention, presented by Lowell Kabnick, MD xÂŽĂŠ 7ÂœĂ•Â˜`ʓ>˜>}i“iÂ˜ĂŒĂŠÂœvĂŠĂ›iÂ˜ÂœĂ•ĂƒĂŠĂƒĂŒ>ĂƒÂˆĂƒĂŠĂ•Â?ViĂ€>ĂŒÂˆÂœÂ˜]ĂŠÂŤĂ€iĂƒiÂ˜ĂŒi`ĂŠ LÞÊ7ˆÂ?Â?ˆ>“Ê>Ă€ĂƒĂŒÂœÂ˜]ĂŠ ĂŠ ĂˆÂŽĂŠ ÂœÂ“ÂŤÂ?iĂ?ĂŠ >VĂ•ĂŒiĂŠ 6/ĂŠ ÂˆÂ˜ĂŒiÀÛiÂ˜ĂŒÂˆÂœÂ˜]ĂŠ ÂŤĂ€iĂƒiÂ˜ĂŒi`ĂŠ LÞÊ ,>LÂˆÂ…ĂŠ Chaer, MD ǎÊ ޓ…>ĂŒÂˆVĂŠ `ÂˆĂƒi>ĂƒiĂŠ “>˜>}i“iÂ˜ĂŒ]ĂŠ ÂŤĂ€iĂƒiÂ˜ĂŒi`ĂŠ LÞÊ ĂžĂ•Â˜}‡ œœ˜}ĂŠii]ĂŠ

The concurrent Specialty Symposium from 1:15-3:15 p.m. Feb. 27 will include: UĂŠ 6>ĂƒVĂ•Â?>ÀÊ “i`ˆVˆ˜iĂŠ >˜`ĂŠ ĂŒÂ…Ă€ÂœÂ“LÂœĂƒÂˆĂƒ]ĂŠ VÂ…>ÂˆĂ€i`ĂŠ LÞÊ /Â…ÂœÂ“ĂŠ 7°Ê Rooke, MD, FSVM UĂŠ ˆœ“iVÂ…>˜ˆVĂƒĂŠ >˜`ĂŠ Lˆœi˜}ˆ˜iiĂ€ÂˆÂ˜}]ĂŠ VÂ…>ÂˆĂ€i`ĂŠ LÞÊ -iĂƒÂ…>`Ă€ÂˆĂŠ Raju, MD, FACS UĂŠ 7ÂœĂ•Â˜`ĂŠV>Ă€iĂŠ>˜`ĂŠVÂœÂ“ÂŤĂ€iĂƒĂƒÂˆÂœÂ˜]ĂŠVÂ…>ÂˆĂ€i`ĂŠLÞÊ7ˆÂ?Â?ˆ>“Ê>Ă€ĂƒĂŒÂœÂ˜]ĂŠ MD UĂŠ ĂŠ Â?ÂˆĂ›iĂŠ Ă›iÂ˜ÂœĂ•ĂƒĂŠ Ă•Â?ĂŒĂ€>ĂƒÂœĂ•Â˜`ĂŠ VÂ…>ÂˆĂ€i`ĂŠ LÞÊ ˆVÂœĂƒĂŠ >LĂ€ÂœÂŤÂœĂ•Â?ÂœĂƒ]ĂŠ *Â… ]ĂŠ  ]ĂŠ,6/ÆÊÊ>˜`ĂŠÂ˜ĂŒÂœÂ˜ÂˆÂœĂƒĂŠ>ĂƒÂŤ>Ă€ÂˆĂƒ]ĂŠ

There will be eight scientific sessions: Session 1, which runs from 3:45-5:35 p.m. Feb. 27, is Chronic Venous Disease 1: Varicose Veins. Session 2, running from 8-9:55 a.m. Feb. 28, is Deep Vein Thrombosis 1. Session 3, DVT 2 runs from

10:50 a.m. – 12:20 p.m.; and Session 4, Chronic Venous Disease 2, begins at 3:30 p.m. and ends at 5:30 p.m. On March 1, Session 5, Chronic Venous Disease 3 runs from 8-9:20 p.m. Session 6, from 10 a.m.-12:05 p.m., includes the president’s sessions. At 8 a.m. March 2, Session 7, DVT 3 will be presented; and at 1 p.m., Session 8, Chronic Venous Disease 4. Two Poster sessions will be held concurrently from 5:45-7 p.m. Feb. 28: Joseph Raffetto, MD, will moderate 12 Posters in Session 1; and Marc Passman, MD, will moderate the other 11 Posters in Session 2. Other events include: UĂŠ °Ê Ă•}i˜iĂŠ-ĂŒĂ€>˜`˜iĂƒĂƒĂŠiÂ“ÂœĂ€Âˆ>Â?ĂŠiVĂŒĂ•Ă€iĂŠĂœÂˆÂ?Â?ĂŠLiĂŠÂŤĂ€iĂƒiÂ˜ĂŒi`ĂŠLÞÊ Susan R. Kahn, MD, professor of medicine at McGill University. UĂŠ /Â…iĂŠ6ˆÂ?Â?>Ă›ÂˆVi˜VÂˆÂœĂŠ-ĂžÂ“ÂŤÂœĂƒÂˆĂ•Â“ĂŠ>``Ă€iĂƒĂƒÂˆÂ˜}ĂŠÂŤiÂ?Ă›ÂˆVĂŠVœ˜}iĂƒĂŒÂˆÂœÂ˜ĂŠ syndrome will be lead by AVF Past President Mark Meissner,  °Ê/Â…ÂˆĂƒĂŠ>Â˜Â˜Ă•>Â?ĂŠĂƒĂžÂ“ÂŤÂœĂƒÂˆĂ•Â“ĂŠÂ…ÂœÂ˜ÂœĂ€ĂƒĂŠ À°Ê°Êiœ˜iÂ?ĂŠ6ˆÂ?Â?>Ă›ÂˆVi˜Vˆœ]ĂŠ an AVF founding member who is noted for his career in treating venous malformation. UĂŠ /Â…iĂŠ Ă“xĂŒÂ…ĂŠ Â˜Â˜ÂˆĂ›iĂ€Ăƒ>ÀÞÊ >Â?>ĂŠ iÂ?iLĂ€>ĂŒÂˆÂœÂ˜ĂŠ vi>ĂŒĂ•Ă€iĂƒĂŠ >ĂŠ reception, dinner and live entertainment. VT N For a look at the preliminary program, see http://veinforum.org.

ClosureFast RF CVI treatment at 5 years studied

Covidien, parent company to VNUS Medical Inc. and a global provider of health care products, has released the five-year results of the ClosureFast Long-Term European Multi-Center Study in patients with chronic venous insufficiency (CVI). This study evaluates the five-year outcomes of a minimally invasive endovascular therapy for treatment of CVI. The ClosureFast Study was conducted at eight centers in Europe. The Venefit procedure (using the ClosureFast radiofrequency ablation catheter) was used to treat 295 lower limbs in 225 patients diagnosed with superficial venous reflux, the underlying cause of varicose veins and CVI. This progressive medical condition affects the veins in the leg and compromises their ability to carry blood back to the heart. This is a worldwide issue and, in fact, affects more than 30 million Americans in the United States alone.1 If left untreated, varicose veins can become CVI, which, in severe cases, may result in lower leg pain, skin damage and leg ulcerations. Thomas Proebstle, MD, Universitaets Hautklinik Heidelberg in Germany, who recently presented the study at the American College of Phlebology 26th Annual Congress, said the fiveyear final analysis from the ClosureFast Study shows sustained treatment success in anatomical and clinical categories and supports its leading position in endovenous vein treatment.

STUDY DESIGN, RESULTS

This prospective, multi-center study enrolled 225 patients and treated 295 limbs at eight centers in Europe from April 2006 to June 2007. The study treated patients diagnosed with superficial venous reflux with the minimally invasive Venefit procedure using the ClosureFast radiofrequency ablation catheter. Patients were evaluated following the procedure by duplex ultrasound imaging and clinical examination at three days, three months, six months and in yearly intervals up to five

6

CVI, VENEFIT PROCEDURE

years. Of the 295 treated limbs, 233 (79 percent) were available for examination at five years. According to Kaplan-Meier analysis, at five-year follow-up, full occlusion of the treated vein was observed in 92 percent of patients (vs. 98 percent at one year). The vast majority (95 percent) of patients were free of pathological venous reflux (vs. 99 percent at one year). This demonstrates durable results of the Venefit procedure out to five years. The average Venous Clinical Severity Score (a multifactorial score measuring disease severity and quality of life) improved from 3.9 Âą 2.1 before treatment to 1.3 Âą 1.7 at five years. In addition, only 14 percent of limbs were CEAP (disease severity classification) class 3 or higher at five years, while, at baseline, 48 percent of limbs were in the same category. “This pivotal study provides substantial long-term data on relevant end-points to help clinicians decide the appropriate treatment for their patients, thus defining Covidien’s commitment to a strong foundation of clinical research,â€? said Mark A. Turco, MD, chief medical officer for vascular therapies at Covidien.

CVI is a progressive, sometimes debilitating medical condition. It occurs when valves in the veins of the lower leg no longer function to push blood back to the heart. This allows blood to flow backward, or reflux, resulting in enlarged, or varicose, veins. If left untreated, the condition can progress, and, in severe cases, can result in lifestyle-limiting lower leg pain, skin damage and ulcerations. Traditional surgical treatments that close or remove the diseased veins, including vein stripping, may be painful and can result in long recovery times for patients.2 Alternatively, patients can be treated with a minimally invasive endovascular procedure such as the Venefit procedure. During the Venefit procedure, the ClosureFast catheter is inserted into the diseased vein and radiofrequency energy is used to seal the vein shut. Blood that would normally return to the heart through the diseased vein travels back through other veins instead. Over time, the treated vein shrinks and is absorbed by the body. Compared with surgical options, minimally invasive ablation of the vein can result in less pain and quicker recovery time.2 VT N READ MORE: www.covidien.com

RESOURCES:

1 Gloviczki P, et al. The care of patients with varicose veins and associated chronic diseases: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. JVS; May 2011. 2 L. H. Rasmussen, M. Lawaetz, L. Bjoern, B. Vennits, A. Blemings, and B. Eklof, Randomized Clinical Trial Comparing Endovenous Laser Ablation, Radiofrequency Ablation, Foam Sclerotherapy and Surgical Stripping for Great Saphenous Varicose Veins. British Journal of Surgery Society Ltd, Wiley Online Library, www.bjs.co.uk, March 15, 2011.

February / March 2013

VEIN THERAPY News


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February / March 2013

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NEWS Theragenics mum on stock activity in late December

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Theragenics Corp., (NYSE: TGX), a medical device company serving the surgical products and prostate cancer treatment markets, announced that in view of the market activity in the company’s stock on Thursday, Dec. 20, 2012, the New York Stock Exchange contacted the Company on Dec. 24, 2012, in accordance with the Exchange’s usual practice. A Theragenics spokesman said that its policy is not to comment on market activity. As of Dec. 10, its stock was down 13 percent YTD and flat for the past five trading sessions where it was $1.47 per share in light trading. As of Dec. 31, it opened $1.56 and rose to $1.60. On Dec. 13, Theragenics signed a valueadded loading services agreement with Oncura, a unit of GE Healthcare to provide worldwide brachytherapy loading services to Oncura. Under the three-year agreement, Theragenics will load and package Oncura manufactured brachytherapy seeds in prescription loaded needles, custom strands and other configurations. Oncura’s iodine-125 brachytherapy seeds are utilized primarily in the treatment of early stage prostate cancer. This agreement provides for loading services for most Oncura sales of prescription and custom loaded brachytherapy seeds worldwide, which currently includes North America, Europe, Australia and portions of Asia. In its brachytherapy business, Theragenics manufactures, markets and distributes “seeds” used primarily in the minimally invasive treatment of localized prostate cancer. Although, the increased activity is no doubt related to this brachytherapy business, Theragenics also operates a surgical products business. The surgical products business (www. cpmedical.com, www.galtmedical.com, www. needletech.com) manufactures and distributes wound closure, vascular access and specialty needle products. This surgical products segment serves a number of markets and applications, including, among other areas, interventional radiology, vascular surgery, plastic surgery, interventional cardiology and endoscopy. Vascular access includes introducers, guidewires and related products. Wound closure products include sutures, needles and other surgical products. Specialty needles include coaxial, biopsy, spinal and disposable veress needles, access trocars, RF devices, implanters, introducer products and other needle-based products. Theragenics’ brachytherapy business manufactures, markets and distributes “seeds” used primarily in the minimally invasive treatment of localized prostate cancer. VT N READ MORE: www.theragenics.com

February / March 2013

VEIN THERAPY News


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NEWS

Mayo Clinic intros new book about social media use in health care The Mayo Clinic Center for Social Media has introduced “Bringing the Social Media Revolution to Health Care,” a new book aimed at helping health care professionals join consumers in employing social media tools to promote health, fight disease and improve health care. Mayo Clinic has been a pioneer in applying “new media” in health care, beginning with podcasting in 2005 and then moving into other social media platforms – YouTube, Facebook, Twitter and blogs – to make its physicians’ expertise available broadly and to enable patients to share their stories. Building on that leadership, Mayo Clinic created its Center for Social Media in 2010. In the foreword to “Bringing the Social Media Revolution to Health Care,” Mayo Clinic President

Report says use social media to recruit patients Everyone is interested in patient recruitment. A new market research report provides insight into the strategic use of social media for patient recruitment. “Social Media: Best Practices and Strategic Use in Patient Recruitment,” by Industry Standard Research (ISR), is based on data compiled from a survey of 104 patient recruitment professionals. Kevin Olson, CEO of ISR, said the report quantifies pharma’s use of social media and other web-based channels now and through 2015, as well as profiles the “ideal trial” for social media recruitment. “With 62 percent of worldwide population somehow engaged in social media, there’s no surprise pharma is eager to take advantage of the pool of potential subjects for their clinical trials,” Olson said. “Patient recruitment professionals we spoke to feel the use of social media will grow drastically between now and 2015; however, they are proceeding with caution as they wait for regulatory guidance and continue testing strategies for the new channel in a proportion of their studies. “Data we were able to capture in this report allowed ISR to establish a profile for an “ideal study” in which social media would be a successful channel for patient recruitment. Along with varying therapeutic areas, phases, and number of site locations, respondents indicated that studies with a diverse sample of patients or healthy volunteers in North America and Western Europe would be most successful.” In addition to an evaluation of social media and other web-based channels for clinical trial recruitment, ISR’s report also explores macro recruitment trends, including the how patient recruitment skills are sourced (in-house vs. CROs vs. specialty recruitment companies) and the use of and satisfaction with third-party service providers. VTN READ MORE: www.ISRreports.com/industry-reports/social-media-bestpractices-and-strategic-use-in-patient-recruitment

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and CEO John Noseworthy, MD, explains the rationale for both the center and the book. “As stewards of the Mayo Clinic legacy and early adopters of modern social networking tools, we see an opportunity and feel a responsibility to help the broader health care system harness social tools safely and effectively,” he says. “Bringing the Social Media Revolution to Health Care” features essays by 30 industry thought leaders, making the case for social media in health care and offering inspiration and encouragement to both newcomers and experienced users of social media. Contributors are members of the Mayo Clinic Center for Social Media advisory board and Mayo’s Social Media Health Network. “When it comes to changing health care, we must crowd-source the change we want to see in the world,” says Farris Timimi, MD (@FarrisTimimi), the center’s medical director. “Social media allows that to happen, and this book is a guide to doing so.” “‘Bringing the Social Media Revolution to Health Care’ simultaneously encapsulates our experience at Mayo Clinic and offers a broader call to action for the future,” says Lee Aase (@LeeAase), the center’s director. “We hope to inspire our peers to apply these tools to work more effectively on behalf of -- and with -- patients.” The book includes a section on legal issues in health care social media by Dan Goldman, JD (@danielg280), Mayo Clinic legal counsel, and a checklist to help readers develop their social media strategies. The book is $9.95 paperback, and available at Mayo Clinic (http://socialmedia.mayoclinic.org/ learning/book/). Net proceeds from book sales fund scholarships for patients to attend events sponsored by the Mayo Clinic Center for Social Media. VTN READ MORE: www.mayoclinic.com and www.mayoclinic.org/news

Reprocessthis.com blog roster adds Burgess as sterile processing expert “Reprocess This!”, a social media site for sterile processing professionals, continues to add to its roster of contributing experts. The blog’s newest writer is Lena Burgess, CRCST, CHL, CSPDM, a 14-year veteran of sterile processing who oversees seven sterile processing departments in six states. As a clinical operations director for Integrated Medical Systems International Inc. (IMS), Burgess said she views her work in the SPD as an opportunity to advocate for both patients and employees. “As someone who acquired an MRSA infection after a routine surgical procedure, I know the importance of utilizing best practices in every step of sterile processing,” said Burgess, who lives in Tennessee. MRSA is a methicillin-resistant staphylococcus aureus infection. Earlier this year, www.reprocessthis.com was launched as an online forum for SPD professionals to share ideas and information, solve problems together and build a supportive online community. The blog is hosted by IMS, a surgical instrument management and consulting company with facilities in Alabama, Florida, Maryland and Arizona, as well as sales and clinical teams serving more than 2,500 health care facilities nationwide. IMS provides instrument and device inventory management; realtime online data and tools to track instruments, tissue and implants; restoration of instruments to manufacturers’ performance standards; and on-location clinical personnel to manage sterile processing and interface with the operating room. VTN READ MORE: www.imsready.com

February / March 2013

VEIN THERAPY News


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NEWS DEVICE TAX

continued from page 1

clearly assigns responsibility to pay the tax to the manufacturer and the importer, but the word “generally” in the law may leave some wiggle room. Generally, the manufacturer or importer of a taxable medical device is responsible for filing Form 720, Quarterly Federal Excise Tax Return, and paying the tax to the IRS. Some tax experts say that adding the word “generally” may allow for the manufacturers and importers to pass that 2.3 percent MDET on to consumers through higher prices to hospitals, clinics and doctors. In the vein industry, a big concern is for items such as disposables, which are used in volume, that are subject to the tax. The assumption is that the medical device companies that are taxed will pass this increase along to the market – vein practices and hospitals. Analysts have shown this can be a significant chunk of change. AngioDynamics CEO, President and Director Joseph M. DeVivo told the question-answer earnings call participants discussing its second quarter earnings that AngioDynamics was looking at $6 to $7 million tax for the balance of the year. The tax that AngioDynamics will pay is already fully covered. Incoming Chief Financial Officer Mark Frost said the tax was “incorporated into the guidance [for the next quarter] we discussed … But it is fully baked into the expectations we set so we’re covering it.”

At least one source at another major American manufacturer – who asked not to be named – said the company will be forced to increase prices. “If our profit margin is 4 percent, and we’re hit with an added 2.3 percent charge by this tax, more than half of our profit is instantly gone,” the company source said. Several medical device manufacturers say that their operating profit margins are already so thin that they have no choice but to pass the cost on to their consumers. Normand Chevrette, president of Claflin Medical Equipment, told VTN that it is a real mixed bag right now, predicated on the assumption that few companies can afford not to pass it to market. “Some manufacturers are going to bear the brunt until they have their next price list change,” Chevrette said. “Some manufacturers are not going to change their price list, but will add the excise tax as a line item on their invoices. Some manufacturers will just simply change their price list immediately to reflect the 2.3 percent increase.” Invacare Corp. tax experts examined the final law in December and estimated that the effect from the tax in 2013 will be less than $1.5 million on those products that are eligible, and they said that they intend to pass that cost on to the market. But not everyone serving the vein industry is planning to pass it along. “We are not going to raise prices to offset the cost of the medical device excise tax,” said David Centanni, president and co-founder of Total Vein Systems in Houston. Total Vein is a

Ablation device market moderate growth predicted The segment of the United States nonvascular interventional radiology device market with the fastest growth and greatest potential is ablation devices, comprising radiofrequency (RF) ablation, cryoablation and microwave ablation devices. The overall market will grow moderately to $295 million by 2017. Ablation devices offer a minimally invasive alternative to traditional surgical treatments. The segment is growing quickly because of the increasing popularity of minimally invasive treatments. RF ablation is the most established device type, but microwave ablation and cryoablation are growing rapidly, due to some advantages these types of ablation offer. Microwave ablation devices can produce larger ablation zones and do not suffer as much from the heat sink effect that can handicap RF ablation. Growth in microwave ablation devices has stalled growth in RF ablation, and this segment of the market will slightly decline through 2017. Millennium Research Group (MRG) analyst Sean Messenger said microwave ablation devices are currently sold mainly by smaller companies with limited distribution networks. This has made them an attractive acquisition targets by more established companies. For example, AngioDynamics, a leader in RF ablation, recently made a large investment in Microsulis, a microwave ablation company. Messenger said cryoablation devices are the only kind of ablation device that can be used to treat prostate cancer. Urologists and interventional radiologists both use cryoablation to treat kidney cancer, using differing techniques. “Cryoablation is more versatile than other ablation devices because its effects do not need to be permanent,” Messenger said. “As a result, it can be useful in indications outside of cancer, most prominently in pain palliation, another growing market. Competitors see the opportunity for significant growth, leading Endo Health Solutions, a company with a large pain franchise and a focus on pain palliation, to acquire the top cryoablation manufacturer, HealthTronics, in 2010.” MDR has issued a report titled “U.S. Markets for Nonvascular Interventional Radiology Devices 2013,” that includes unit, installed base, average selling price and revenue information, along with market drivers and limiters and competitive landscape for ablation devices, percutaneous drainage catheters and soft tissue biopsy needles in the United States. VT N READ MORE: www.MRG.net or www.DecisionResourcesGroup.com

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major supplier of medical devices to the vein industry. “Our customers have already had a hard time in the last two years,” Centanni said. “Passing this tax onto them is not good for medicine, it’s not good for the vein industry and it’s not good for patients.”

ANATOMY OF THE TAX

In general, a taxable medical device is a product that is listed as a device with the Food and Drug Administration under section 510(j) of the Federal Food, Drug, and Cosmetic Act and 21 CFR part 807, unless the device falls within an exemption from the tax, such as the retail exemption. Section 501 is a 23-page document that seems to say the tax applies only to commercial sales and importation of medical devices. There are two main categories of devices exempt from the tax. First, eyeglasses, contact lenses and hearing aids are specifically listed as being exempt. The second, and broader category, commonly referred to as the “Retail Exception,” exempts a device that is “of a type which is generally purchased by the general public at retail for individual use.” “The proposed regulations also provide a non-exclusive list of factors to be considered in determining whether the design of a device demonstrates that it is primarily intended for use in a medical institution or office, or by medical professionals, and DEVICE TAX

continued on page 22

Clot management device market to grow 4% thru ’17 The segment of the United States nonvascular interventional radiology device market with the fastest growth and greatest potential is ablation devices, comprising radiofrequency (RF) ablation, cryoablation and microwave ablation devices. The overall market will grow moderately to $295 million by 2017. Ablation devices offer a minimally invasive alternative to traditional surgical treatments. The segment is growing quickly because of the increasing popularity of minimally invasive treatments. RF ablation is the most established device type, but microwave ablation and cryoablation are growing rapidly, due to some advantages these types of ablation offer. Microwave ablation devices can produce larger ablation zones and do not suffer as much from the heat sink effect that can handicap RF ablation. Growth in microwave ablation devices has stalled growth in RF ablation, and this segment of the market will slightly decline through 2017. Millennium Research Group (MRG) analyst Sean Messenger said microwave ablation devices are currently sold mainly by smaller companies with limited distribution networks. This has made them an attractive acquisition targets by more established companies. For example, AngioDynamics, a leader in RF ablation, recently made a large investment in Microsulis, a microwave ablation company. Messenger said cryoablation devices are the only kind of ablation device that can be used to treat prostate cancer. Urologists and interventional radiologists both use cryoablation to treat kidney cancer, using differing techniques. “Cryoablation is more versatile than other ablation devices because its effects do not need to be permanent,” Messenger said. “As a result, it can be useful in indications outside of cancer, most prominently in pain palliation, another growing market. Competitors see the opportunity for significant growth, leading Endo Health Solutions, a company with a large pain franchise and a focus on pain palliation, to acquire the top cryoablation manufacturer, HealthTronics, in 2010.” MDR has issued a report titled “U.S. Markets for Nonvascular Interventional Radiology Devices 2013,” that includes unit, installed base, average selling price and revenue information, along with market drivers and limiters and competitive landscape for ablation devices, percutaneous drainage catheters and soft tissue biopsy needles in the United States. VT N READ MORE: www.MRG.net or www.DecisionResourcesGroup.com

February / March 2013

VEIN THERAPY NEWS


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ThePractice How to measure – and manage – patient satisfaction By David P. Schmiege Part 2 of 2 parts Patient satisfaction surveys measure whether a patient’s expectations of a physician, sclerotherapy nurse, ultrasound tech or your vein practice product has been met or surpassed, enabling your medical practice to make improvements when and where necessary, or to maintain successful standards. By soliciting patient experience reviews, a medical practice is able to learn not only where it can improve, but also how to increase internal employee performance. This valuable David Schmiege information helps an organization maintain patient loyalty while improving internal efficiency. When improvements are made, your patients notice!

DATA CAN SET PRIORITIES

Patients, employees and referral physicians give you the best information about what shines about your practice, and what needs polishing. Satisfaction surveys are your best tool for asking key audiences what they think about your practice. For reliable data you need a well-designed survey, a distribution method that produces the highest response and easily understood reports that help you set priorities for improving the work processes and staff performance that affect patient satisfaction and referrals. Nationwide, satisfaction surveys have long been popular among health plans and employers. Increasingly, physicians are also conducting surveys, and for good reason. Every single practice, no matter how big, has competitors who want their patients. If you don’t know what your strengths and weaknesses are, you can’t compete. Ask the right questions. Choose questions carefully, or your survey won’t give you the information you really need. Surveys typically cover the following areas: UÊ >VViÃÃÊ­i>ÃiʜvÊ}iÌ̈˜}Ê̅ÀœÕ}…Êœ˜Ê̅iÊ«…œ˜i]Êi>ÃiʜvÊ}iÌ̈˜}Ê >˜Ê>««œˆ˜Ì“i˜Ì]ÊÜ>ˆÌˆ˜}Ê̈“iÃ®Æ UÊ Vœ““Õ˜ˆV>̈œ˜Ê LiÌÜii˜Ê «>̈i˜ÌÊ >˜`Ê œvvˆViÊ ­µÕ>ˆÌÞÊ œvÊ health information materials, ability to get a call returned, }iÌ̈˜}ÊÌiÃÌÃÊÀiÃՏÌÃÊL>VŽÊµÕˆVŽÞ®ÆÊ UÊ ÃÌ>vvÊ ­VœÕÀÌiÃÞÊ œvÊ Ì…iÊ ÀiVi«Ìˆœ˜ˆÃÌ]Ê V>Àˆ˜}Ê œvÊ ˜ÕÀÃiÃÊ >˜`Ê “i`ˆV>Ê>ÃÈÃÌ>˜ÌÃ]ʅi«vՏ˜iÃÃʜvÊ«iœ«iʈ˜Ê̅iÊLÕȘiÃÃʜvvˆVi®ÆÊ>˜` UÊ ˜ÌiÀ>V̈œ˜Ê ÜˆÌ…Ê Ì…iÊ `œV̜ÀÊ ­Ü…i̅iÀÊ Ì…iÊ `œV̜ÀÊ ˆÃÌi˜Ã]Ê thoroughness of explanations and instructions, whether the doctor takes time to answer questions, how much time the doctor spends with the patient). It’s easy for practices to devote too many questions to waiting rooms and waiting times. Although those areas are important, they pale in significance to the interaction between the physician and the patient. What I find is that the interaction between the patient and the physician counts for more than all other factors combined. If there is a good relationship there, patients will put up with other problems.

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TYPES OF SURVEYS

Most satisfaction surveys must rely on essentially three basic methodologies. Surveys may be administered in-person; they may be conducted with individuals over the telephone, via a focus group; or they may be executed via mail with a stamped, self-addressed return envelope. Your practice may elect to mail your surveys and follow up with a telephone reminder to enhance the response rate. A telephone survey may be preceded by a letter announcing the anticipated date of the phone call. A hand-delivered questionnaire given to a patient at the end of their office visit may be followed up with a telephone call or a letter / post card.

While you don’t have to act on every suggestion that your patients give you, you should take action on the key items that are causing dissatisfaction. Remember that your goal is to improve quality, not to place blame. STATISTICS

Sample size. When you distribute your patient satisfaction survey, try to survey the largest number of patients possible. This will improve your chances of getting an adequate number of responses. For example, survey nearly every patient after every encounter for two to three months. If surveying every patient is simply out of your reach, you can survey a random sample of your patients – say, every third or fifth patient. A minimum goal for a vein practice would be to distribute 750 surveys, with an anticipated response rate of 30 percent, yielding 225 responses. Response rates. A typical response rate is 30 to 35 percent. To bring your response rate to that level, mail the survey with a postage-paid reply envelope and a cover letter from the physician that explains the importance of patient feedback to your vein practice. Follow up on the survey five to seven days later with a reminder card. Where you might have otherwise gotten a 30 percent response rate, it may increase to 45 percent or 50 percent. Number of responses. An adequate response rate is important, but what is more important is the number of responses you receive. If you’ve managed to get a 45 percent response rate on your survey, but you’ve surveyed only 100 patients, you will not have enough data to draw meaningful conclusions. The more responses you can get, the more valid and reliable your results are likely to be. But what’s the minimum? I would suggest a minimum of 200 responses. Analyzing the data. Analyzing the data may be the most complex part of the survey process. Usually, you can put together a survey yourself; you can access your patient records to determine who to send the surveys to; and you may come up

with a reasonable response rate. The primary challenge emerges when the completed surveys are returned. If you don’t have someone with strong analytic and databasemanagement skills, you are prone to end up with a stack of surveys that are never analyzed adequately. If your practice does not have the time or resources to analyze your survey data, consider outsourcing this step to a firm that specializes in health care data analysis.

NOW WHAT?

While you don’t have to act on every suggestion that your patients give you, you should take action on the key items that are causing dissatisfaction. Remember that your goal is to improve quality, not to place blame. đŏ%//0%/"0%+*ŏ 3%0$ŏ 3%0ŏ 0%)!/čÊ /œÊ ˆ“«ÀœÛiÊ ˆ˜Ê ̅ˆÃÊ >Ài>]Ê >Ê «À>V̈ViÊ V>˜Ê `iÛiœ«Ê >Ê ºÌˆ“i‡>˜>ÞÈÃÊ ÜœÀŽÃ…iiÌ]»Ê which tracks patients’ visits by the minute for the time a patient arrived at the office, entered the exam room, was greeted by the `œV̜ÀÊ >˜`Ê ÃœÊ œ˜°Ê /…ˆÃÊ ˆ˜vœÀ“>̈œ˜Ê >œÜÃÊ Ì…iÊ «…ÞÈVˆ>˜Ê >˜`Ê staff to see how they’re spending their time and identify possible sources of delays. đŏ%#$ŏ (!2!(/ŏ +"ŏ /0%/"0%+*čŏ It’s nice to know that there are many patients with a positive image and positive viiˆ˜}ÃÊ>LœÕÌÊޜÕÀʜvvˆVi°Ê ÛiÀޜ˜iʏˆŽiÃÊ>Ê«>Ìʜ˜Ê̅iÊL>VŽ°Ê đŏ 0""ŏ +*1/ŏ 0.101.!čŏ Ո`Ê Ì…iÊ ÀiÃՏÌÃÊ ˆ˜ÌœÊ ޜÕÀÊ staff compensation structure. I believe in the carrot, not the stick. /…iʅˆ}…iÀÊ̅iÊÃÌ>vvÊÃVœÀiÃʜ˜Ê̅iÊÃ>̈Ãv>V̈œ˜ÊÃÕÀÛiÞÃ]Ê̅iʓœÀiÊ ÃÌ>vvÊLœ˜ÕÃʓœ˜iÞÊ>œV>Ìi`°Ê/…>ÌÊ}iÌÃÊ«iœ«iÊ̜ʫ>ÞÊ>ÌÌi˜Ìˆœ˜°

SUMMARY

A provision in the healthcare reform bill promises to bring significance and urgency to measuring patient satisfaction. However, the benefits of these surveys extend far beyond meeting emerging government mandates, and some practices are already using them to make operational improvements. đŏ$!ŏ /).0ŏ ,.0%!/ŏ 3%((ŏ 0'!ŏ %*"+.)0%+*ŏ #%*! ŏ".+)ŏ,0%!*0ŏ"!! ' and use it to strengthen the practice, processes and relationships with their patients. đŏ! 1!ŏ 0%!*0ŏ 1.*+2!.ċ Practices can reduce patient turnover by using patient satisfaction surveys to improve customer service. Physicians with patient satisfaction ratings ˆ˜Ê ̅iÊ œÜiÃÌÊ ÓäÊ «iÀVi˜ÌÊ >ÀiÊ ˜i>ÀÞÊ vœÕÀÊ Ìˆ“iÃÊ “œÀiÊ ˆŽiÞÊ to experience patient turnover than physicians in the top ÓäÊ«iÀVi˜Ì°Ê˜`ÊÀi“i“LiÀ]Ê«>̈i˜ÌÃÊ܅œÊ>ÀiÊ՘…>««ÞÊ܈̅Ê̅iˆÀÊ experience tend to spread the word to their friends and relatives. đŏ! 1!ŏ 5+1.ŏ )(,.0%!ŏ .%/'ċŏ /…iÊ ivviV̈ÛiÊ ÕÃiÊ of patient satisfaction surveys can also reduce your likelihood of being sued. Research has shown that poor communication between doctors and patients is more likely to lead to a malpractice suit than an unsatisfactory clinical outcome. VT N David Schmiege is the president and CEO of Vein Specialists of America. If you would like to comment on this article or offer a topic suggestion for a future article, Schmiege can be reached at (630) 638-0060 or via e-mail at David.Schmiege@VeinBusiness.com.

February / March 2013

VEIN THERAPY NEWS


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P.O. Box 1027 Asheboro, NC 27204 1-800-432-5347 www.VenosanUSA.com Venosan@VenosanUSA.com


SECONDLOOK

Affordable Care Act will collapse on itself By Matt McCord, MD The debacle that we witnessed in Washington at the end of the year about the “fiscal cliff ” negotiations is small potatoes compared to the brewing catastrophe that is the Affordable Care Act (ACA). As health care providers, it may be instructive for us to begin 2013 with a review of the ACA, the costs, its effect on physicians and why many believe that this law will collapse under its own weight. To paraphrase Ronald Reagan, the ACA brings the efficiency of the post-office and the charm of the IRS to our nation’s health care. Recall that the purported goal of the law was to increase health coverage for the 30 million or so uninsured Americans. According to the Congressional Budget Office (CBO) this law will cost American taxpayers $836.3 billion over the next nine years. American taxpayers can expect to pay an additional $36.3 billion dollars in additional taxes this year alone. Many will notice the increase in income tax for Medicare from 2.9 to 3.8 percent. Less obvious will be the 2.3 percent excise tax on medical device manufacturers (e.g. heart valves, joint implants, pacemakers, etc.) that will be passed on to Americans.

WHERE’S THE LOGIC?

That seems pretty expensive to provide insurance coverage for 10 percent of America. Why so much? Sadly, that only covers half of the cost; the other half will be paid for by $716 billion in Medicare cuts, which will be phased in over time where Medicare pay to doctors will be less

VEIN CARE

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when obtaining a history, such as what kind of limitations their loved one experiences due to leg problems. If a patient’s family is involved from the beginning, the rewards and benefits of treatment take on greater significance. At Rocky Mountain Vein Institute, most new patient visits begin with a comprehensive lower extremity reflux ultrasound exam. Family members can accompany the patient and watch ̅iÊ iÝ>“Ê œ˜Ê >Ê v>̇ÃVÀii˜Ê ÌiiۈȜ˜°Ê Ê Vœ˜ÃՏÌ>̈œ˜Ê ÜˆÌ…Ê >Ê …i>Ì…Ê V>ÀiÊ «ÀœÛˆ`iÀÊ vœœÜÃÊ Ì…iÊ iÝ>“°Ê /…iÊ Vœ˜ÃՏÌ>̈œ˜Ê ˆÃÊ where we find it most helpful to have a family member present because this is where the patient history, ultrasound findings and physical examination come together. Family members can also benefit indirectly when >VVœ“«>˜Þˆ˜}Ê>˜œÌ…iÀÊv>“ˆÞʓi“LiÀʜ˜Ê̅iˆÀÊiÝ>“°Ê iV>ÕÃiÊ venous insufficiency has a strong hereditary component, raising awareness to other family members about signs and symptoms related to venous reflux is important. Investing in vein health enhances the quality of life for the retirement years, and this can simply be accomplished by providing information to a new patient and their family members about what venous insufficiency is as well as other important topics such as the benefits of wearing compression stockings for the working adult. /…ˆÃʈ˜vœÀ“>̈œ˜Ê…ˆÌÃʅœ“iÊ܈̅Êv>“ˆÞʓi“LiÀÃÊ܅œÊÃiÀÛiÊ as caretakers for aging parents or grandparents. Patients who have postponed retirement and continue in professions on their feet for many hours of the day reap the benefits of this inside information as well.

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than Medicaid. For comparison, a 10-year repeal of the annual doctor “SGR fix” would amount to $244 billion according to the CBO. Massachusetts enacted a health care reform law in 2006 that is the model for the ACA, and Massachusetts is at least four years ahead of the ACA. The numbers do not lie; according to the Wall Street Journal, health costs now make up 54 percent of that state’s budget (up from 21 percent in 2001); health spending has increased 59 percent while spending on education is down 15 percent, police/fire spending is down 11 percent and roads and bridges down 23 percent. Most striking, Massachusetts now spends more per capita on health care than any other place on earth. The ACA will fail simply because it increases costs and it (paradoxically) decreases access to care. Annual private insurance health care premiums have increased $1,300 on average since enactment of the law. The CEO of Aetna, our nation’s third largest private health insurer, warned this December that “health care premiums in some markets may increase 100 percent.” He cautioned investors about “premium rate shock” where the average premium increase will be 25-50 percent by 2014. Since the law was passed in Massachusetts, emergency rooms are 4-8 percent more crowded and in some areas it takes one year to see a doctor. American consumers and businesses will not tolerate this.

BIG BUSINESS RESPONSE

Big business is already providing the viable alternative: consumer-driven health care. In October, Wal-Mart announced

that it had contracted directly with six large health systems for specific care with no out-of-pocket expenses to its insured employees. Beginning in 2013, Sears and Darden Restaurants will utilize a private insurance exchange where their employees will purchase health plans that win on price and value. To mitigate the above costs and added taxation brought by the ACA, more companies are moving to self-insured models and utilizing health savings accounts linked to high deductible health plans for their employees. According to John Goodman, the father of health savings accounts, this model averages a 30 percent cost-reduction over traditional health plans. The greater choice provided by these models also improves access to care. The liberation of American health care will occur out of necessity and fiscal survival. Business will begin this trend and government will follow. It is no coincidence that the two most competitive economies in the world, Singapore and Switzerland, have consumer-driven health care. Eventually, America will too. VT N Dr. Matt McCord is a practicing anesthesiologist, clinical instructor and health care administrator in Ann Arbor, Mich. He is the secretary for the Michigan Chapter of Docs4PatientCare, a national nonpartisan grassroots doctor organization seeking to repeal the ACA and create a sustainable health care reform law that minimizes government intrusion, maintains freedom of choice and preserves the sanctity of the doctor-patient relationship. For more information, see http://docs4patientcare.org/about.

EDUCATIONAL CORNERSTONE Patient education is a cornerstone to improving health, and having a family member attend the appointments helps our patients fully understand and appreciate the topics we cover. Some topics that we routinely address with patients and their families include: đŏ!/.%%*#ŏ 3$0ŏ 2!*+1/ŏ %/!/!ŏ .!((5ŏ %/Čŏ defining the symptoms and the treatment options. For example, our patients are often surprised that ̅iˆÀÊ «ÀœLi“ÃÊ ­ˆŽiÊ `>ˆÞÊ i}Ê >V…iÃÊ œÀÊ Û>ÀˆVœÃiÊ Ûiˆ˜Ã®Ê V>˜Ê LiÊ ÌÀi>Ìi`°Ê7iʅ>ÛiÊ«>̈i˜ÌÃÊ܈̅ÊÃÌ>ÈÃÊ`iÀ“>̈̈ÃÊ܅œÊ…>ÛiʘiÛiÀÊ been given medical reasoning as to why it developed, and ̅>ÌÊ ˆÌÊ ˆÃÊ ˜œÌÊ i>ȏÞÊ ÌÀi>Ìi`°Ê "̅iÀÊ «>̈i˜ÌÃÊ >ÀiÊ œ˜Ê œ˜}‡ÌiÀ“Ê diuretics for leg swelling, or are on medications like Requip for leg restlessness. For all of these types of conditions, there may be venous insufficiency as an underlying problem or contributing factor. đŏ%/1//%*#ŏ %*/1.*!ŏ +2!.#!ŏ "+.ŏ 2!%*ŏ treatments. ­>˜ÞÊ«iœ«iÊ>ÀiʘœÌÊ>Ü>ÀiÊ̅ˆÃʈÃÊ>ÊVœÛiÀi`Ê benefit.) đŏ 10%*#ŏ,0%!*0/ŏ3%0$ŏ)!)+.5ŏ+.ŏ$!.%*#ŏ problems. 7iÊ >ˆ“Ê ÌœÊ i˜ÃÕÀiÊ Ì…>ÌÊ iÛiÀޜ˜iÊ i>ÛiÃÊ Ì…iÊ Rocky Mountain Vein Institute fully understanding why they were sent to us or what their evaluation was about.

GETTING INFORMATION HOME /…iÊ «ÀœÛˆ`iÀÊ Vœ˜ÃՏÌ>̈œ˜Ê VœÛiÀÃÊ >Ê œÌÊ œvÊ ˆ˜vœÀ“>̈œ˜Ê ˆ˜Ê a short time. As vein disease is often new to the patient, the jargon and technical terms may sound intimidating or overwhelming. Venous insufficiency” or “venous reflux”

are terms that also comprise complicated language, such as, ”saphenous veins, incompetent perforators, radiofrequency ablation, sclerotherapy and graduated compression stockings.” 7…i̅iÀÊ œÀÊ ˜œÌÊ œÕÀÊ «>̈i˜ÌÊ …>ÃÊ >˜ÞÊ Žˆ˜`Ê œvÊ “i`ˆV>Ê background, it may be beneficial to have family around during ̅iÊۈÈÌÊ̜ʅi«ÊÜ>ŽÊˆÌÊ>Êˆ˜°Ê/Ài>̓i˜ÌʜvÊÛi˜œÕÃÊ`ˆÃi>ÃiʈÃÊ not intuitive to most people, and having family present to ask questions only improves the overall level of understanding. 7iÊ …>ÛiÊ `ˆvviÀi˜ÌÊ “œ`>ˆÌˆiÃÊ ÌœÊ …i«Ê i`ÕV>ÌiÊ «>̈i˜ÌÃÊ >˜`Ê Ì…iˆÀÊ v>“ˆˆiÃ]Ê ˆ˜VÕ`ˆ˜}\Ê œÕÀÊ ÜiLÈÌiÊ ­ÜÜÜ°À“Ûiˆ˜°Vœ“®]Ê handouts, posters, videos and iPad presentations.

February / March 2013

VEIN CARE

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VEIN THERAPY News


VENOSAN COMPRESSION STOCKINGS

P.O. Box 1027 Asheboro, NC 27204 1-800-432-5347 www.VenosanUSA.com Venosan@VenosanUSA.com


SECONDLOOK VEIN CARE

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Ideally, a patient leaves our office and continues the conversation at home with a spouse, partner or family regarding what they i>À˜i`°Ê/…ˆÃÊi˜>LiÃÊ̅iÊ«iÀܘÊ̜ʈ˜ÛiÃ̈}>ÌiÊ information further as needed. Having a family member present when we iÝ«>ˆ˜Ê̅iʓi`ˆV>ÊÌÀi>̓i˜ÌÃÊ>˜`Ê>vÌiÀ‡V>ÀiʈÃÊ key to a successful outcome. It is one thing to explain why it is important to wear graduated compression stockings after a procedure, but it is an entirely different matter getting some patients to put them on. Not everyone has the strength or dexterity ÌœÊ `œ˜Ê >Ê «>ˆÀÊ œvÊ Ì…ˆ}…‡…ˆ}…Ê Vœ“«ÀiÃȜ˜Ê stockings. A “team approach” with a family member can make the difference because the ˆ“«œÀÌ>˜ViÊ >˜`Ê «ÕÀ«œÃiÊ œvÊ Ì…iÊ Vœ“«ÀiÃȜ˜‡ wear is understood and facilitated. Moreover, if there are wounds and dressing changes, putting compression stockings over these dressings can be tricky – but absolutely imperative to healing. Physical activity after a vein treatment is also encouraged, and having a family to motivate is helpful. Finally, after a patient has completed a course of vein treatments, it’s nice for the provider team to hear perspective on how that patient has recovered and improved. /Ài>̓i˜ÌÊ «>˜ÃÊ vœÀÊ Ûi˜œÕÃÊ `ˆÃi>ÃiÊ ÀiµÕˆÀiÊ multiple return visits after the initial ultrasound >˜`Ê Vœ˜ÃՏÌ>̈œ˜°Ê /…ˆÃÊ ˆÃÊ `ˆÃ̈˜VÌÊ vÀœ“Ê œÌ…iÀÊ specialties. Vein treatments can be numerous, œvÌi˜Êœ˜ÊVœ˜ÃiVṎÛiÊ`>ÞÃ]Ê>˜`ʈ˜VÕ`iÊvœœÜ‡ up ultrasounds – not just after the procedures, but also throughout the following year. Family participation helps ensure that the patient keeps these appointments. An important aspect of successful vein care is >««Àœ«Àˆ>ÌiÊvœœÜ‡Õ«ÊœÛiÀÊ̈“i°Ê/…ˆÃÊ>œÜÃÊÕÃÊ to review our patients’ original symptoms, their expectations of care and the overall picture of ˆ“«ÀœÛi“i˜Ì°Ê iV>ÕÃiÊ Ûi˜œÕÃÊ ˆ˜ÃÕvvˆVˆi˜VÞÊ is a chronic and progressive disease, it is important to emphasize that future signs and Ãޓ«Ìœ“ÃÊ Liޜ˜`Ê Ì…iÊ œ˜i‡Þi>ÀÊ Üˆ˜`œÜÊ “>ÞÊ need further investigation.

CONCLUSION Involving a spouse, partner and/or family in the comprehensive approach to vein care ˆÃÊ }À>̈vވ˜}Ê œ˜Ê “>˜ÞÊ iÛiÃ°Ê 7…i˜Ê v>“ˆÞÊ is involved in a patient’s vein care, there is an improved overall understanding of what venous insufficiency is, as well as enriched aftercare and outcomes. `ÕV>̈˜}Ê >Ê «>̈i˜ÌÊ >˜`Ê …ˆÃÊ œÀÊ …iÀÊ v>“ˆÞÊ about venous insufficiency is a healthy, «Àœ>V̈Ûiʓi>ÃÕÀiÊ̜ÊÌ>ŽiÊ>ÃÊ>ÊVˆ˜ˆVˆ>˜°Ê7…i˜Ê following vein care treatments, it is also very VEIN CARE

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VEIN THERAPY News


SECONDLOOK

AmesWalker.com makes compliance easy, economical Like all healthcare providers, both phlebologists and vascular specialists share the concern of patient compliance. If patients don’t follow all of their healthcare provider’s instructions, they can limit the effectiveness of their recovery. For instance, some patients receive, as a part of their vein care treatment, a prescription for compression hosiery. All too often, patients don’t follow through with the purchase after leaving the doctor’s office. They discover the cost of compression hosiery, which they may already be disinclined to wear, and they opt not to buy any at all. Kaki Zell, vice president of sales and marketing for Ames Walker, said phlebologists and vascular specialists have found an option to encourage patients to go through with a purchase of compression hosiery – AmesWalker.com. “AmesWalker.com offers one of the broadest selections of affordable products, including both our own high-quality brand and a full range of industry-known name brands, including Jobst, Juzo and Sigvaris and Venosan,” she said. “Other companies sell compression hosiery products online, but they don’t have the private label selection that AmesWalker. com has available. We are the stocking experts. “With Ames Walker, our private label brand, patients receive the exact same quality as some of the larger, more expensive name brands at a fraction of the cost,” Zell said. “Patient compliance is a big reason for doctors to send their patients to us. If patients desire a specific brand, they have the option of choosing a large national brand; but if they are budget conscious, they can go with our Ames Walker brand because we offer both options.” “Ames Walker has been serving doctors and patients since 1995, and we are just as concerned with product compliance as they are. All the products available at Ames Walker are made to exacting medical standards. Our Ames Walker brand

is manufactured in North Carolina in our certified, FDAapproved facility.”

CUSTOMER SERVICE

Zell said the company’s exceptional customer service is unmatched and offers more than 50 years of combined experience. In fact, it has earned Ames Walker the Better Business Bureau’s highest rating – an A+. “All of our customer service representatives are certified fitters. If a patient has any question about what to order; how to select the proper product in terms of size, construction and compression; or how to measure their legs, our customer service representatives can help them to insure they get the proper fit.” Should a product not work, for any reason, patients can easily return their order. “Customer service is what we are known for,” she said. “We strive every day to make sure we take care of our customers. “For instance, if a customer orders something and a week later that item is on sale, we don’t hesitate to give them the discount if they call back. We’re extremely focused on making sure our customers are happy. And AmesWalker.com customers are happy – as our onsite testimonials, from doctors and patients, show.”

CUSTOMER FEEDBACK

Kathryn Keeler wrote: “As an orthopedic surgeon (and distance runner), I’m on my feet all day and Ames Walker helps keep me there. I love the compression stockings for long days in the OR. Their compression socks are great for running and recovery. I tell all the nurses and staff that I work with about your products. Everyone who I’ve recommended Ames Walker to agrees that the price, quality and customer service is unbeatable. Thank you Ames Walker!”

Susan Collins wrote: “I buy surgical support hose for my mother. She has been wearing the Futuro and other big name brands for about 20 years. She has been paying about $75 per pair for them and on a limited income, this was outrageous! Thank goodness I discovered Ames Walker. I have been buying similar compression hose – the Ames Walker brand – and mum swears that they last longer and are a better fit than the expensive name-brand hose. I buy a bunch and ship them to her in Canada several times a year.”

AMES WALKER PROFESSIONAL

Ames Walker also offers doctors and healthcare providers the option of carrying compression hosiery products in their offices as well. “Our professional website, Ameswalkerprofessional. com, is a wholesale site where you can purchase retail products to sell to your patients. This guarantees that patients are receiving the correct product for their needs, without even leaving your office. “Another option provided by Ames Walker is our professional pack – an in-office, single stocking dispenser pack that physicians can utilize for any onsite procedures. It is an inexpensive, efficient and easy way for healthcare providers to assist patients. “Whether you want the extra guarantee of selling Ames Walker compression hosiery in your office, or simply want to recommend ameswalker.com to your patients, Ames Walker is the source for the greatest selection and best prices on all the leading brands of graduated compression products,” Zell said. Patients can learn more about Ames Walker by visiting the website at www.ameswalker.com or by calling a certified fitter at 1-877-525-7224. Healthcare providers can contact Ames Walker Professional at 1-866-232-3655 or visit that website, www.ameswalkerprofessional.com. VT N

EVRF, CR45i studied in 150 endovenous saphenous ablations By Attila Szabó, MD, PhD and Patrick Danciu

closure of the vein trunks with minimal heat transfer to the surrounding tissues, causing minimal damage, no pain and providing an excellent closure rate.

Radiofrequency ablation (RFA) is a medical procedure where part of the electrical conduction system of the heart, tumor or other dysfunctional tissue is ablated using the heat generated from the high frequency alternating current. RFA has become increasingly accepted in the last 15 years with promising results. Endovenous radiofrequency (EVRF) ablation has replaced stripping and ligation as the technique for elimination of saphenous vein reflux. One of the endovenous techniques is a radiofrequency-based procedure. Newer methods of delivery of radiofrequency were introduced in 2007. Endovenous procedures are far less invasive than surgery and have lower complication rates. The procedure is welltolerated by patients, and it produces good cosmetic results. Excellent clinical results are seen at four to five years, and the long-term efficacy of the procedure is now known with 10 years of experience. The Belgian F Care systems introduced EVRF for transdermal treatments 14 years ago and started its use for saphenous closure with the CR45i catheter in 2010. It works on 4MHz and uses 25 watts, which provides an effective

STUDY OBJECTIVE

VEIN THERAPY News

We evaluated the effectiveness of EVRF treatment and analyzed the early and middle-term results using the EVRF device with a CR45i catheter for the endovenous ablation of GSV and/or SSV.

METHODS

From July 16, 2011, to Sept. 29, 2012, we treated 150 patients (98 women, 52 men, with an average age of 45) with saphenous reflux and varicosity using EVRF. The output power was 25 watts, the catheter removal rate was 4 beeps/0.5cm with 8 beeps at the beginning 2cm back from the sapheno-femoral (sapheno-popliteal) junction. In every case, we used tumescent local anesthesia with some superficial sedation in the present of an anesthesiologist. Patients’ clinical data, the data of the pre- and postoperative ultrasound examinations, the total power emitted and the diameters and flow of the treated veins measured by ultrasound have been recorded. Photo documentation was prepared in each case. Clinical evaluation was performed one day, one week and

February / March 2013

one to two months after surgery using a scale of postoperative pain, patient satisfaction and outcome ultrasound procedure.

RESULTS

The procedures were performed on 150 limbs – 129 GSV, 15 SSV, 6 GSV+SSV; 131 patients belonged to CEAP 2,3 and 19 patients to CEAP 4,5; 135 primary cases, 15 recurrent varicosity. Crossectomy was performed in six cases due to the GSV larger than 20mm at the junction. Tributaries were treated in the same session in all of the cases. The mean diameter of the GSV was 6,2 and of the SSV 4,8cm consequently, reflux more than 0,5sec was detected with duplex scan in all patients. The length of the treated vein segment ranged from 15cm to 82cm, using an amount of 7200 Joules energy emitted on average. The average duration of surgery was 54 minutes, including the treatment of the enlarged tributaries. Complete occlusion was found in 149 of the total 150 cases (99 percent) at the one-month ultrasound control, one GSV in a 160kg heavy patient remained open. Postoperative pain reported by the patients on a visual analogue scale was 2 out of 10; and the average patient satisfaction was 149 of 150 EVRF

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SECONDLOOK VEIN CARE

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The Art of Growing Your Vein Practice

satisfying to celebrate together when a patient has a clear improvement in their ability to sleep, to get through the day with less pain, and simply to feel better about the status of their legs and their quality of health. VTN

Introducing the new upgraded VeinGogh. ™ The only device featuring Bristle technology for a true one treatment solution for all of your patients. This is the piece you have been waiting for.

Dr. Kristina Sanchez serves as medical director for the Parker, Colorado Rocky Mountain Vein Institute. She is also a staff phlebologist for the Pueblo RMVI facility. Dr. Sanchez is one of only 11 board certified phlebologists in Colorado, and one of only two women in the state with the credential. She was formerly a family practice physician at Touchstone Health, the Colorado Mental Health Institute Pueblo, the Pueblo Community Health Center and the Southern Colorado Clinic Urgent Care. In addition to completing the phlebology fellowship at the RMVI, Dr. Sanchez holds a bachelor of science in biology and a doctor of medicine degree from the University of New Mexico. The mother of two is married to a Pueblo, Colo., native. DEVICE TAX

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“We have been using VeinGogh almost exclusively on facial telangiectasias, but since we began using the new bristle tips on the legs, we have seen amazing results. It is now our go-to treatment for those patients with residual, small, recalcitrant vessels after sclerotherapy treatment”. Dr. Mark A. Schwartz MD, FACS, RPVI Lake Success, N.Y.

VeinGogh Ohmic Thermolysis Using the skin’s impedance to selectively destroy vascular targets, VeinGogh rapidly clears even recalcitrant vessels with minimal discomfort, delivering immediate, consistent, repeatable results. VeinGogh is color blind, easy to learn and can be used by anyone currently performing vein treatments. Refine USA, LLC 340 3rd Avenue South Jacksonville Beach, FL 32250

1-866-333-6858 www.veingogh.com

Designed, built and serviced in the United States. Copyright 2012, Refine USA, LLC., All rights reserved. VeinGogh and Bristle are registered trademarks of Refine USA, LLC. Patent Pending. 510(k) Cleared for lower limb spider veins or telangiectasia

The Art of Vein Treatment

®

therefore not intended for purchase and use by individual consumers.” the IRS bulletin states. “The factors are (i) whether the device generally must be implanted, inserted, operated, or otherwise administered by a medical professional; (ii) whether the cost to acquire, maintain, and/or use the device requires a large initial investment and/or ongoing expenditure that is not affordable for the average consumer; (iii) whether the device is a Class III device under the FDA system of classification; (iv) whether the device is classified by the FDA under certain enumerated parts or subparts of 21 CFR; and (v) whether the device qualifies as durable medical equipment (DME), prosthetics, orthotics, and supplies (collectively, DMEPOS) for which payment is available exclusively on a rental basis under the Medicare Part B payment rules and is an “item requiring frequent and substantial servicing” as defined in 42 CFR 414.222 (referred to collectively herein as the “negative factors”).” Melissa Gwozdz, marketing communications coordinator for Sigvaris Inc., said the new 2013 medical device excise tax does not affect compression hosiery because it excludes medical devices generally purchased by the general public at retail for individual use. “At least as the law stands today it affects only DEVICE TAX

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February / March 2013

VEIN THERAPY News


B R E A K T H R O U G H IMMEDIATELY VISIBLE RESULTS NON-INVASIVE, NO ANESTHESIA NO BRUISING OR SCARRING NO PIGMENTATION CHANGES USE ON ALL SKIN TYPES IMMEDIATE SUN EXPOSURE SIMPLE TO USE AFFORDABLE

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RESULTS FOR PATIENTS - REVENUE FOR YOU Treat untreated veins in your practice - On the legs to treat small veins and matting inappropriate for sclerotherapy - On other difficult to treat areas such as ankles, knees or feet Unipolar thermocoagulation with proprietary square-wave technology Average fee charged for 15 min. Treatment session $300-$500 Cash-flow positive in 1 hour of treatments per month BEFORE

AFTER

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SECONDLOOK DEVICE TAX

continued from page 22

medical devices that are used by health care practitioners, such as surgical and laboratory equipment and devices.”

DEVICE START-UPS

When It Comes to Your Financial Success, You Need a Strong Partner. Today, the changing landscape of medicine poses more challenges for your vein practice than ever before. From increased competition offering similar Phlebology services in your service area to difficulties managing your revenue cycle processes, your Phlebology practice faces a host of complex issues that threaten your fiscal health and your ability to delivery high quality medical services. Call David Schmiege today at (630) 638-0060 to schedule a no cost telephone consultation or site visit. You’ll be glad you did. Vein Specialists of America

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For medical start-ups that barely survived the recession, the MDET is a new challenge to the company and its new technologies. The 2.3 percent excise tax that became effective on medical-device sales in January has no exception for loss-making companies. This will make it harder for start-ups to raise capital to launch and expand. Frank Fischer, chief executive of NeuroPace Inc., a firm that is seeking U.S. regulatory approval for an implantable device that detects abnormal brain activity that could result in a seizure. The device can send electrical stimulation to a targeted area of the brain to prevent the seizure from happening. An implantable device for treating neurological disorders, such as epilepsy, is made by NeuroPace. Fischer told the Wall Street Journal that he hopes to get FDA approval by mid-2013. The company has recently leased a new facility where it plans to manufacture the devices. Fischer acknowledges that the device tax may dampen financial projections, potentially making the firm less attractive to investors at a time when it will need more financing to launch manufacturing operations and establish a sales and marketing team. “If we were trying to start the company today, I don’t believe we’d be able to fund it,” he said. “[With] the length of time the regulatory process has been taking over [the] last several years, and this additional issue of the tax on top of that, I believe many companies – if they weren’t in the later stages of approval – wouldn’t get the funding to get there.” The tax is also forcing start-ups with marketed products to make difficult choices. Entellus Medical Inc., whose devices enable minimally invasive treatment of sinusitis, or inflammation of the tissue lining the sinuses, will consider various measures to offset the new expense, such as raising prices, making fewer new hires or investing less in research and development, according to CEO Brian Farley. The Plymouth, Minn., company has less than $30 million in revenue and isn’t profitable yet. Spine Wave Inc. , a device maker of spinalproducts, had expected to break even this year but won’t be able to now because of the tax, said CFO Terry Brennan. The Shelton, Conn., company, which has 110 employees, will continue to hire but not at the same rate that it otherwise would. “We’re a growth DEVICE TAX

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VEIN THERAPY NEWS


www.varicoseveinslaser.com


SECONDLOOK

F Care System research director spent almost a decade honing monopolar thermocoagulation Patrick Danciu, clinical research director of F Care Systems, has been working in the medical field for almost 10 years and chose to specialize in the treatment of venous vascular disease in collaboration with Rudi Devers, owner of F Care Systems and inventor of the real monopolar thermocoagulation device. Danciu collaborated on the first thermocoagulation device and more recently in the design of the EVRF (Endo Venous Radio Frequency). He said it is an innovative thermocoagulation device that brings immediate and permanent results with fewer side effects for the patient and an easier use for the doctor. “Venous problems are probably among the most common chronic conditions in North America and Western Europe, and varicose veins occur in both women and men,” Danciu said. “However, spider veins are more frequent in women.”

Having worked with many vascular surgeons and vein specialists worldwide, Danciu said it was clear in his mind that he had to bring all patients with venous disease a technology that can solve vein problems, as well giving them drastic advantages from pain and discomfort from treatments that are available in most offices today. More than 24 million Americans suffer from varicose veins. He said that is why he was one of the main protagonist to the patent of the needle and the catheters for thermalcoagulation of blood vessels. He said he also applied for a procedure patent for the EVRF that treats all types of veins diseases: UÊ -«ˆ`iÀÊ Ûiˆ˜Ã]Ê Ìi>˜}ˆiVÌ>È>]Ê ÀœÃ>Vi>]Ê «iÌiV…ˆ>]Ê V…iÀÀÞÊ angioma are treated with a thin, isolated needle. UÊ *iÀvœÀ>̈˜}]ÊVœ>ÌiÀ>Ê>˜`ÊÀïVՏ>ÀÊÛiˆ˜Ã]Ê>ÀiÊÌÀi>Ìi`Ê܈̅Ê

̅iÊ«>Ìi˜Ìi`ÊV>̅iÌiÀÃÊ ,£ÓˆÊ>˜`Ê ,ÊÎ䈰 UÊ œÀÊ̅iÊÛiˆ˜ÊvÀœ“Ê£““Ê̜Êx““Ê>˜`Ê̅iÊ}Ài>ÌÊÃ>«…i˜>ÊÛiˆ˜]Ê Ì…iÊÌÀi>̓i˜ÌʈÃÊV>ÀÀˆi`ʜÕÌÊ܈̅Ê̅iÊ ,{xˆÊV>̅iÌiÀ°Ê Danciu is now working on the catheters for hand veins and hemorrhoids. Danciu said he is working closely with doctors and surgeons to provide them with a useful device and procedure; improve the techniques; design a new hand piece for more treatments; and offer less discomfort to the patients. VT N Patrick Danciu is the clinical research director of F Care Systems. He can be reached by e-mail at pdanciu@fcaresystems.us.

Choose an EMR with Customer Care Extraordinaire! •We know the vein & vascular business….isn’t that the point? •We answer our phones…..but they hardly ever ring •We don’t make false promises….because we don’t have to •We listen to our customers….because they are important to us •We help customers understand our system….with onsite training •We identify and anticipate needs….because we speak your language •We promptly address issues that arise….why wait? •We are always courteous….because rude isn’t tolerated •We properly train our staff….because you need the right answers •We take the extra step….because we think you’re worth it •We always throw in something extra….don’t you like the cherry on top?

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26

February / March 2013

VEIN THERAPY News


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SECONDLOOK

PHYSICIAN CALL TO ACTION

Docs 4 Patient Care offers avenue to reform health care correctly “The ultimate measure of a man is not where he stands in moments of comfort, but where he stands at times of challenge and controversy.” –Martin Luther King Jr.

By Jeffrey Miller, MD Imagine possessing super-human power that gave you authority over our government when it makes health care decisions. You can decide how to reform health care so that every American could afford health insurance and enjoy the benefits of the best medical care in the world. The decision is yours. How would you use this special gift? Before you answer, consider the following. As a physician or health care provider in the phlebology world: UÊ 9œÕÊŜՏ`ÊLiʜÕÌÀ>}i`Ê>ÌʅœÜÊ̅iÊ*>̈i˜ÌÊ *ÀœÌiV̈œ˜Ê >˜`Ê vvœÀ`>LiÊ >ÀiÊ VÌÊ ­** ®Ê will limit your ability to treat patients. UÊ 9œÕÊ Ã…œÕ`Ê LiÊ >˜}ÀÞÊ Ì…>ÌÊ ˆ˜˜œÛ>̈ÛiÊ strategies for managing venous insufficiency will come to a screeching halt as the medical industry can no longer afford expensive research and development. UÊ 9œÕÊ Ã…œÕ`Ê LiÊ vÕÀˆœÕÃ]Ê >ÃÊ >Ê «…ÞÈVˆ>˜ÃÊ should, that you will be forced to follow nonsensical government established protocols instead of using your brain to treat patients. UÊ 9œÕÊ Ã…œÕ`Ê LiÊ ÃV>Ài`Ê ÌœÊ `i>Ì…Ê œvÊ Ì…iÊ ˜`i«i˜`i˜ÌÊ*>ޓi˜ÌÊ`ۈÜÀÞÊ œ>À`Ê­* ®]Ê £xÊ ˜œ˜‡iiVÌi`]Ê ˜œ˜‡«…ÞÈVˆ>˜Ê LÕÀi>ÕVÀ>ÌÃ]Ê who will decide what physicians will be paid for, and ultimately will ration care. Adding to your frustration might be that the health care debate is like watching a football season where your team keeps coming close to victory only to lose one nail-biter after another. You witness exciting moments when it looks

like the PPACA will be put in the trash where it belongs, yet it keeps surviving near death experiences and looks like it’s here to stay. Or is it? Don’t forget you’ve got super human powers … I’m assuming that as a health care provider you are against Obamacare and you either read the bill or familiarized yourself with its contents. If not, I can assure you that universal health insurance is not for the “greater good.” Our politicians will tell you that it’s not fair how we currently care for Americans, especially the poor. They will tell you about a better solution, which will thankfully provide universal healthcare insurance, and thus great care to all. The poor will finally get better health care and it will be equally good as the rich, eliminating the health-income gradient. Unfortunately, nothing could be further from the truth. Look no further than your neighbors to the North who have experimented with such a health care system. Studies have demonstrated that Canada has not abolished the tendency for health status to improve with income. In fact, the health-income gradient is more prominent in Canada than it is in the United States. If you really want to improve health care, more government is not the answer. More than 70 percent of German, Canadian, Australian, New Zealand and British adults say their health care system needs either “fundamental change” or “complete rebuilding.” They have very good reasons for being upset – they wait longer for care that is not as good as we have in the United States. Americans spend less time waiting for care than patients in Canada and the U.K. Canadian and British patients wait about twice

EVRF

DEVICE TAX

continued from page 24

company, but we’re not going to be able to continue to grow and invest the way we used to.”

LOOKING FORWARD

Mark Leahey, president and CEO of the Medical Device Manufacturers Association (MDMA), issued the following statement regarding the failure to repeal the medical device tax during the “fiscal cliff ” debate and vote: “While MDMA is disappointed that a deal was not reached to repeal the medical device tax, we are heartened by the bipartisan and growing support in both the House and Senate to end this policy. There

28

as long – sometimes more than a year – to see a specialist, to have elective surgery such as hip replacements or to get radiation treatment for cancer. Obamacare is fashioned after European health care, which begs the question: Why would you want to give up being number one in survival rates for cancer? Americans have better survival rates than Europeans for common cancers. Breast cancer mortality is 52 percent higher in Germany than in the United States, and 88 percent higher in the United Kingdom. Prostate cancer mortality is 604 percent higher in the U.K. and 457 percent higher in Norway. The mortality rate for colorectal cancer among British men and women is about 40 percent higher. So once again, imagine possessing superhuman power that gives you authority over our government when it makes all health care decisions. How would you use that special gift? If I told you it would take only five minutes to obtain such strength would you take the time? It’s actually almost that easy. These are challenging times. Health care as we know it is about to be decimated unless we take action. You do have super-human powers that are attained through the power of numbers (i.e., other health care providers). It’s time to support groups that promote freedom and real health care reform with the interest of patients. I found such an organization that is called Docs 4 Patient Care (D4PC), http:// docs4patientcare.org/. Take five minutes and join. Get your voice heard. D4PC advocates the following health care reforms that you can read more about: 1) Increase competition by allowing individuals to purchase health insurance across state lines.

continued from page 21

is wide recognition that the device tax has already led to job losses and that it is impacting patient care, and this will continue if Congress doesn’t act quickly in 2013. “MDMA and our members remain committed to repealing the medical device tax so the United States can continue to lead the world in medical innovation, but the real world impact of this job-destroying policy is unfortunately already being felt across the country.” VT N

(99 percent). There were no cases of deep vein thrombosis, skin burns, neuritis or bleeding, but we found minimal bruising at the treatment site of the tributaries in some cases, and two patients had mild inflammation, treated conservatively.

CONCLUSION

The EVRF saphenous ablation is a safe, painless procedure for the treatment of the GSV and/or SSV. The high patient acceptance and minimal postoperative discomfort allows the quick return to work and normal life. The procedure under local tumescent anesthesia is simple, and the disposable devices are easy to use.

Ó®Ê µÕ>ˆâiÊ Ì…iÊ Ì>ÝÊ ÌÀi>̓i˜ÌÊ œvÊ “œ˜iÞÊ spent for health insurance by employers and individuals. Î®Ê ˜VœÕÀ>}iÊ Ì…iÊ i>Ì…Ê ->ۈ˜}ÃÊ VVœÕ˜ÌÊ qualified High Deductible Health Plan ­-Ê µÕ>ˆvˆi`Ê  *®Ê “œ`iÊ >ÃÊ Ì…iÊ L>ÈVÊ structural health insurance model across the entire spectrum of health insurance options by broadening allowable use. 4) Promote transparency in medical costs. x®Ê ˜VœÕÀ>}iʓi`ˆV>Êˆ>LˆˆÌÞÊÀivœÀ“° È®Ê/À>˜ÃvœÀ“Ê i`ˆV>ÀiÊ ˆ˜ÌœÊ >Ê `ivˆ˜i`Ê contribution program. Ç®Ê,iÃÌÀÕVÌÕÀiÊi`ˆV>ˆ`Ê̜Ê>ÃÈÃÌʏœÜ‡ˆ˜Vœ“iÊ families to purchase health insurance. n®Ê ˜VœÕÀ>}iÊ …ˆ}…‡ÀˆÃŽÊ «œœˆ˜}Ê vœÀÊ ˆ˜`ˆÛˆ`Õ>ÃÊ܈̅ʫÀi‡i݈Ã̈˜}ÊVœ˜`ˆÌˆœ˜Ã° “There are two primary choices in life: to accept conditions as they exist, or accept the responsibility for changing them.” –Dr. Denis Waitley Herein lies our super powers! Please accept your responsibility to determine the future of medicine and join Docs 4 Patient Care (D4PC) now at http://docs4patientcare.org/. VT N Jeffrey H. Miller, MD, is the founder and CEO of Miller Vein with offices located in Novi and Troy, Mich. Dr. Miller is a board certified phlebologist and he is a board certified interventional radiologist and holds a Certificate of Added Qualification in the specialty. Dr. Miller has received numerous awards and honors in his field, including being named one of Hour Detroit Magazine’s “Top Docs.”

In our practice the EVRF treatment with CR45i catheter was superior to conventional varicectomy or to laser ablation using a second generation device with bare laser fiber. One- and two-year controls are planned. VT N Dr. Attila Szabó has his medical degree and his doctor of philosophy degree from Semmelweis University in Budapest, Hungary. He can be contacted at szabodrat@t-online.hu.

February / March 2013

Patrick Danciu is the clinical research director of F Care Systems. He can be reached by e-mail at pdanciu@fcaresystems.us.

VEIN THERAPY News


PRODUCTNEWS Sigvaris: New /+'/ŏ*ŏ!ŏ'!5ŏ to longer life Doug Handy, who works as a commercial pilot in Atlanta, is aware that the Sigvaris Business Casual Socks that he wears to make his legs feel better also act as a preventative measure against blood clots (economy-class syndrome), particularly during long flights overseas. “I find that the Business Casual Socks make my legs feel better when I arrive at my destination,” he said. “Even on days when I’m flying short runs, I can tell a difference in how my legs feel when wearing compression socks. I like to be proactive when it comes to my health and in preventing blood clots.”

Every year, more than 2 million Americans experience a deep vein thrombosis (DVT). These blood clots often lead to a pulmonary embolism (PE), and every year, more people die from DVT/PE than AIDS and breast cancer combined, according to the National Blood Clot Alliance. However, a simple change in socks could be the key to avoiding a similar fate. Judith Brannan, Sigvaris medical affairs and education manager, said that people everywhere are unaware that graduated compression socks can help prevent DVTs. “Businessmen and pilots are particularly at risk for developing circulation disorders because they spend so much of their time sitting at their desk and/or traveling for work.” To help promote the use of the Business Casual line for men, Sigvaris has recently added a new color addition. The Business Casual line of compression socks for men are now available in navy, brown, black and charcoal. They

also feature a subtle striped pattern and are constructed with a soft microfiber yarn for all day comfort. “The Sigvaris Business Casual Socks are a necessary wardrobe addition for any professional businessman who wants to add years to his life by preventing blood clots and vein disease,” Brannan said. “In fact, the Centers for Disease Control and Prevention (CDC) recommends graduated compression socks as a preventative measure against DVT.” Sigvaris North America in Peachtree City, Ga., is part of an internationally active medical device group that focuses on the development, production and distribution of medical compression garments, including hosiery and socks. With distribution in more than 60 countries on six continents, Sigvaris is a global manufacturer of compression therapy for the management of chronic venous disorders. VTN

T r a n s L i T e

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TransLite, LLC Veinlite® Transilluminators 8410 Hwy. 90A, #150, Sugar Land, TX 77478 www.veinlite.com info@veinlite.com Tel: 281.240.3111 Fax: 281.240.3122 BOOK continued on page 30

VEIN THERAPY NEWS

February / March 2013

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PRODUCTNEWS

New Bristle needle brings advantage to thermocoagulation of spider veins By Jeffrey Miller, MD I thought it was a marketing ploy! VeinGogh announces the development of a new needle, the Bristle, for thermocoagulation of tiny spider veins. My suspicion arose when I found that this new needle is more expensive. “Hah,” I told my staff, “can’t be any different than the old needle. The concept is the same and thus it’s just a way for a company to make more money.” Oh, was I wrong! The only way to appreciate the difference is to demo the new needle. I noticed the difference immediately. Veins just seemed to

disappear quicker and easier with the use of the new Bristle needle. Please understand that this is just my opinion and it’s not evidence-based. I have not put a study together comparing the Bristle needle to the older Ballet needle of VeinGogh, nor the VeinWave device. This is just my view, based on my real world experience. VeinGogh needles deliver microbursts of high-frequency electrical energy into the vessel via a hair-thin needle. The resistivity of the vessels converts the energy to heat instantly, coagulating the blood and collapsing the vessel wall while leaving the outer layers of the skin unaffected.

The new Bristle needle is 27-gauge and is insulated except for the distal 1 mm, which allows more targeted energy to be deployed to vessels without damaging surrounding tissue. At the same time, less energy needs to be used giving the operator the ability to safely retreat a vessel that does not blanch. Using an ice pack in a proposed treatment zone for 10 to 20 seconds just before treatment enhances comfort. You can place the needle perpendicular or angled to the skin surface. I have noticed you can treat a longer area of vein with an angle, but it’s probably insignificant. Keep in mind that neither VeinGogh nor Veinwave are standalone devices for the treatment of spider or reticular veins. We have found neither device useful for reticular veins. But both are excellent adjuncts to sclerotherapy for the tiny veins. With this in mind, I have to give two thumbs up to the new Bristle needle for treating telangiactasias. VT N Jeffrey H. Miller, MD, is the founder and CEO of Miller Vein with offices located in Novi and Troy, Mich. Dr. Miller is a board certified phlebologist and he is a board

VeinViewer Flex hand-held gets Image Capture Christie Medical Holdings Inc. has introduced the Image Capture capability, an addition to the ASSESS Imaging Suite on VeinViewer Flex, the company’s 5th generation VeinViewer device. Image Capture, which existed on larger previous models but for research purposes only, allows medical professionals to capture and store 200 images on the device and transfer them to hospital or physician office information systems. Chris Schnee, general manager and vice president of sales and marketing at Christie, said the feature is HIPAA-compliant because no patient information is stored on the device. Image Capture is especially useful when performing vein mapping, tracking previous venous access points and noting before and after results of sclerotherapy procedures. Before the end of 2012, additional value for Image Capture was offered through the Customer Loyalty Program and the FreshStart Competitive Trade-In Program, Christie’s solution for customers who are unhappy with their current peripheral vascular access device.

30

Newly designed Bristle Needle

Pre-treatment

3 minutes post-treatment Photography courtesy of Dr. Ronald Bush

certified interventional radiologist and holds a Certificate of Added Qualification in the specialty. Dr. Miller has received numerous awards and honors in his field, including being named one of Hour Detroit Magazine’s “Top Docs.” The FreshStart opportunity allows customers to trade in a competitive product, and apply the trade-in value towards the purchase of a VeinViewer. VeinViewer provides a direct-projection vein illumination device that has been clinically demonstrated to improve peripheral vascular access while reducing the number of sticks and improving patient satisfaction. Christie now boasts three product offerings, including the VeinViewer Vision, VeinViewer VisionXTND and VeinViewer Flex. All VeinViewer products include Christie’s AVIN (Active Vascular Imaging Navigation), which is used in pre-, during and post-vascular access. Schnee said VeinViewer provides a number of benefits to practitioners and patients, from easing the process during a pediatric blood draw to improving vascular access for a cancer patient. “Patients and practitioners will see improvement in vascular access procedures, patient outcomes and cost savings,” Schnee said. “Evidence demonstrates that VeinViewer increases successful vascular access, reducing pain and increasing patient satisfaction. Among the benefits that practitioners can expect are improvements in patient throughput; a reduction in secondary procedures and treatment delays; and an increase in referrals and revenue.” VT N READ MORE: www.veinviewer.com

February / March 2013

VEIN THERAPY NEWS


PRODUCTNEWS

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February / March 2013

VEIN THERAPY NEWS

Vein Therapy News - Feb/March 2013  

Despite efforts to repeal the 2.3 percent Medical Device Excise Tax (MDET), the new tax designed to raise $29 billion to help pay the cost o...

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