Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.
Issue link: http://outpatientsurgery.uberflip.com/i/459853
W ith 40% of women and 25% of men suffering from varicose veins, spider veins or venous insufficien- cy, and new treatments that are less painful and invasive, now might be a good time to add venous disease treatments to your case mix. In addition to being in demand, these treatments are known for their high reim- bursement, quick turnover and low risk of complications. To treat achy varicose veins and their underlying causes, venous abla- tion — which uses a catheter to apply energy to a diseased vein and close it off — is a popular treatment. Anthony Smeglin, MD, an inter- ventional cardiologist at the Venus Vein Center and assistant director of the vascular invasive service line at Our Lady of Lourdes Medical Center in Camden, N.J., says that patient comfort is essential for abla- tion. He prescribes patients 5 mg of diazepam to take before the proce- dure and tells them to apply a numbing EMLA cream. Dr. Smeglin also injects lidocaine as a local anesthetic before inserting tumescent anes- thesia — a mix of saline, sodium bicarbonate and lidocaine — around the veins. He then inserts the catheter using ultrasound guidance, and uses heat from either radio waves or a laser to close the targeted vein. Patients are wrapped in elastic bandages following the ablation and can usually return to normal activities by the next day. Reimbursement hoops For venous ablation, insurers typically require pre-authorization that can involve a detailed and complex protocol. "If a patient has a med- ical venous disease, many insurers will require 3 months of graduated compression stockings before they'll authorize a vein procedure," says Dr. Smeglin. Laser ablation reimbursement is usually around $1,500, while radiofrequency ablation is paid at about $1,800, but typically has higher per-case costs. For sclerotherapy, where patients pay up front for the cosmetic treatment, the cost per session is usually around $400. These procedures take between 30 and 60 minutes, and often require 8 4 O U T PAT I E N T S U R G E R Y M A G A Z I N E O N L I N E | February 2015