I hadn’t seen them in years, maybe even a couple of decades. But when I recently opened the glovebox of an old car I’ve kept for sentimental reasons, there was that dusty pouch. And inside—all those roadmaps. 

Spreading each one across the hood of the car, I studied the highlighted routes, destinations circled in pencil, notes in the margins. All the stories came back to me—the road trips we took, the places we stopped, even meetings I attended.

One side of the map gave the bird’s eye view from city to city—along highways with numbers as familiar now as they were then—405, 5, 101 … On the other side the focus narrowed to the granularity of neighborhoods and city streets.

Frankly, it boggled my mind to think about how we used to travel from neighborhood to neighborhood, state to state, and even across the country with nothing more than paper to guide us. And it wasn’t that long ago.

We’ve gone from pencils on paper to pressing a 7-inch screen with the world of where we’re going mapped out for us. Coincidentally, all that transition has happened within a window that mirrors my own leadership journey.

And that got me thinking. How much has leadership changed … or has it? 

Clearly, there are fundamentals of leadership. A few of these essential truths come to mind:

Leadership is inspiring others to believe and enabling that belief to become reality. First and foremost, that is our primary role as leaders.

It’s not about you, but it starts with you. Humility and self-awareness go hand in hand. If you don’t improve yourself, you’ll never improve an organization.

Coaches don’t win games, players do. It’s all about the mosaic of talent you surround yourself with.

Establish the left and right guardrails. Leaders define the mission and values of the organization—then others take it from there.

Listen to what you don’t want to hear. The difference between hearing and listening is comprehending.

Learn—always. Knowledge is what we know; wisdom is acknowledging what we don’t know. Learning is the bridge between the two.

Communicate to constantly connect with others. This is where leadership lives and breathes.

Then as now, the essence of good leadership is timeless. 

It’s just like those old maps. Sure, there are a few different street names or errant exits, but no doubt today I could still use them to get from Point A to Point B.

But that isn’t evolving. 

Over the past few years, I’ve witnessed no greater evolution in leadership, from the ways of the past to the new world of working, than the premium placed on authenticity and vulnerability.

Early in my CEO career, I would have described a great leader as someone with vision, a growth mindset, confidence, charisma, courage … Then a board member called me aside: “Burnison, you need to be more vulnerable. You’ll be amazed by the results.”

To navigate so much uncertainty and ambiguity, leaders need to be confident; but too much self-confidence can narrow our peripheral vision. As counterintuitive as it may seem, vulnerability is actually a strength for leaders, particularly when we know that all of tomorrow’s answers won’t be found at the top. Rather, they emerge from the mosaic of people, talents, and perspectives around us. And the more we as leaders are willing to be vulnerable, the more we empower others.

But here’s the thing. A leader can’t wake up one day and declare, “I’m going to be a great leader today,” then go to bed that night saying, “And tomorrow, vulnerable!”

The landscape is always changing, but our direction is always driven by our “why”—our overarching purpose. It’s a journey—one we have to navigate day to day, week to week, one destination to the next.

It’s a fact of life and leadership—the roadmap that got us here, won’t get us there.

Reprinted with permission.

As AVF members are all too aware, in recent years, Medicare’s reimbursement for vein procedures has seen annual cuts due to CMS’s regulatory policies.  In the office setting, these cuts to key vein codes have been anywhere from about 3% to as much as 10% a year for some codes.

In a nutshell, Federal statute mandates that the total Medicare Part B pool of total physician payments be budget-neutral from year to year.  This means that CMS has to make adjustments in relative value units (RVUs) every year; and they do this by calculating a new Conversion Factor every year.  This budget neutrality requirement is despite usual inflation, rising indirect costs, and despite more people joining the Medicare system.  Our payment system needs deep reform, and long term, is not sustainable, so we can only hope that Congress takes up the issue of systemic reform.

For 2026, the Centers for Medicare and Medicaid Services (CMS) has released its Proposed Rule for Part B Physician Fee Schedule.  All stakeholders may submit comments, due September 12^th. A brief overview of the Proposed Rule, is available here on the CMS website.

We know that private practices are continuing to be stressed to serve patients due to long-term reimbursement cuts to interventional procedures and due to hospital consolidation.  These issues were discussed at the AMA House of Delegates meeting in June and our AVF Delegate to the AMA, Loay S Kabbani, MD, MHSA, FACS, was front and center as he spoke to the need for reform to help office-based proceduralists and maintain patient access to office-based specialty care.

A report from the AMA highlights the role of private equity and the forces impacting private practices, and I encourage our members to give it a quick review.

Allow me to highlight a few key items, and how these proposals may impact venous physicians and other venous providers.  I’m very pleased at how these changes for 2026 may impact office-based reimbursement, and we at the AVF applaud CMS for recognizing that office-based specialty care is a vital part of our nation’s healthcare system.

Conversion Factor–Two Updates. CMS is proposing two different conversion factors, depending on whether the provider participates in an alternative payment model (APM).  For providers who are in a qualified APM, the CY2026 qualifying APM conversion factor is projected to increase by $1.24 (3.83%) to $33.59, from the current $32.35.   However, and I think this applies to most AVF members, the “traditional” conversion factor will apply, and this is projected to increase by $1.17 (3.62%) to $33.42, from $32.35.

These two conversion factors factor in the adjustments made by the recent passage of the “One Big Beautiful Bill,” specifically a one-year increase of 2.5 percent for CY2026 and an estimated 0.55 percent adjustment necessary to account for proposed changes in work RVUs.

Efficiency Adjustment. It’s a complex topic, but CMS is unveiling a new proposal that they term “the efficiency adjustment.” The adjustment would apply to the work RVU and corresponding intra-service portion of physician time of non-time-based services. This would apply to all codes except time-based codes, such as evaluation and management (E/M) services, care management services, behavioral health services. and services on the Medicare telehealth list. Specialties that rely more heavily on time-based codes, such as family medicine and psychiatry, could see small RVU increases, while procedural or diagnostic specialties, such as some surgical fields, may see slight reductions. CMS anticipates that most specialties would see no more than a 1 percent change in total RVUs.

Proposed Site of Service Payment Differential. CMS proposes adjusting the methodology for allocating indirect practice expense (PE) RVUs based on the site of service. Specifically, for services valued in the facility setting, CMS would reduce the portion of indirect PE RVUs tied to work RVUs to half the amount used for non-facility services.

The American Medical Association has put out a nice overview of these two new proposals, HERE.

In my view, these two new proposals will help offset some of the recent cuts to office- based specialty care.  This simple table looks at some of the common venous codes, and how they would be reimbursed in the office setting (EXCEL File)