SVS Vascular Quality Initiative passes milestone 1,000thcenter mark

By Jocelyn Hudson

The Society for Vascular Surgery Vascular Quality Initiative (SVS VQI) clinical registry recently announced it has achieved another milestone, with more than 1,000 centers enlisted in VQI registries. This achievement will strengthen vascular care, improve outcomes and underscore the value of real-world data in analyzing outcomes and reducing resource utilization, a press release reports.

The SVS VQI is a clinical registry dedicated to improving the care of vascular patients through a data-driven approach to healthcare. In late 2022, the organization achieved a significant milestone by surpassing one million procedures collected in its database. Since its inception, the SVS VQI claims, clinical data gathered from participating centers has dramatically impacted patient care, leading to scientific discoveries that have changed the way in which care is delivered, improving outcomes and saving thousands of lives.

“Improving quality is a high priority for everyone in the medical community. This long list of SVS VQI participating centers reflects their commitment to quality. By collecting detailed clinical and procedural data that is usable and actionable, the SVS VQI is a critical tool that provides invaluable insight to providers and device manufacturers. We are all committed to improving patient care and the data provides a path,” said Jens Eldrup-Jorgensen, MD, medical director, SVS Patient Safety Organization.

Since 2011, when the SVS VQI was formed, VQI registries have achieved growth in participation and engagement. In 2022 alone, 100 quality charters have gotten underway. Other major milestones include:

◆ More than 600 articles published in peer-reviewed journals using SVS VQI data

◆ Eighteen regional groups formed and meeting biannually to discuss outcomes and quality improvement projects

◆ More than 250 physician volunteers contributing to registry design and operations.

◆ More than 6,000 participating physicians from multiple disciplines engaged in using the SVS VQI

◆ More than 4,000 data managers, hospital managers and other professionals participating in the SVS VQI

◆ Numerous collaborations with other organizations, including the American College of Cardiology (ACC), American Venous Forum (AVF), American Heart Association (AHA), Society for Vascular Medicine (SVM), Vascular Access Society of the Americas (VASA), Society for Vascular Ultrasound (SVU) and many regional vascular societies, governmental regulatory agencies, device manufacturers and payers

◆ Fourteen VQI registries established, each collecting demographic, clinical, procedural and outcomes data from more than one million vascular procedures performed in the USA, Canada, Puerto Rico and Singapore

On average, more than 10,000 new procedures are added to the clinical registry each month. The wealth of data in the registry enables providers to track their performance and compare it against regional and national benchmarks.

The SVS VQI Vascular Implant Surveillance and Interventional Outcomes Network (VISION) is a partnership between the SVS VQI and Medical Device Epidemiology Network (MDEpiNet) that directly supports the mission of the SVS VQI to improve the quality, safety, effectiveness and cost of vascular health care by collecting and exchanging information. VISION links SVS VQI registry data to Medicare claims to generate novel registry claims-linked datasets. The datasets combine the clinical detail from the SVS VQI with long-term outcome variables derived from Medicare claims.

Another major initiative launched in 2022 is the SVS VQI Fellowship in Training (SVS FIT) program. Individuals completing their medical residencies or fellowships in any vascular disease-focused specialty (e.g., vascular surgery, cardiology, radiology, vascular medicine) may participate in the 12- to 18-month program. It fosters an understanding of quality processes and metrics among vascular residents and fellows through mentorship in the VQI, in collaboration with the Association of Program Directors in Vascular Surgery (APDVS), American College of Cardiology and the Society for Vascular

SVS VQI registries are powered by the Fivos Pathways platform, a secure, cloud-based solution for data collection and analysis. Using Pathways, SVS VQI participating providers can utilize real-time reporting to benchmark performance, while device manufacturers can develop custom projects that leverage registry data to accelerate device development, evaluation, or approval.

Jens EldrupJorgensen

By Beth Bales

THE USE OF INTRAVASCULAR ultrasound (IVUS) can provide helpful information for assessment of pre- and post-intervention vascular status and, thus, is an important part of the management of patients with arterial and venous disease. IVUS can provide information about lesions not evident with angiography or standard ultrasound. Correct coding of IVUS depends on anatomic considerations in addition to accurate documentation of the procedure and findings.

For Current Procedural Terminology (CPT) 2016, the surgical and interpretation components of IVUS were combined into two new bundled codes for reporting IVUS in the initial noncoronary vessel (37252) and each additional noncoronary vessel

(37253). IVUS codes may be reported in addition to any angiographic or interventional procedure codes when treating peripheral arteries and/or veins.

Certain principles of documentation and vascular nomenclature will help inform the use of and number of units of IVUS that may be reported for any given intervention; specifically, one unit of service for each IVUS procedure for each vessel (vessels are defined in Appendix L of the CPT codebook). In other words, separate coding for a pre- and post-intervention IVUS examination is not permitted. The number of units of IVUS reported is based on the number of vessels studied and includes all work necessary to perform the procedure. While it is possible to code for each vessel studied, when a lesion spans two different vessels those two vessels are considered a single vessel. For example, a stenosis involving the external iliac vein that continues into the common iliac vein would be coded as one vessel. This is based on CPT codebook guidelines for characterizing anatomic definitions of vessels and applies to IVUS and other procedures.

Documentation must support the number of units of IVUS reported. Each vessel, with laterality specified, needs to be included in the documentation. In addition, the physician must describe the IVUS findings for each vessel before and after any intervention. Quantification of percentage stenosis is always helpful as documentary support for the intervention and the use of IVUS. As is always the case, the clinical indications for the procedure should support the use of IVUS technology in each vessel that is being studied. When performed, IVUS is included in IVC (inferior vena cava) filter placement, repositioning and removal, and foreign body retrieval and should not be separately reported with these procedures.

Physicians who use advanced technologies such as IVUS to improve outcomes for their patients should be reimbursed accordingly. The guidance provided is designed to facilitate the documentation and coding for use of this technology.

There may be situations where questions arise regarding the proper documentation and coding for more complex lesions and anatomic features. For help, email advocacy@vascularsociety.org

To learn more, visit https:// www.vqi.org

Dialysis Access

EndoAVF usually less cost effective

THOUGH ARTERIOVENOUS FISTULAS created endovascularly (endoAVF) increase quality-adjusted life years (QALYs) by about one-and-a-half months, “it comes at a significantly greater cost,” a new cost-effectiveness systematic review recently reported. Bianca Mulaney, MD, from Stanford University, California, delivered the findings at the 2023 Society for Clinical Vascular Surgery Annual Symposium (March 25–29) in Miami.

Mulaney stated that endoAVF was found not to be cost effective when compared with surgical AVF. Comparing endoAVF ($24.9 million costs, 1177 QALYs, 74% patent at five years) with sAVF ($9.5 million costs, 1142 QALYs, 68% patent at five years) generated an incremental cost-effectiveness ratio (ICER) of $441,641 per QALY gained. The study ascribes endoAVF’s inferior cost effectiveness when modeling five-year outcomes to the “four times higher up-front cost for endoAVF creation as well as a relatively low initial maturation rate and low primary unassisted patency rate.”—Benjamin Roche

CLASSICAL OPEN AND ENDOVASCULAR SOLUTIONS

CARDIAC, VASCULAR AND ENDOVASCULAR AORTIC ADVANCES