Dr. John Happel | May 19, 2018 | 0
Unnecessary Vein Treatments and Growing Physician Greed
Varicose Veins Lies, Damned Lies and Statistics Exposed
Varicose Veins Truth and Facts Revealed
Mark Twain popularized most of the theme of today’s article except for the words, varicose veins. Twain did say that lies can run around the world before the truth gets its boots on.
This article is an attempt to bring awareness of these problems in Pittsburgh and across the country.
We will attempt to expose some of the shenanigans going on in the vein world.
What are the statistics?
Venous procedures have increased by over 1600% over the past ten years.
That is unsustainable financially to this country and to the insurance industry.
They are limiting varicose vein treatments more and more every year.
Many People Feel That All of Their Veins Should Be Covered by Insurance
You pay a lot for your health insurance.
Should cosmetic vein procedures be covered?
Let’s take a closer look.
Have you seen the unscrupulous Pittsburgh ad that says 95% of veins are covered by insurance?
That is simply not true. It is a lie and a damned lie – as Mark Twain would say.
Either people who respond to this false marketing will get the bait-and-switch or their insurance claims will be submitted fraudulently.
There is a vein franchise in Pittsburgh that advertises that 95% of veins are covered by insurance. They have declared Chapter 11 bankruptcy.
The sad fact is that advertising works.
Advertising that 95% of veins are covered by insurance is not true.
Most vein patients who present to vein centers request treatment for veins that are cosmetic. Most visible veins are just unsightly.
Dr. Ron Bush MD, a nationally recognized director of Vein Experts, estimates that 80% of venous disease is cosmetic. In his opinion, that means that only 20% of veins should be covered by insurance.
That’s quite a discrepancy!
Those are the statistics.
Fraudulent Vein Testing and Procedures
Every patient who walks into vein franchise doors with any type of vein issue is automatically ordered a venous Doppler.
That occurs even before they see a doctor!
People with spider veins don’t need a venous Doppler examination. Nevertheless, they are told that they need it.
That is also a damned lie.
These places also have to falsify venous Doppler results to the insurance company if they find an abnormal Doppler test in order to ablate their saphenous vein.
That is because spider veins are considered cosmetic.
Routine Doppler exams on people with spider veins leads to unnecessary saphenous vein ablations, according to Dr. Peter Lawrence, president of the Society for Vascular Surgery.
The following statement is his position and that of The Internal Medicine Board.
Avoid routine venous ultrasound tests for patients with asymptomatic spider veins. Routine testing could result in unnecessary saphenous vein ablation procedures. Spider vein treatment can be considered for cosmetic improvement unless associated with bleeding. Spider veins are usually asymptomatic blemishes found on the legs but can also involve other areas such as the face and chest. They almost never cause pain and seldom bleed. They are treated primarily for cosmetic purposes by injection or laser therapy. Although occasionally associated with disorders of the larger leg veins (saphenous, perforator and deep), treating the underlying leg vein problem is seldom necessary. Even if an incompetent saphenous vein is identified and treated by ablation or removal, the spider veins will remain. Since the saphenous vein can be used as a replacement artery for blocked coronary or leg arteries, it should be preserved whenever possible. Therefore, an ultrasound test to diagnose saphenous vein or deep venous incompetence is not required when the patient does not have varicose veins.
Overutilization 0f fiscal resources of this magnitude is resulting in a day of reckoning.
The Abuse of Free Vein Screenings.
Sometimes things are not what they seem to be. The purpose of a health screening should be to prevent health problems.
Preventative vein care is not a covered service. If your veins are not large enough or do not interfere with your daily activities or result in bleeding, ulcers, or phlebitis, insurance companies won’t pay to have them removed.
To get around these strict rules, vein franchises have gone on the hunt.
They need lots of patients to stay in business. Referrals from primary care doctors are not enough for them to keep their doors open.
What to do?
Vein franchises hire field-marketing reps to chase down prospective patients. Since nearly everyone has at least a few abnormal veins in their legs, there is a lot of stalking going on at public events.
These events are like salt licks for attracting deer. They advertise by giving out “goodies” for a chance to talk to you and entice you to come to their office for a free vein examination.
Their field marketing reps organize these to troll for patients. Trolling is done just like when people go fishing!
Look at their Facebook pages. Yoga classes, senior’s programs like senior’s Olympics, Italian Heritage Festivals, events for military families, car collector events, weekend art shows, corporate health care outings, conventions, healthy living expos, are all likely pickings. They love to sponsor golfing events, walk-a-thons, and 5 K runs.
Hmmmmm. That sounds awfully entrepreneurial.
Why Are So Many Vein Patients Treated Unnecessarily?
What is the background of the vein doctors who work in franchises?
I am curious as to what ignited the passion of doctors in non-vascular specialties – doctors who never treated a vein in their lives – to switch their life’s work to treating a previously underserved population – patients with varicose veins. (Sarcasm implied.)
Often the excuse is that they were burned out in the field that they had originally chosen.
Why did they suddenly develop a passion and become enamored with treating veins.
For one reason, there is a lot of vein disease out there.
Secondly, it can be done outside auspices and scrutiny closely regulated environment of a hospital.
There is no accountability.
There is no oversight.
Translated that means no one is looking over their shoulder to see if safety and quality standards are being followed.
The incentives are enormous.
Consider all of the unnecessary back surgery, heart stents and PAP smears that are being done. In Florida, a cardiologist was reported in the Wall St. Journal, as among the highest billing doctors in the Medicare program. He billed Medicare $16 million dollars in 2013 and $18.3 million dollars in 2012.
That is a sad comment on modern venous medicine.
Whatever you can get away with seems to be the modern mantra in the modern day varicose vein surgery treatment field.
Round Up the Usual Suspects
Remember that famous line delivered by Claude Rains in the 1942 movie, Casablanca?
Metaphorically speaking, Ashely’s Ozimandias discusses what will inevitably occur to the “reign” of these entrepreneurial “kings of veins”.
Their modus operandi is to metastasize into a myriad of satellite offices.
Vein treatments at the expense of doing what is best for the patient will result in their inevitable fall into the decay of the sands of time.
There are more vein centers in most cities than Starbucks.
When results of quality of life studies are rigorously examined by the government and insurance companies, their formulas for generating profits will fade away. More bankruptcies will result.
The Opening Debate at a Recent International Vein Conference
The following is not just one vascular surgeon’s rant. The problem is a widespread disturbing trend across this country.
It’s was a dirty little secret that the vein treatment specialty is being taken over by entrepreneurs. Vein Directory, an online magazine for vein doctors, warned doctors what not to do when treating venous disease.
A recent discussion emphasized the unethical types of behavior that are occurring in an increasing frequency in the field of varicose vein disease.
The dilemma is how to report these abuses when people come for a second opinion and were advised to have unnecessary procedures for all of the wrong reasons.
Some suggestions to stop the abuse were:
- Inform the insurance provider of these abusive practices.
- Informing the state medical board.
- Inform the Intersocietal Accrediting Commission who credentials venous ultrasound testing and vein centers. However, this body has no power in these matters.
One Patient’s Story Who Was Seen at a Vein Franchise
The following is a story written on the internet.
They [the vein franchise] were able to schedule me very quickly! My husband was bugging me about getting a second opinion (WHICH I STRONGLY SUGGEST) and I did! My husband gave me the name of a well-known vein specialist in Pittsburgh (Dr. Happel) so I went to see him. He told me I don’t need the surgery…. He looked at my left leg and did an ultrasound and said there’s nothing wrong with it. Plus insurance doesn’t cover that type of surgery which the xxxxxxxxx xxxxxxx never told me that!! I would have been screwed and would have had to pay out of pocket.!!! I didn’t understand why they wanted me to get a surgery I didn’t need! Especially for both legs. Long story short… Just don’t Google a place and pick the first one that pops up really do your research and always ALWAYS get a second opinion!!! I got really lucky and found and honest Dr that cared about my health and well-being instead of trying to make a quick buck.
Not all unsightly veins need treated.
Especially if they do not cause symptoms.
Never ask a barber if you need a haircut.
Second Patient’s Story with Only Spider Veins Who Came for a Second Opinion
I had some unsightly spider veins that I wanted eliminated. So, I thought why not get a free evaluation – I certainly had a few spots on my legs that could look better. I went to the xxxxxxxxxx xxxxxxxx (nearby vein franchise) for this free evaluation. This included an ultrasound. I ended up having injections to dissolve the veins and even better, my insurance paid for it! (That is insurance fraud because spider veins are considered by all insurance companies as cosmetic like a tummy tuck or a face-lift). I had to wear a compression stocking for 4 days after each time I had injections (wearing this stocking was not fun), but I was mostly pleased with the results.
Fast forward 5 years. I recently noticed more spider veins in my shins so I called the xxxxxxxxxxx xxxxxxxxx again and made an appointment for a touch up. They told me because it was 2010 since I had been there that they would do another ultrasound before agreeing to do the injections. I met with several people, one who took me into a room to change to shorts, then a very nice ultrasound technician. After the ultrasound I met with another technician. She told me that before I could have any treatments on spider veins that I needed something called EVLA which is a procedure where they make a slit near the ankle and introduce a wire and use a laser to go up inside your vein to remove it permanently. I would then need to wear the compression stocking for 7 days; sometime within 3-5 days after this procedure I would have to go back for an appointment to make sure I did not have any blood clots. This would have to be done on each leg at separate appointments and after 90 days I would return for the same procedure on 2 more veins near the groin. After all that I could pursue the spider veins (which insurance no longer pays for I found out – but it does pay for EVLA). I left the xxxxxxxxx xxxxxxxxx feeling very scared and nervous about this procedure. I wanted to get this over with before summer because that stocking can be very hot to wear on a warm day, so I scheduled the appointments for the first 2 treatments.
I must say something about this kept nagging at me, especially because to look at my legs there are no visible varicose veins. But since the valves weren’t working, I decided to go ahead with it. Then out of the blue, I remembered a friend of mine had the spider vein injections and had gone to a vascular surgeon. I called the surgeon’s office, explained that I was nervous about the procedure, and wanted a second opinion. I obtained a copy of my ultrasound report and took it with me to the appointment. The report stated I had varicose veins and several areas where the valves weren’t functioning properly. The second opinion doctor looked at the report and examined my legs. At first, he did not say much. He then said he wanted to see what the ultrasound showed. All I had was the written report. So he did his own ultrasound, explaining where the veins were and how they worked. It was explained in detail. Guess what? My veins were working just fine. I was so relieved! And so furious! The veins that the Xxxxxxxxxx xxxxxxxxx was going to laser are the same veins that are used in heart bypass surgery. I started thinking of all the people who have had this procedure and really did not need it. I am not sure who is to blame but if it happened to me, it could happen to you. I have good insurance and was told I did not need an authorization for this procedure. Interesting. Sorry to rattle on, but I just wanted all of you to have a heads up and if you are unsure or uncomfortable with a doctor’s opinion, then don’t hesitate to get a second opinion. Oh, I forgot to tell you that I never even saw a doctor at this national franchise.
These are examples of what vein experts Dr. Peter Gloviczki, Dr. Peter Lawrence, Dr. Robert Weiss, Dr. Robert Kistner, Dr Jose Almeida, Dr. Russell Sampson and many others have described as a disturbing trend in the over treatment of veins for questionable reasons.
Great varicose vein care begins and ends with the doctor.
Self-interest is a powerful force and can cloud the judgment of otherwise honest doctors.
Beware of the vein fakirs, charlatans and cheaters of the system.
These doctors and vein franchises exist in every city.
Their numbers are growing.
Hint – They usually advertise.
Examine your potential vascular surgeon’s experience, their actual training in vein disease and their ethics. Reviews and recommendations from friends and family can be helpful in your research.
At the expense of sounding like a sound bite, one thing that I know is true.
The vein doctor whom you choose makes or breaks the success of your treatment.
Success is not a given. Venous disease is more complicated, complex and more diverse as compared with arterial disease. Take that advice from a Mayo Clinic trained vascular surgeon.
This article is meant to empower you to take control of your medical and varicose vein treatment.
Choose your vein doctor carefully. Make sure you speak to your doctor on your initial consultation and prepare questions ahead of time.
If you don’t see a physician on your first visit, that is a troublesome sign.
Dr. John Happel MD does not delegate any vein treatments to assistants. He has the longest experience of any physician treating varicose veins in Pittsburgh.
For personalized treatment by a board certified vascular surgeon who specializes in veins, call us at 724-969-0600 to learn more.