Where is Varicose Vein Insurance Reimbursement Heading?

Where is Varicose Vein Insurance Reimbursement Heading?

What Forces Are Dictating Varicose Vein Insurance Coverage in Pittsburgh?

UPMC and Highmark are battling for the healthcare market share.

The patient and the doctors are caught in the middle. Doctors who have sold their practices so one or the other can not see the competitor’s patients anymore.

This is being followed closely by other insurance companies across the country.

Happel Laser & Vein Centre remains independent.

That means we can accept varicose vein patients from both UPMC and Highmark as well as many others.

Competition in Treating Varicose Veins

Today’s modern vein practice must obtain marketing and search engine savvy to effectively compete and survive. Phlebology or the field of treating veins has become a business.

Why?

Competition in the vein world has become increasingly fierce as more and more doctors flock into the field of treating superficial venous disease.

Let’s be honest. In growing numbers, emergency room physicians, cardiologists, interventional radiologists, dermatologists and surgeons are looking to escape from their trained specialty in hopes of a better lifestyle and income.

Today’s medical students with their huge educational debts have become more entrepreneurial than ever by necessity. This thinking must eventually carry on into their practice of medicine after they graduate.

In opposition to this trend, insurance companies are restricting more and more services. There is no uniformity in coverage for vein services from one insurance company to the next. Coverage has nothing to do with evidence based medicine or guidelines created by venous societies in this country.

How does a newly established phlebologist become established in this overcrowded field?

By establishing lots of new patients, of course.

How does one do that?

Free Doppler screenings and free consultations are commonplace in the vein world. Would a urologist, gynecologist or a family practice physician, give away free services just to entice patients into their practice?

Of course not.

So Why is Phlebology (Vein Disease) Different?

According to one of the most experienced phlebologists in the country, Ron Bush MD, director of Vein Experts, 80% of patients who present to a vein practice truly have only cosmetic concerns. Many patients with varicose veins are asymptomatic.

However, one vein franchise in my city advertises on television and on their web site that 95% of all veins are covered by insurance.

If both numbers are even remotely close to being correct then there is a huge disconnect. That must mean that many venous procedures are being performed which are billed to insurance companies inappropriately.

Over the past couple of years there have been countless published complaints of unethical conduct and unnecessary venous Doppler ultrasound testing and saphenous ablations voiced by concerned vein experts and venous societies.

Insurance companies continually keep nipping at the edges of determining medical necessity. Claims are being denied. Audits are increasing. Reimbursement is falling at a faster rate than in other specialties.

What is the result of all of these forces?

Unnecessary ultrasound testing and saphenous ablation have become rampant in many areas of the country. Vein franchises often have field-marketing experts who recruit new patients outside of the traditional ways.

Ethics 101 anyone? In too many cases, financial forces prevail over what is best for the patient.

In areas of high utilization, marketing expertise is becoming a necessity to keep the lights on.

That wasn’t taught in medical school.

Business concepts and marketing tools that are often incorporated into the modern independent vein doctor’s practice including:

  • Search engine optimization
  • Keywords choices and stuffing
  • Short vs. long tailed keywords
  • High quality content blogs
  • Hiring SEO experts vs. do-it-yourself
  • Quality back links
  • Google search engine ranking vs. pay per click advertising
  • Medi spa expansion

The limitation of referrals from primary care doctors who have sold their practice and must refer inside their network is an enormous blow to an independent vein center.

Family doctors are obligated to keep the patient in the local insurance network run by the hospitals that pay their salary.

If a phlebologist works for a franchise, business experts manage these concerns.

What Does the Vein Patient Really Want?

Today’s varicose vein patient is looking for a doctor who advertises effectively and has an office location that is conveniently located.

Those are their two most important criteria that most patients use to choose a vein doctor. Location and advertising.

Quality? Meh. It’s assumed by most that all doctors and all vein centers are the same.

So where are we headed?

Capitation vs. More of the Same?

Talk of capitation has been in the air for a couple of years. With capitation, a vein doctor would be given a lump sum to care for all of the patient’s vein problems for a designated period of time.

There are too many variables to make it viable.

  • What if the patient changes insurance companies which has become commonplace?
  • How would that work?
  • What if a physician would retire?
  • How long of a period would the capitated fee encompass?

If there is one thing that insurance companies do best, it is constructing actuarial tables to maximize their profits.

After a trial period of significantly decreasing reimbursements, will phlebologists stop participating with insurance coverage for veins? Time will tell.

If a physician is primarily motivated primarily by money, abuses will occur. More minor procedures like phlebectomies and sclerotherapy and more unnecessary saphenous ablations would prevail.

Since venous treatment is palliative, the trend in a financially driven vein practice under capitation would be to provide the minimum of care and kick the problem down the road. This would speed up the inevitable the rate of varicose vein recurrence.

However, wasn’t that the case twenty years ago before radiofrequency closure and laser saphenous ablations? The difference is that we now also have ambulatory phlebectomy and ultrasound guided sclerotherapy.

If capitation for the treatment of venous disease is ever to arrive in this country, treatments may more closely resemble the European models of vein care including variations of CHIVA and ASVAL. In these models, the saphenous veins are spared.

The golden age of medicine and of phlebology is over. Doing whatever the phlebogist “feels” is in the best interest of their patient has ended.

Venous procedures are increasing exponentially because vein care is primarily driven by volume. Free vein screenings and consults are the proof. They are pervasive throughout this country. That’s not the way medicine should be practiced.

Insurance companies are already determining medical necessity. Are venous societies and the IAC vein center accreditation too late to the party?

The requirement for a three-month trial of compression stockings established by consensus panels in the United States and Great Britain was not supported by evidence-based medicine. Abandoning this worthless prerequisite before definitive care be undertaken has been completely ignored by insurance companies.

The American conformity of venous treatment opinion was published three years ago. With this in mind, can venous registries in the future prove that improved quality of life after a procedure makes a difference and therefore should be covered?

One thing is sure, continued exponential growth in vein procedures is not viable.

Conclusion

Dorothy in the Wizard of Oz taught us that the answer to the problem might be right in front of you.

The Scarecrow from the Wizard of Oz was confused about giving directions. Do we really have a choice as to which path we will take in deciding the future of venous medical care?

On the other hand, have market driven forces in the form of insurance mandates already made the decision for us?

One thing is for sure. Dr. Oz is not the answer.

If only there was a wizard to give us the brains, the heart and the courage to get us what we need to optimally care for patients with venous disease.

Maybe we already have it.

Happel Laser & Vein Centre does accept and participate in the following health insurance plans.

  • Aetna
  • Advantra
  • Anthem/BCBS
  • Cigna
  • Coventry
  • Devon
  • 4Most
  • Health America
  • Health Assurance
  • Health Plan of Upper Ohio Valley
  • Humana
  • Highmark/BCBS
  • Medical Mutual
  • Mon-Valley Health Plan
  • Multi-Plan
  • Tricare
  • United Health Care
  • Western Pennsylvania Electric (WPEE)
  • UPMC
  • All BC/BS plans

About The Author

Dr. John Happel

Dr. John Happel has been in practice as a surgeon since 1986 in the Pittsburgh region. He specializes in vascular surgery and has subspecialized in the treatment of varicose and spider veins since 1999. Dr. Happel is board certified in vascular surgery and recertified in vascular surgery in 2012. He was chosen in 1985 to fulfill the position for the vascular surgical fellowship at the world renowned Mayo Clinic.