Whether it’s branding, advocacy or determining research initiatives, the process of setting Society for Vascular Surgery (SVS) priorities and objectives begins with SVS members.
The SVS conducts a census, which includes asking members to rank-order priorities, every other year. In the off-years, such as this one, SVS adds new and emerging priorities to the existing list and asks members of the Strategic Board of Directors (SBOD), and council and committee volunteers, to do new rank-ordering for the next fiscal year.
The SBOD will meet virtually Jan. 14–15 to set priorities, programming and activities for the 2022–23 fiscal year, which begins April 1. The meeting was to have been in-person, but the Omicron variant forced a change. “What we do begins with input from our members: Learning about their biggest concerns and determining how the SVS should address them,” said SVS Executive Director Kenneth M. Slaw, PhD. The five SVS councils each address priorities that fall within their purviews, establishing two or three objectives for potential programs that allow the Society to make progress on those priorities. The Executive Board addresses priorities of several other committees and programs.
“The method is not haphazard but, rather, data-driven and focused, with the SBOD shaping strategic policy to realize members’ key priorities,” said SVS President-Elect Michael Dalsing, MD. Then, “Council and committee volunteers plan, implement and monitor for success projects to help realize the strategic plan with the support of the administrative staff.”
Late last year members declared advocacy the No. 1 priority for this fiscal year, which ends March 31. Through digging further into the survey data, payment emerged as the important point within that priority. “So the Policy and Advocacy Council discussed challenges with payment and what we could proactively do going forward in the new year,” said Slaw.
Last July’s virtual fly-ins with lawmakers—resumed after a COVID-induced hiatus—directly addressed the payment issue, as will next summer’s advocacy skills-building course. The course will be geared to those interested in learning more about how advocacy affects healthcare decisions and policies in Washington, D.C.
Of course, members saw payment return to center stage during the summer, after the Centers for Medicare and Medicaid Services (CMS) released its preliminary Physician Fee Schedule, which included large cuts to vascular surgery reimbursement. Combined with a number of other planned reductions, vascular surgeons were facing cuts that for some members could total nearly 20%. The Policy and Advocacy Council has worked for months to meet with lawmakers to encourage legislation to reduce or delay the devastating reimbursement reductions and encourage grassroots efforts on the part of SVS members. Congress ultimately voted to delay some of the cuts, but more work remains.
All signs, said Slaw and Council Chair Matthew Sideman, MD, point to advocacy, payment and reimbursement remaining one of the top items on the FY22–23 priority list.
While the core of the initiatives process focuses on what members want and need, the SBOD also tries to broaden its focus to what’s on the horizon—what experts are saying that might impact medicine, surgery and vascular surgery in the coming three to five years. “We discuss those at the Strategic Board retreat as well, to make sure we’re not missing something critical on the larger landscape,” said Slaw.
“Reflecting on the next three to five years, change is a certainty,” said Dalsing. “Whether it is a friend or foe is up to us. We will have to embrace change over and over again as we reshape ourselves into the vascular surgeons and SVS of the future. Changing political winds, increasing regulation, new payment structures, population health, surgical innovations and other future forces will provide us the opportunity to be even more influential advocates for our patients. We have to be up to the task and, if past experience is foreshadowing, we will be successful.”
Following discussion of member priorities and accompanying programming ideas from respective councils, the Strategic Board reviews all ideas and further prioritizes them into the top three or four in each council that will move forward.
Then, said Slaw, “all those programs and ideas become part of the budgeting process, so we can make sure we have the resources available to move programs forward. We try to include as many as we can accommodate in the budget, which is approved in March, to go into implementation beginning April 1.”
Late in 2021, with surveying and ranking ongoing, council chairs nonetheless offered their early opinions as to priorities for 2022–23 and discussed the value of the overall process.
Clinical Practice Council
Chaired by William Shutze, MD, this council oversees the Community Practice Section, which includes the Sub-Section on Outpatient and Office Vascular Care (SOOVC); the Physician Health and Wellness Committee (formerly Task Force); the Health Information Technology Committee; and the Population Health Task Force, whose work is winding down.
The SBOD retreat provides the very real benefits of getting a wide range of people, viewpoints, backgrounds and areas of focus together, said Shutze. Members sometimes bring up suggestions others hadn’t considered, or a concern that’s not currently on the radar. “Everyone is able to weigh in with their ideas,” he said.
Shutze said that clinical practice is “kind of the translational end of quality and research; how do you translate those components into clinical practice?” Shutze added, “We also look at issues uniquely related to clinical practices, such as physician value and the physician workforce. That’s why the Wellness Committee—and wellness is an important issue—and the Community Practice Section are part of the Clinical Practice Council.”
The council works with the others in terms of this translational effect, providing feedback on how other issues affect—positively or negatively—clinical practice. For example, payment cuts could speed retirements and impact workforce issues, he said.
The entire process of setting priorities began earlier this year, with an impetus to think in visionary terms when investigating ideas at the retreat, he said, adding, “We’ve had three or four terrific suggestions for 2023 Clinical Practice Council goals” the council hopes to bring to the retreat for discussion.
On surveys, Shutze noted, “The information is vitally important, but response rates remain an issue.” They will be a valuable way for the SVS to understand itself and its direction, he added.
Important changes are ahead for members in terms of the education SVS offers, said Linda Harris, MD, chair of the Education Council. The council oversees the Education, Leadership Development, Postgraduate Education, Program, Resident and Student Outreach, and VAM Video committees.
Atop the list is introducing the SVS’ new 2022–2025 education strategic plan. This includes adding a framework and cataloging for its educational offerings and stresses collaboration, coordination and shared planning among councils, committees and SVS staff.
All councils and committees have ideas for educational offerings, said Harris. Each is subject to three questions: “Is a new product helping our members, improving patient care or the healthcare systems, or our members’ own health? Is it fulfilling one of those three?”
Appropriate benchmarks also are important, she said. “New product development has to be based on what our membership needs, not what we assume is a good idea. We want what our membership wants, not what we think they want.”
The new strategic plan focuses on five pillars: A portfolio approach, shared content planning, a global plan for content use/reuse, using best practices in formal education methodologies, and enhancing the SVS governance structure to accelerate the development and implementation of education of importance to members and their patients.
Plan tactics include a universal content framework to catalog current educational offerings. “We will know what we currently have to offer within our educational portfolio and where the gaps are. All education will be categorized before and as it’s being created, rather than after the fact,” said Harris. “For example, if the Clinical Practice Council hosts a webinar, organizers would tag it appropriately as they’re preparing the webinar.”
The goal is simple. “We want SVS to be the premier source for education. And that means our offerings have to be searchable to allow for ease of use and reuse.”
Harris credited Education Committee Kellie Brown, MD, for spearheading the framework project. “It was an enormous undertaking, and I thank the Education Committee for this herculean effort. SVS is now in a great place to roll this out for use in 2022.”
Other parts of the plan include:
- Plans to re-use and share content, avoiding duplication of efforts
- Enhanced communication across the councils and with staff to determine what new content should be created in this portfolio approach
- Developing a methodology in order to
- consistently assess SVS programs and offerings
- Considering how to move forward with educational offerings. With remote learning now part of the mix, that includes possibly collaborating with regional and other national societies
- Analyzing the recently completed Educational Needs Assessment Survey, which has provided a wealth of information
One of the council’s biggest issues from an overall education perspective and with financial ramifications is, “What’s COVID done to us,” said Harris. “There are huge issues going forward. How do we integrate changes? Hybrid is much more expensive, and virtual education has its own set of issues. How do we continue to evolve the VAM? We’ve already transitioned to year-long education—one benefit of the pandemic. But we have to look at what people can afford both financially and in time away from work and family. We must find an appropriate, forward-thinking plan to deliver education when and where people need it.”
The SVS’ new new learning management system (LMS) is making education accessible, but more opportunities, both online and in-person, exist, she said. “And we know we can offer more opportunities both online and in-person.” At the same time, Harris stressed that while remote and hybrid opportunities have their pluses, human interaction is vitally important and cannot be duplicated. “We expect an in-person meeting to remain a key factor for SVS for many years to come.”
Advocacy and Policy Council
Matthew Sideman, MD, chairs the Advocacy and Policy Council, but it’s his additional position as co-chair of the SVS Medicare Cuts Task Force that helped with SVS members’ No. 1 priority during the current fiscal year: payment.
The latter entity was created in the summer of 2021 after CMS released the 2022 Medicare Physician Fee Schedule, which included a 3.75% cut for vascular surgeons. This cut, plus four others, meant vascular surgeons were facing cuts of more than 20%, depending on practice setting and other factors.
In mid-December, after months of work by the task force and council, Congress moved to delay some of the cuts.
However, warned Sideman and others, the job isn’t done. “There is still a lot of work to be done to reach a permanent solution. Vascular surgeons provide valuable, life-saving work to society’s most vulnerable patients. We are not going to rest until our healthcare system recognizes that value with real, long-term solutions to reimbursement.”
Task force members will work toward ending automatic cuts and provide suggestions for payment answers.
“This remaining work will undoubtedly be a major focus in setting priorities,” he said. He added, in tandem with other council chairs, that payment issues can trigger other changes—such as retirements and career changes—which could impact workforce shortages. Payment could also lead to possible difficulty in paying dues or program fees, which would impact overall SVS revenue and the Society’s ability to offer robust programming.
“We have our work cut out for us,” said Sideman in mid-December. “After an incredibly busy time fighting this latest round, we will get a brief respite over the holidays and begin again in January on more permanent answers.”
Dalsing offered his own personal reflection on the “big picture” of medicine. “All of us in the medical profession are in the same boat but do not seem to realize it,” he said. “We have been forced to bicker over slices of a small and shrinking financial pie resulting from a lack of cost-of-living increase perpetuated over decades, which other stakeholders in the medical space have not had to endure. Eventually, all physicians—with vascular surgery at the leadership table—will have to find a solution to this conundrum.”
The Research Council, chaired by Raul Guzman, MD, will soon have a new set of research priorities. A list of some 10 priorities cover such areas as carotid, aortic, and lower-extremity arterial and venous disease; dialysis; healthcare disparities; and vascular medicine/vascular health.
The SVS strategic plan guided the Research Council in drafting the new priorities, which the SBOD will discuss, tweak and approve at the retreat, said Guzman. This is especially true of three specific proposed new priorities “aimed at improving quality and appropriateness, optimizing vascular intervention, and assessing population health measures,” he said.
These priorities are expected to guide research initiatives for the coming decade. While noting again that priorities are yet to be finalized, Guzman believes one of his council’s top concerns is related to identifying areas within vascular surgery that would benefit from increased investigational efforts. “Results from studies in these priority domains will be important for moving forward with guidelines and appropriate use criteria for many of our major areas of interest,” he said.
“Quality is job one,” said Thomas Forbes, MD, offering his apologies in advance to Ford Motor Co. for using the automaker’s slogan in relating what members emphasized in previous surveys.
“I think tracking quality outcomes has always been in the DNA of vascular surgeons. It’s in our blood,” noted Forbes, chair of the Quality Council. And over the past several years, he said, “The SVS has invested in quality in terms of people, time and expertise.”
“We heard loudly and clearly that patients should have quality of care, regardless of where they live and who they’re being treated by,” he said. Quality initiatives have and continue to include the creation of clinical practice guidelines, a “distillation of the current body of evidence … that indicates how we should be treating our patients.” Under the direction of Ruth Bush, MD, and the Document Oversight Committee, a number of guidelines are being prepared.
Appropriate use criteria (AUC), an exciting initiative chaired by Adam Beck, MD, is another. The first AUC, on peripheral arterial disease (PAD), is in the finalization phases. These criteria account for some “specific nuances of very specific clinical situations,” based on the “best of the current review of the evidence.”
Then there is the Vascular Center Verification and Quality Improvement Program (VCV&QIP), being spearheaded by Kim Hodgson, MD, and Anton Sidawy, MD. “You can’t talk about quality without talking about this program,” said Forbes. Now nearing the end of its pilot phase, the program is nearly ready for official kick off, with both inpatient and outpatient facilities able to enroll in the accreditation process. “And the whole purpose is improving patient care,” he emphasized.
The Vascular Quality Initiative (VQI), an SVS Patient Safety Organization (PSO) program, meanwhile, has seen an investment of time and money make “huge inroads into the general quality initiative of the SVS over the last number of years,” said Forbes. But because not all SVS members participate in VQI, “it’s important to have a culture of quality both within and outside VQI.”
The new Quality Improvement Committee, which is advancing the overall strategy of quality and engagement within and outside VQI, is “an opportunity for other national registries to be used,” he said. “It’s made huge inroads and will continue to do so.”
SVS Health and Vitality
The SVS Health and Vitality umbrella includes a large number of committees, overseen by the SVS Executive Board. The Communications Committee and its three subcommittees, in fact, owe their creation to a previous SVS initiative of a few years ago. The Diversity, Equity and Inclusion (DEI) Committee, likewise, graduated from task force status as a result of its important work in its previous form and the SBOD’s commitment to DEI issues.
The Executive Committee oversees these diverse committees, and manages the everyday challenges and opportunities that surface in an active society, said Dalsing. “It is a structure built for innovation and success in a constantly changing world.”