Presidential Address

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During his address, outgoing SVS President Robert M. Zwolak, MD, PhD, took the opportunity to inspire incoming students and residents, to commend the Society on its recent accomplishments, and to exhort the SVS membership to deal proactively with the current economic woes in the health care system.

Dr. Zwolak reminded students and residents that, whatever message they might take home from the economic information he presented, “the fact is that being a vascular surgeon is a fabulously rewarding career. Our work is technically complex; our patients have too many comorbidities; we work long hours. Nevertheless, we save lives, prevent strokes, and preserve our patients’ ability to walk. It’s a great career.”



Photo credit: Catherine Harrell/Elsevier.

New SVS President Richard P. Cambria (left) congratulates Robert Zwolak, M.D., on his Presidential Address at the 2011 Vascular Annual Meeting.

Dr. Zwolak presented a “state of the union” of the SVS, portraying its accomplishments in the last year. SVS is much better off than many other specialty societies whose membership is declining – in contrast, SVS has seen a 37% increase in membership over the last four years.

He highlighted important developments within the SVS during his tenure, but modestly indicated that “these are not my accomplishments, but the hard work of SVS members who rolled up their sleeves and did some hard work.”

This past year, the SVS has implemented the Vascular Quality Initiative (VQI), a concept that involves the development of regional quality groups, “with the crown jewel being acquisition of the first professional society-owned Patient Safety Organization (PSO),” Dr. Zwolak said.

In education, a new Vascular Review Course – a concentrated two-day program for recertifying vascular surgeons – is coming this fall. VESAP 2, the follow-up to the “extraordinarily successful VESAP 1” will be ready in two weeks, and Sean Roddy, MD, has developed the first SVS coding manual. The SVS has set aside $100,000 for multicenter clinical studies, and has renamed its foundation the SVS Foundation in order to enhance its ability to attract contributions.

With regard to runaway health care costs, the need for reform, he said that the future demands that “volume-driven health care” – which focuses on number of patients and fee for service – must be replaced by “value-driven health care” – which focuses on the value of successful outcomes. Dr. Zwolak believes vascular surgery is in a good position to help enhance the health care system with its own focus on quality initiatives.

Unfortunately, Congress does not have the apparent will to fix the system, and the general public translates cost-effectiveness as rationing, and appropriate end-of-life care as “kill granny.”

Dr. Zwolak pointed out that in the use of current relative value unit (RVU) payment structures, vascular surgery is not as bad off as many specialties. Major vascular procedures are still all down, however, with the sustainable growth rate (SGR) conversion factors falling well behind inflation, and reimbursement has seen a significant drop in buying power for vascular surgery codes overall since 1992.

“While Congress struggles with the SGR fix, what can SVS do to prospectively get from volume to value? We know there’s clinical value in almost everything we do, but we can define it better. Does Medicare really need 3 million carotid duplex exams and 1.6 million bilateral venous duplex exams each year? SVS has made dozens of trips to Baltimore over the past 15 years in an effort to convince the agency that vascular lab accreditation is a marker of quality and should be a requirement for Medicare reimbursement.

“They keep saying no, but we need to endure. Is it appropriate to study endovenous vein ablation or peripheral atherectomy to focus on indications, and to write and rewrite reasonable care guidelines to control the volume and enhance the clinical and economic value of the services we provide? I think so,” he said.

“If SVS data and practice guidelines generate savings through responsible, evidence-based volume control, can we redirect a portion of those savings towards reimbursing complex open procedures whose inflation adjusted payments are 30% less than they were in 1991?” he asked.

For now, the answer to most of these questions is no. However, he expressed his belief that it is “worthwhile to test each of these concepts and to pursue them. Many of these questions just don’t have answers, but SVS is at the table, and we will remain so.”

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