In June of 2024, the American Venous Forum was officially seated in the American Medical Association’s House of Delegates during the 2024 AMA Annual Meeting, capping off several years of persistent work that opened new opportunities for the AVF to advocate for our members.  The issue of reimbursement in the United States healthcare system is very complex, but this new recognition of the AVF gives us a seat at the table for important coding and payment discussions and decisions.   Here are a few things I’ve learned and would like to report to members after my first few months as serving as your Committee Chair.

Evidence and published papers are critical in our advocacy toolkit

As specialists in venous disease, our research and clinical opinions have real impact.  The recent Parts I and II of the multi-society Guidelines (Part I: https://doi.org/10.1016/j.jvsv.2022.09.004, Part II:  https://doi.org/10.1016/j.jvsv.2023.08.011)  are now routinely cited by payers in their coverage policies.  As payers increasingly outsource their coverage analysis to third-party evidence organizations, being able to cite papers and data is critical.  For example, in my opinion, the 2024 decision of United Healthcare to cover non-compounded foam sclerotherapy was helped by the results of the JURY I trial, which highlighted that interventional care was indicated irrespective of the presence or absence of concomitant junctional reflux.  Also, as a likely result of the Jury I trial, a regional Blue Cross/Blue Shield payer, Excellus, amended their policy to cover junctional reflux, which may be viewed here: https://www.excellusbcbs.com/documents/d/global/exc-prv-varicose-vein-treatments

As our research and data repository expands, our ability to impact payers and policies also increases.  I am pleased to report that effective July 1, 2025, United Healthcare has deemed cyanoacrylate closure medically necessary for treatment of the Great Saphenous Veins (GSV), Small Saphenous Veins (SSV), and Accessory Veins.  We will have additional information about this important policy update change as the AVF learns more.

What is the RUC, and why am I asked to complete surveys?

For almost three decades, the system of assessing physician work and intensity, and later practice expense, has been the Resource-Based Relative Value Scale, or RBRVS.  Since 1992, the RBRVS Update Committee (aka, RUC Committee) has been the venue where RVUs and practice expense and supplies are deliberated.  As AVF’s RUC Advisor, it is my pleasure to represent our organization at this key venue.  But what does this mean to our members?  

Most importantly, at some point in the future, you may be asked to complete a survey where you will be given a series of questions about a specific clinical service, or CPT code.  The survey will ask about the service and ask you to compare and rank the work and intensity of the surveyed service to other procedures.  The specialties collate these survey responses, and make a formal recommendation to the RUC as to RVUs and inputs necessary to accomplish the service. CMS is the ultimate arbiter of the RUC’s recommendations, and CMS issues their ruling in the annual summer Proposed Rule for the Physician Fee Schedule.    

I encourage you to carve out some quiet time and to complete a RUC survey if you receive a survey link. Carefully complete the survey questions based on your typical patient that you care for.  This is a key part of the survey-taking process;  your responses are based on your typical patient. 

Get Involved in politics– or someone else will decide our fate

Lastly, I encourage you to get involved in your local political scene, at both the state and national levels.  As vein specialists, we must advocate for our practices and continuing access to care for our patients.  

This is bipartisan. Democrat and Republican lawmakers need to hear from doctors, allied healthcare providers, and our patients.  If you support your local member of Congress, consider donating to their campaign, or even more impactful, perhaps volunteering in an upcoming election.  They will remember, and when the time comes when you need to ask for their support, your calls will get returned.

At present, AVF supports pending Capitol Hill bills that would link annual physician payment updates to a measure of inflation, as well as a bill that would remove high-cost supplies and equipment from the office-based payment formula.  We expect Congress will act this September on pending 2026 physician payment issues, and we will keep members apprised as developments unfold.

Some the recent political campaigns that AVF has endorsed include Reform of Prior Authorization for Medicare Advantage Plans, Scope of Practice for non-MDs, and Physician Payment Reform, namely zHR 879, the Medicare Patient Access and Practice Stabilization Act. This legislation, if passed, would prospectively cancel the 2.83% payment cut that went into effect on January 1, 2025  while also providing a 2.0% payment update, linked to general Medicare inflation, helping to stabilize physician practices and protect patients’ access to care.  

Thank you, and please consider me at your service if you have any advocacy questions.  The AVF sincerely thanks our volunteers who take time from their busy schedules to serve on our 2025-2026 Healthcare Policy committee.