News from the SVS

SVS members preparing for recertification this November can benefit from the Vascular Education and Self-Assessment Program, VESAP2. Now in its second edition, VESAP2 is an online program that helps vascular surgeons preparing for the qualifying, certifying, or recertification exams in vascular surgery and endovascular therapy. But more than that, for anyone with a foot in the vascular surgery world – interventional radiologists, cardiologists, vascular medicine specialists, and allied health care professionals – VESAP2 offers updates on the most current practice standards.

Comprising 450 questions, detailed references, and discussions, VESAP2 covers:

• Current treatment of aortoiliac aneurysmal and occlusive disease

• Possible etiologies of extremity arterial disease and appropriate interventions

• Evaluation and management of brachiocephalic and cerebrovascular disease

• Medical management of vascular disease and critical features of dialysis access

• Non-invasive vascular laboratory tests, CT and MR angiography used in the evaluation of vascular disease, including the benefits and limitations of each

• Etiology and treatment of acute and chronic venous disease and lymphatic disease

• Vascular trauma management and the surgical nutrition and critical care essentials of the vascular patient

Physicians who use VESAP2 between now and September 1, 2014 are eligible for a maximum of 60 AMA PRA Category 1 Credits™.

Find out more, including how to purchase, at http://bit.ly/vesap2.

SVS members preparing for recertification this November can benefit from the Vascular Education and Self-Assessment Program, VESAP2. Now in its second edition, VESAP2 is an online program that helps vascular surgeons preparing for the qualifying, certifying, or recertification exams in vascular surgery and endovascular therapy. But more than that, for anyone with a foot in the vascular surgery world – interventional radiologists, cardiologists, vascular medicine specialists, and allied health care professionals – VESAP2 offers updates on the most current practice standards.

Comprising 450 questions, detailed references, and discussions, VESAP2 covers:

• Current treatment of aortoiliac aneurysmal and occlusive disease

• Possible etiologies of extremity arterial disease and appropriate interventions

• Evaluation and management of brachiocephalic and cerebrovascular disease

• Medical management of vascular disease and critical features of dialysis access

• Non-invasive vascular laboratory tests, CT and MR angiography used in the evaluation of vascular disease, including the benefits and limitations of each

• Etiology and treatment of acute and chronic venous disease and lymphatic disease

• Vascular trauma management and the surgical nutrition and critical care essentials of the vascular patient

Physicians who use VESAP2 between now and September 1, 2014 are eligible for a maximum of 60 AMA PRA Category 1 Credits™.

Find out more, including how to purchase, at http://bit.ly/vesap2.

SVS members preparing for recertification this November can benefit from the Vascular Education and Self-Assessment Program, VESAP2. Now in its second edition, VESAP2 is an online program that helps vascular surgeons preparing for the qualifying, certifying, or recertification exams in vascular surgery and endovascular therapy. But more than that, for anyone with a foot in the vascular surgery world – interventional radiologists, cardiologists, vascular medicine specialists, and allied health care professionals – VESAP2 offers updates on the most current practice standards.

Comprising 450 questions, detailed references, and discussions, VESAP2 covers:

• Current treatment of aortoiliac aneurysmal and occlusive disease

• Possible etiologies of extremity arterial disease and appropriate interventions

• Evaluation and management of brachiocephalic and cerebrovascular disease

• Medical management of vascular disease and critical features of dialysis access

• Non-invasive vascular laboratory tests, CT and MR angiography used in the evaluation of vascular disease, including the benefits and limitations of each

• Etiology and treatment of acute and chronic venous disease and lymphatic disease

• Vascular trauma management and the surgical nutrition and critical care essentials of the vascular patient

Physicians who use VESAP2 between now and September 1, 2014 are eligible for a maximum of 60 AMA PRA Category 1 Credits™.

Find out more, including how to purchase, at http://bit.ly/vesap2.

For the first time in more than 30 years, the Society for Vascular Surgery, in joint sponsorship with the American Venous Forum, launched a new peer-reviewed journal in 2013, the Journal of Vascular Surgery: Venous and Lymphatic Disorders (JVS: VL). Anton Sidawy, MD, and Bruce Perler, MD, editors of the Journal of Vascular Surgery, developed the concept for this journal and are serving as the inaugural editors of JVS: VL.

Drs. Sidawy and Perler stated the following in the first volume.

"Venous and lymphatic diseases are emerging as an increasingly important part of the spectrum of circulatory disease and clinical practice of comprehensive vascular specialists. We are in the midst of an unprecedented expansion in minimally invasive treatment options for the millions of individuals with venous disease. Just as our founding editors of the JVS recognized ‘unprecedented advances have been made in vascular surgery,’ which justified the establishment of that publication, we believed that unprecedented advances in venous disease merited a dedicated high quality premier academic journal devoted to the treatment of and research in venous and lymphatic diseases. We firmly believe that the JVS: VL will fill that void. We also believe that the JVS: VL will highlight the unparalleled leadership of vascular surgeons in the crowded field of specialists treating venous disease."

JVS: VL, introduced as a quarterly publication, publishes the highest quality peer-reviewed clinical and research studies in the fields of venous and lymphatic disease, as well as similar special features to those found in the JVS. Published in the first volume of JVS: VL were:

• 43 peer-reviewed clinical studies

• three basic science studies

• 10 case reports

• seven vascular images

• three review articles

• two venous techniques

• two practice management articles

• and two historical vignettes.

In addition, abstracts from the 2013 Annual Meeting of the American Venous Forum were published in the January issue of the JVS: VL in advance of its annual meeting in February, 2013.

By all metrics, the JVS has become the pre-eminent publication in the world in the field of vascular surgery. The Impact Factor of the JVS is the highest among all vascular surgical journals and this past year received about 1,800 manuscript submissions, including more than half from outside the United States and North America.

"It is our expectation, and our firm commitment, to likewise see the JVS: VL become the pre-eminent international publication in the field of venous and lymphatic disorders, and to reflect the leadership of vascular surgeons in the research and clinical care of patients with these disorders," said Drs. Sidawy and Perler.

For the first time in more than 30 years, the Society for Vascular Surgery, in joint sponsorship with the American Venous Forum, launched a new peer-reviewed journal in 2013, the Journal of Vascular Surgery: Venous and Lymphatic Disorders (JVS: VL). Anton Sidawy, MD, and Bruce Perler, MD, editors of the Journal of Vascular Surgery, developed the concept for this journal and are serving as the inaugural editors of JVS: VL.

Drs. Sidawy and Perler stated the following in the first volume.

"Venous and lymphatic diseases are emerging as an increasingly important part of the spectrum of circulatory disease and clinical practice of comprehensive vascular specialists. We are in the midst of an unprecedented expansion in minimally invasive treatment options for the millions of individuals with venous disease. Just as our founding editors of the JVS recognized ‘unprecedented advances have been made in vascular surgery,’ which justified the establishment of that publication, we believed that unprecedented advances in venous disease merited a dedicated high quality premier academic journal devoted to the treatment of and research in venous and lymphatic diseases. We firmly believe that the JVS: VL will fill that void. We also believe that the JVS: VL will highlight the unparalleled leadership of vascular surgeons in the crowded field of specialists treating venous disease."

JVS: VL, introduced as a quarterly publication, publishes the highest quality peer-reviewed clinical and research studies in the fields of venous and lymphatic disease, as well as similar special features to those found in the JVS. Published in the first volume of JVS: VL were:

• 43 peer-reviewed clinical studies

• three basic science studies

• 10 case reports

• seven vascular images

• three review articles

• two venous techniques

• two practice management articles

• and two historical vignettes.

In addition, abstracts from the 2013 Annual Meeting of the American Venous Forum were published in the January issue of the JVS: VL in advance of its annual meeting in February, 2013.

By all metrics, the JVS has become the pre-eminent publication in the world in the field of vascular surgery. The Impact Factor of the JVS is the highest among all vascular surgical journals and this past year received about 1,800 manuscript submissions, including more than half from outside the United States and North America.

"It is our expectation, and our firm commitment, to likewise see the JVS: VL become the pre-eminent international publication in the field of venous and lymphatic disorders, and to reflect the leadership of vascular surgeons in the research and clinical care of patients with these disorders," said Drs. Sidawy and Perler.

For the first time in more than 30 years, the Society for Vascular Surgery, in joint sponsorship with the American Venous Forum, launched a new peer-reviewed journal in 2013, the Journal of Vascular Surgery: Venous and Lymphatic Disorders (JVS: VL). Anton Sidawy, MD, and Bruce Perler, MD, editors of the Journal of Vascular Surgery, developed the concept for this journal and are serving as the inaugural editors of JVS: VL.

Drs. Sidawy and Perler stated the following in the first volume.

"Venous and lymphatic diseases are emerging as an increasingly important part of the spectrum of circulatory disease and clinical practice of comprehensive vascular specialists. We are in the midst of an unprecedented expansion in minimally invasive treatment options for the millions of individuals with venous disease. Just as our founding editors of the JVS recognized ‘unprecedented advances have been made in vascular surgery,’ which justified the establishment of that publication, we believed that unprecedented advances in venous disease merited a dedicated high quality premier academic journal devoted to the treatment of and research in venous and lymphatic diseases. We firmly believe that the JVS: VL will fill that void. We also believe that the JVS: VL will highlight the unparalleled leadership of vascular surgeons in the crowded field of specialists treating venous disease."

JVS: VL, introduced as a quarterly publication, publishes the highest quality peer-reviewed clinical and research studies in the fields of venous and lymphatic disease, as well as similar special features to those found in the JVS. Published in the first volume of JVS: VL were:

• 43 peer-reviewed clinical studies

• three basic science studies

• 10 case reports

• seven vascular images

• three review articles

• two venous techniques

• two practice management articles

• and two historical vignettes.

In addition, abstracts from the 2013 Annual Meeting of the American Venous Forum were published in the January issue of the JVS: VL in advance of its annual meeting in February, 2013.

By all metrics, the JVS has become the pre-eminent publication in the world in the field of vascular surgery. The Impact Factor of the JVS is the highest among all vascular surgical journals and this past year received about 1,800 manuscript submissions, including more than half from outside the United States and North America.

"It is our expectation, and our firm commitment, to likewise see the JVS: VL become the pre-eminent international publication in the field of venous and lymphatic disorders, and to reflect the leadership of vascular surgeons in the research and clinical care of patients with these disorders," said Drs. Sidawy and Perler.

Plan to attend and submit an abstract for presentation at the 28th Annual Vascular Research Initiatives Conference (VRIC), presented by SVS, to be held April 30, 2014 in Toronto, Canada.

"VRIC is a high-level, really intense basic science session, a day dedicated to a single program," said John Curci, MD, VRIC Course Director.

This allows those who investigate peripheral vascular disease and its treatments to meet in a small group setting prior to the American Heart Association’s ATVB Meeting.

VRIC also strives to encourage an interest in research among trainees who are aspiring academic vascular surgeons, showcasing young surgeon investigators. The SVS Foundation VRIC Travel Scholarship is awarded to selected trainee presenters.

The VRIC call for abstracts deadline is January 17, 2014.

Selected high-impact abstracts presented at the VRIC session may also be invited for presentation at the Vascular Annual Meeting, June 5-7, 2014, Boston.

Acceptance and presentation of an abstract at the VRIC session does not preclude additional poster presentation at ATVB. SVS registrants wishing to attend the ATVB meeting will receive a $100 ATVB discount on their registration fee.

Abstracts can be submitted online at http://bit.ly/vricabstract.

Plan to attend and submit an abstract for presentation at the 28th Annual Vascular Research Initiatives Conference (VRIC), presented by SVS, to be held April 30, 2014 in Toronto, Canada.

"VRIC is a high-level, really intense basic science session, a day dedicated to a single program," said John Curci, MD, VRIC Course Director.

This allows those who investigate peripheral vascular disease and its treatments to meet in a small group setting prior to the American Heart Association’s ATVB Meeting.

VRIC also strives to encourage an interest in research among trainees who are aspiring academic vascular surgeons, showcasing young surgeon investigators. The SVS Foundation VRIC Travel Scholarship is awarded to selected trainee presenters.

The VRIC call for abstracts deadline is January 17, 2014.

Selected high-impact abstracts presented at the VRIC session may also be invited for presentation at the Vascular Annual Meeting, June 5-7, 2014, Boston.

Acceptance and presentation of an abstract at the VRIC session does not preclude additional poster presentation at ATVB. SVS registrants wishing to attend the ATVB meeting will receive a $100 ATVB discount on their registration fee.

Abstracts can be submitted online at http://bit.ly/vricabstract.

Plan to attend and submit an abstract for presentation at the 28th Annual Vascular Research Initiatives Conference (VRIC), presented by SVS, to be held April 30, 2014 in Toronto, Canada.

"VRIC is a high-level, really intense basic science session, a day dedicated to a single program," said John Curci, MD, VRIC Course Director.

This allows those who investigate peripheral vascular disease and its treatments to meet in a small group setting prior to the American Heart Association’s ATVB Meeting.

VRIC also strives to encourage an interest in research among trainees who are aspiring academic vascular surgeons, showcasing young surgeon investigators. The SVS Foundation VRIC Travel Scholarship is awarded to selected trainee presenters.

The VRIC call for abstracts deadline is January 17, 2014.

Selected high-impact abstracts presented at the VRIC session may also be invited for presentation at the Vascular Annual Meeting, June 5-7, 2014, Boston.

Acceptance and presentation of an abstract at the VRIC session does not preclude additional poster presentation at ATVB. SVS registrants wishing to attend the ATVB meeting will receive a $100 ATVB discount on their registration fee.

Abstracts can be submitted online at http://bit.ly/vricabstract.

The Southern Association for Vascular Surgery demonstrated its commitment to the advancement of vascular surgery with a pledge of $25,000 to the SVS Foundation.

"The SAVS Executive Committee unanimously recommended making this commitment because we all appreciate the Foundation’s efforts on behalf of all vascular surgeons, " said SAVS President, Thomas Huber, M.D.

The Foundation awards clinical and basic research grants to vascular surgeons, including those just beginning their careers in research. SVS grant recipients often go on to receive government or other competitive funding. In this way, the Foundation keeps the pipeline of innovative researchers open and solidifies vascular surgeons’ position as the experts in the field. The Foundation’s mission not only advances the specialty’s goals, it helps ensure quality patient care.

"The SVS Foundation extends its thanks to SAVS Board and members," said SVS Foundation Development Committee Chair Ali AbuRahma, MD. "The Foundation’s goal is to move our specialty forward through research to help build research scientists’ careers and improve patient care. SAVS pledges, along with support from other societies, strengthen our field and demonstrates our unity."

The other societies that have committed support to the SVS Foundation include:

• Eastern Vascular Society

• Midwestern Vascular Surgical Society

• New England Society for Vascular Surgery

• Western Vascular Society

With its contribution, SAVS is now honored in the Foundation’s Legacy Program: Director’s Circle. To learn more about the SVS Foundation and read testimonials visit svsfoundationsite.org.

The Southern Association for Vascular Surgery demonstrated its commitment to the advancement of vascular surgery with a pledge of $25,000 to the SVS Foundation.

"The SAVS Executive Committee unanimously recommended making this commitment because we all appreciate the Foundation’s efforts on behalf of all vascular surgeons, " said SAVS President, Thomas Huber, M.D.

The Foundation awards clinical and basic research grants to vascular surgeons, including those just beginning their careers in research. SVS grant recipients often go on to receive government or other competitive funding. In this way, the Foundation keeps the pipeline of innovative researchers open and solidifies vascular surgeons’ position as the experts in the field. The Foundation’s mission not only advances the specialty’s goals, it helps ensure quality patient care.

"The SVS Foundation extends its thanks to SAVS Board and members," said SVS Foundation Development Committee Chair Ali AbuRahma, MD. "The Foundation’s goal is to move our specialty forward through research to help build research scientists’ careers and improve patient care. SAVS pledges, along with support from other societies, strengthen our field and demonstrates our unity."

The other societies that have committed support to the SVS Foundation include:

• Eastern Vascular Society

• Midwestern Vascular Surgical Society

• New England Society for Vascular Surgery

• Western Vascular Society

With its contribution, SAVS is now honored in the Foundation’s Legacy Program: Director’s Circle. To learn more about the SVS Foundation and read testimonials visit svsfoundationsite.org.

The Southern Association for Vascular Surgery demonstrated its commitment to the advancement of vascular surgery with a pledge of $25,000 to the SVS Foundation.

"The SAVS Executive Committee unanimously recommended making this commitment because we all appreciate the Foundation’s efforts on behalf of all vascular surgeons, " said SAVS President, Thomas Huber, M.D.

The Foundation awards clinical and basic research grants to vascular surgeons, including those just beginning their careers in research. SVS grant recipients often go on to receive government or other competitive funding. In this way, the Foundation keeps the pipeline of innovative researchers open and solidifies vascular surgeons’ position as the experts in the field. The Foundation’s mission not only advances the specialty’s goals, it helps ensure quality patient care.

"The SVS Foundation extends its thanks to SAVS Board and members," said SVS Foundation Development Committee Chair Ali AbuRahma, MD. "The Foundation’s goal is to move our specialty forward through research to help build research scientists’ careers and improve patient care. SAVS pledges, along with support from other societies, strengthen our field and demonstrates our unity."

The other societies that have committed support to the SVS Foundation include:

• Eastern Vascular Society

• Midwestern Vascular Surgical Society

• New England Society for Vascular Surgery

• Western Vascular Society

With its contribution, SAVS is now honored in the Foundation’s Legacy Program: Director’s Circle. To learn more about the SVS Foundation and read testimonials visit svsfoundationsite.org.

Understanding the new codes released each year by the Centers for Medicare and Medicaid Services is critical to ensuring proper reimbursement for vascular surgeons. Keep coding staff up-to-date and register today for a 90-minute CPT webinar on the new 2014 codes, sponsored by SVS. Learn about the 2014 coding changes specific to vascular procedures with a highlight of sections on stent, retrograde, FEVAR, and embolization codes. The webinar, which costs $125, will be held on Thursday, December 12 at 3 p.m. ET. Register today. 

Understanding the new codes released each year by the Centers for Medicare and Medicaid Services is critical to ensuring proper reimbursement for vascular surgeons. Keep coding staff up-to-date and register today for a 90-minute CPT webinar on the new 2014 codes, sponsored by SVS. Learn about the 2014 coding changes specific to vascular procedures with a highlight of sections on stent, retrograde, FEVAR, and embolization codes. The webinar, which costs $125, will be held on Thursday, December 12 at 3 p.m. ET. Register today. 

Understanding the new codes released each year by the Centers for Medicare and Medicaid Services is critical to ensuring proper reimbursement for vascular surgeons. Keep coding staff up-to-date and register today for a 90-minute CPT webinar on the new 2014 codes, sponsored by SVS. Learn about the 2014 coding changes specific to vascular procedures with a highlight of sections on stent, retrograde, FEVAR, and embolization codes. The webinar, which costs $125, will be held on Thursday, December 12 at 3 p.m. ET. Register today. 

To ensure the continuation of clinical investigation in vascular disease, the SVS Foundation sponsors the Clinical Research Seed Grant Program. This program:

• Encourages the interest and development of clinical investigators among the SVS membership, particularly among junior members or those with limited prior experience as principal investigators;

• Provides direct support for pilot clinical projects that have the potential to develop into larger studies fundable by industry or governmental sources. Apply today. Complete grant information appears at http://bit.ly/seedSVS.

To ensure the continuation of clinical investigation in vascular disease, the SVS Foundation sponsors the Clinical Research Seed Grant Program. This program:

• Encourages the interest and development of clinical investigators among the SVS membership, particularly among junior members or those with limited prior experience as principal investigators;

• Provides direct support for pilot clinical projects that have the potential to develop into larger studies fundable by industry or governmental sources. Apply today. Complete grant information appears at http://bit.ly/seedSVS.

To ensure the continuation of clinical investigation in vascular disease, the SVS Foundation sponsors the Clinical Research Seed Grant Program. This program:

• Encourages the interest and development of clinical investigators among the SVS membership, particularly among junior members or those with limited prior experience as principal investigators;

• Provides direct support for pilot clinical projects that have the potential to develop into larger studies fundable by industry or governmental sources. Apply today. Complete grant information appears at http://bit.ly/seedSVS.

The Centers for Medicare and Medicaid Services (CMS) is addressing 211 codes the agency believes may have resource inputs that are misvalued in its 2014 Medicare Physician Fee Schedule (PFS) Proposed Rule.

The proposal calls for capping non-facility (office) Practice Expense (PE) Relative Value Units for these codes so they would not exceed facility payments under the Hospital Outpatient Prospective Payment System (OPPS) or Ambulatory Surgical Center (ASC) payment rates, even though vascular surgeons incur full PE in their offices.

CMS has ignored fundamental differences between the resource-based Physician Fee Schedule used for Medicare physician payment, which captures actual costs for each individual service, and the Ambulatory Payment Classifications used for OPPS and ASC rates that bundle high- and low-margin services into a single classification. These differences render service-by-service comparisons inappropriate and inaccurate. Also, ASC rates are at least 40 percent less than OPPS rates.

Under the CMS proposal, services provided less than five percent of the time in the hospital setting are supposedly exempt from the cap. However, many of these services are being capped at the OPPS rates even though they are rarely or never performed in that setting. Even more unreasonable, CMS has chosen to apply the ASC rates to 112 codes, including 13 vascular codes, even though only eight of these services are provided in an ASC at least five percent of the time. In addition, CMS is using the 2013 OPPS/ASC payment rates instead of the corrections and adjustments made to these by CMS for 2014.

The vascular codes that are reduced in the Proposed Rule include:

· CPT Code 36147 – access av dial grft for eval, -40%

· CPT Code 36566 – insert tunneled cv cath, -76%

· CPT Code 37220 – iliac revasc, -24%

· CPT Code 37224 – fem/popl revasc with tia, -37%

· CPT Code 37225 – fem/popl revasc with ather, -56%

· CPT Code 37226 – fem/popl revasc with stent, -47%

· CPT Code 37227 – fem/popl revasc stent & ather, -24%

· CPT Code 37228 – tib/per revasc with tia, -56%

· CPT Code 37229 – tib/per revasc with ather, -55%

· CPT Code 37230 – tib/per revasc with stent, -40%

· CPT Code 37231 – tib/per revasc with stent & ather, -13%

· CPT Code 37234 – revsc opn/prq tib/pero stent, -42%

· CPT Code 37235 – tib/per revasc stent and ather, -41%

· CPT Code 93922 – Upr/l xtremity art 2 levels, -18%

· CPT Code 93924 – Lwr xtr vasc stdy bilat, -31%

SVS has responded to this issue by:

1. Submitting comments to CMS on the Proposed Rule on September 6 opposing the non-facility cap. These comments can be found on VascularWeb.org

2. Meeting with CMS officials on September 10 in opposition to the cap

3. Seeking a legal opinion with other specialty societies (pathologists, interventional radiologists, radiation oncologists, among others) on whether CMS has the legislative authority to cap office reimbursement

4. Emailing grassroots letters from SVS members to their House members, asking them to oppose the cap by sending letters to CMS. As a result, more than 100 letters were sent to House members on this issue

5. Signing onto a letter to CMS with 40 other health care groups in opposition. This letter can be found on VascularWeb.org

6. Leading a coalition of physician associations in opposition to office reimbursement cuts by asking members of Congress, particularly those who are MDs, to contact CMS in opposition to cuts. As a result, 16 members of the House GOP Doctor’s Caucus submitted a letter to CMS on October 17; this letter can be found on VascularWeb.org

7. Raising PAC funds to attend events with targeted members of Congress. As a result of a discussion with Rep. Roe at an event, SVS staff secured his sponsorship of the above letter. SVS members can still contribute to the PAC by completing a donation form on VascularWeb.org

CMS was scheduled to issue its 2014 Medicare PFS Final Rule at the beginning of November; however, because of the government shutdown, the Final Rule will likely be released on November 27.

The Centers for Medicare and Medicaid Services (CMS) is addressing 211 codes the agency believes may have resource inputs that are misvalued in its 2014 Medicare Physician Fee Schedule (PFS) Proposed Rule.

The proposal calls for capping non-facility (office) Practice Expense (PE) Relative Value Units for these codes so they would not exceed facility payments under the Hospital Outpatient Prospective Payment System (OPPS) or Ambulatory Surgical Center (ASC) payment rates, even though vascular surgeons incur full PE in their offices.

CMS has ignored fundamental differences between the resource-based Physician Fee Schedule used for Medicare physician payment, which captures actual costs for each individual service, and the Ambulatory Payment Classifications used for OPPS and ASC rates that bundle high- and low-margin services into a single classification. These differences render service-by-service comparisons inappropriate and inaccurate. Also, ASC rates are at least 40 percent less than OPPS rates.

Under the CMS proposal, services provided less than five percent of the time in the hospital setting are supposedly exempt from the cap. However, many of these services are being capped at the OPPS rates even though they are rarely or never performed in that setting. Even more unreasonable, CMS has chosen to apply the ASC rates to 112 codes, including 13 vascular codes, even though only eight of these services are provided in an ASC at least five percent of the time. In addition, CMS is using the 2013 OPPS/ASC payment rates instead of the corrections and adjustments made to these by CMS for 2014.

The vascular codes that are reduced in the Proposed Rule include:

· CPT Code 36147 – access av dial grft for eval, -40%

· CPT Code 36566 – insert tunneled cv cath, -76%

· CPT Code 37220 – iliac revasc, -24%

· CPT Code 37224 – fem/popl revasc with tia, -37%

· CPT Code 37225 – fem/popl revasc with ather, -56%

· CPT Code 37226 – fem/popl revasc with stent, -47%

· CPT Code 37227 – fem/popl revasc stent & ather, -24%

· CPT Code 37228 – tib/per revasc with tia, -56%

· CPT Code 37229 – tib/per revasc with ather, -55%

· CPT Code 37230 – tib/per revasc with stent, -40%

· CPT Code 37231 – tib/per revasc with stent & ather, -13%

· CPT Code 37234 – revsc opn/prq tib/pero stent, -42%

· CPT Code 37235 – tib/per revasc stent and ather, -41%

· CPT Code 93922 – Upr/l xtremity art 2 levels, -18%

· CPT Code 93924 – Lwr xtr vasc stdy bilat, -31%

SVS has responded to this issue by:

1. Submitting comments to CMS on the Proposed Rule on September 6 opposing the non-facility cap. These comments can be found on VascularWeb.org

2. Meeting with CMS officials on September 10 in opposition to the cap

3. Seeking a legal opinion with other specialty societies (pathologists, interventional radiologists, radiation oncologists, among others) on whether CMS has the legislative authority to cap office reimbursement

4. Emailing grassroots letters from SVS members to their House members, asking them to oppose the cap by sending letters to CMS. As a result, more than 100 letters were sent to House members on this issue

5. Signing onto a letter to CMS with 40 other health care groups in opposition. This letter can be found on VascularWeb.org

6. Leading a coalition of physician associations in opposition to office reimbursement cuts by asking members of Congress, particularly those who are MDs, to contact CMS in opposition to cuts. As a result, 16 members of the House GOP Doctor’s Caucus submitted a letter to CMS on October 17; this letter can be found on VascularWeb.org

7. Raising PAC funds to attend events with targeted members of Congress. As a result of a discussion with Rep. Roe at an event, SVS staff secured his sponsorship of the above letter. SVS members can still contribute to the PAC by completing a donation form on VascularWeb.org

CMS was scheduled to issue its 2014 Medicare PFS Final Rule at the beginning of November; however, because of the government shutdown, the Final Rule will likely be released on November 27.

The Centers for Medicare and Medicaid Services (CMS) is addressing 211 codes the agency believes may have resource inputs that are misvalued in its 2014 Medicare Physician Fee Schedule (PFS) Proposed Rule.

The proposal calls for capping non-facility (office) Practice Expense (PE) Relative Value Units for these codes so they would not exceed facility payments under the Hospital Outpatient Prospective Payment System (OPPS) or Ambulatory Surgical Center (ASC) payment rates, even though vascular surgeons incur full PE in their offices.

CMS has ignored fundamental differences between the resource-based Physician Fee Schedule used for Medicare physician payment, which captures actual costs for each individual service, and the Ambulatory Payment Classifications used for OPPS and ASC rates that bundle high- and low-margin services into a single classification. These differences render service-by-service comparisons inappropriate and inaccurate. Also, ASC rates are at least 40 percent less than OPPS rates.

Under the CMS proposal, services provided less than five percent of the time in the hospital setting are supposedly exempt from the cap. However, many of these services are being capped at the OPPS rates even though they are rarely or never performed in that setting. Even more unreasonable, CMS has chosen to apply the ASC rates to 112 codes, including 13 vascular codes, even though only eight of these services are provided in an ASC at least five percent of the time. In addition, CMS is using the 2013 OPPS/ASC payment rates instead of the corrections and adjustments made to these by CMS for 2014.

The vascular codes that are reduced in the Proposed Rule include:

· CPT Code 36147 – access av dial grft for eval, -40%

· CPT Code 36566 – insert tunneled cv cath, -76%

· CPT Code 37220 – iliac revasc, -24%

· CPT Code 37224 – fem/popl revasc with tia, -37%

· CPT Code 37225 – fem/popl revasc with ather, -56%

· CPT Code 37226 – fem/popl revasc with stent, -47%

· CPT Code 37227 – fem/popl revasc stent & ather, -24%

· CPT Code 37228 – tib/per revasc with tia, -56%

· CPT Code 37229 – tib/per revasc with ather, -55%

· CPT Code 37230 – tib/per revasc with stent, -40%

· CPT Code 37231 – tib/per revasc with stent & ather, -13%

· CPT Code 37234 – revsc opn/prq tib/pero stent, -42%

· CPT Code 37235 – tib/per revasc stent and ather, -41%

· CPT Code 93922 – Upr/l xtremity art 2 levels, -18%

· CPT Code 93924 – Lwr xtr vasc stdy bilat, -31%

SVS has responded to this issue by:

1. Submitting comments to CMS on the Proposed Rule on September 6 opposing the non-facility cap. These comments can be found on VascularWeb.org

2. Meeting with CMS officials on September 10 in opposition to the cap

3. Seeking a legal opinion with other specialty societies (pathologists, interventional radiologists, radiation oncologists, among others) on whether CMS has the legislative authority to cap office reimbursement

4. Emailing grassroots letters from SVS members to their House members, asking them to oppose the cap by sending letters to CMS. As a result, more than 100 letters were sent to House members on this issue

5. Signing onto a letter to CMS with 40 other health care groups in opposition. This letter can be found on VascularWeb.org

6. Leading a coalition of physician associations in opposition to office reimbursement cuts by asking members of Congress, particularly those who are MDs, to contact CMS in opposition to cuts. As a result, 16 members of the House GOP Doctor’s Caucus submitted a letter to CMS on October 17; this letter can be found on VascularWeb.org

7. Raising PAC funds to attend events with targeted members of Congress. As a result of a discussion with Rep. Roe at an event, SVS staff secured his sponsorship of the above letter. SVS members can still contribute to the PAC by completing a donation form on VascularWeb.org

CMS was scheduled to issue its 2014 Medicare PFS Final Rule at the beginning of November; however, because of the government shutdown, the Final Rule will likely be released on November 27.

The SVS Foundation supports surgeons launching their research careers and established researchers to do both clinical and basic research projects. The SVS Foundation's ambitious goals can be reached only with SVS member support. Generous contributors know that the research moves the specialty forward with innovative treatments that help their patients. Each year an Annual Appeal is conducted to raise the money needed to fund the following awards:

1. E. J. Wylie Traveling Fellowship

2. Resident Research Prize

3. Clinical Research Seed Grants

4. Multicenter Clinical Studies Planning Grant

5. Mentored Clinical Scientist Research Career Development Award (K08)

6. Mentored Patient-Oriented Research Career Development Award (K23)

7. Student Research Fellowship

8. Jahnigen Scholars Program: A Model for Career Development

Read what past award winners say about the assistance they received from the Foundation and review the SVS Foundation Annual Report.

The SVS Foundation supports surgeons launching their research careers and established researchers to do both clinical and basic research projects. The SVS Foundation's ambitious goals can be reached only with SVS member support. Generous contributors know that the research moves the specialty forward with innovative treatments that help their patients. Each year an Annual Appeal is conducted to raise the money needed to fund the following awards:

1. E. J. Wylie Traveling Fellowship

2. Resident Research Prize

3. Clinical Research Seed Grants

4. Multicenter Clinical Studies Planning Grant

5. Mentored Clinical Scientist Research Career Development Award (K08)

6. Mentored Patient-Oriented Research Career Development Award (K23)

7. Student Research Fellowship

8. Jahnigen Scholars Program: A Model for Career Development

Read what past award winners say about the assistance they received from the Foundation and review the SVS Foundation Annual Report.

The SVS Foundation supports surgeons launching their research careers and established researchers to do both clinical and basic research projects. The SVS Foundation's ambitious goals can be reached only with SVS member support. Generous contributors know that the research moves the specialty forward with innovative treatments that help their patients. Each year an Annual Appeal is conducted to raise the money needed to fund the following awards:

1. E. J. Wylie Traveling Fellowship

2. Resident Research Prize

3. Clinical Research Seed Grants

4. Multicenter Clinical Studies Planning Grant

5. Mentored Clinical Scientist Research Career Development Award (K08)

6. Mentored Patient-Oriented Research Career Development Award (K23)

7. Student Research Fellowship

8. Jahnigen Scholars Program: A Model for Career Development

Read what past award winners say about the assistance they received from the Foundation and review the SVS Foundation Annual Report.

Donations to the SVS Foundation support vascular surgeons at all stages in their careers, from those just starting in clinical and basic research to those well-established in the field. To honor the generous support of SVS members, the Foundation has created a Legacy Program to recognize lifetime giving.

Become part of this prestigious group by giving back to the specialty. Make an Annual Appeal Donation now. Donations to the SVS Foundation, a 501c(3) organization, may be tax-deductible as charitable contributions.

Donations to the SVS Foundation support vascular surgeons at all stages in their careers, from those just starting in clinical and basic research to those well-established in the field. To honor the generous support of SVS members, the Foundation has created a Legacy Program to recognize lifetime giving.

Become part of this prestigious group by giving back to the specialty. Make an Annual Appeal Donation now. Donations to the SVS Foundation, a 501c(3) organization, may be tax-deductible as charitable contributions.

Donations to the SVS Foundation support vascular surgeons at all stages in their careers, from those just starting in clinical and basic research to those well-established in the field. To honor the generous support of SVS members, the Foundation has created a Legacy Program to recognize lifetime giving.

Become part of this prestigious group by giving back to the specialty. Make an Annual Appeal Donation now. Donations to the SVS Foundation, a 501c(3) organization, may be tax-deductible as charitable contributions.

To ensure the continuation of clinical investigation in vascular disease, the SVS Foundation sponsors the Clinical Research Seed Grant Program. This program:

• encourages the interest and development of clinical investigators among the SVS membership particularly among junior members or those with limited prior experience as principal investigators;

• provides direct support for pilot clinical projects that have the potential to develop into larger studies fundable by industry or governmental sources.

For more information, including how to apply, visit VascularWeb.

To ensure the continuation of clinical investigation in vascular disease, the SVS Foundation sponsors the Clinical Research Seed Grant Program. This program:

• encourages the interest and development of clinical investigators among the SVS membership particularly among junior members or those with limited prior experience as principal investigators;

• provides direct support for pilot clinical projects that have the potential to develop into larger studies fundable by industry or governmental sources.

For more information, including how to apply, visit VascularWeb.

To ensure the continuation of clinical investigation in vascular disease, the SVS Foundation sponsors the Clinical Research Seed Grant Program. This program:

• encourages the interest and development of clinical investigators among the SVS membership particularly among junior members or those with limited prior experience as principal investigators;

• provides direct support for pilot clinical projects that have the potential to develop into larger studies fundable by industry or governmental sources.

For more information, including how to apply, visit VascularWeb.