GRAND ROUNDS EDUCATING THROUGH ADVOCACY

By Anahita Dua, MD

SINCE THE INITIAL LAUNCH OF THE Cancer Moonshot in 2016, the cancer community has made tangible progress towards ambitious goals, including accelerating scientific discovery in cancer, fostering greater collaboration and improving data-sharing.

Just last year, U.S. President Joe Biden announced a re-ignition of the Cancer Moonshot, highlighting new goals, including reducing the cancer death rate by half within 25 years and improving the lives of people with cancer and cancer survivors.

Cancer is a scourge on society, but we as vascular surgeons know that mortality rates in patients with critical limb ischemia (CLI) are higher than all cancers combined.

So how is it that cancer as a disease process has reached the lips of the highest legislators in our society, while peripheral artery disease (PAD) is still essentially an unknown entity?

The answer lies in our need to educate tural heart programs and transcatheter aortic valve procedures has largely driven this need and may create additional utilization when determining expected volume. Once the need for a hybrid OR system has been established within a specific VA medical center, approval through the Veterans Integrated Service Network (VISN) budget is required.

Even with the support of the VISN, the high cost of hybrid room technology and intricate construction required for installation pushes this acquisition into the classification of High-Cost High-Technical (HCHT), and must go through the VA National Acquisition Center (NAC). The application considers all aspects of the project, including clinical justifications, finance, impact of veterans’ wait time, and how this all fits into strategic planning.

Courtney Morgan

Moreover, in selecting the specific hybrid system, because the purchaser is the federal government, additional layers of scrutiny are required to ensure open and fair competition among vendors. Once the system and construction budget is approved, additional time for construction and installation should be anticipated. Multidisciplinary collaboration for shared use of cardiac catheterization labs or interventional radiology suites may be required to continue to provide clinical services during a prolonged construction phase.

Conquering the alphabet soup of government acquisition approval is well worth it in the end, and many high-com- plexity VA facilities already have hybrid ORs. Early adopters have been utilizing their hybrid ORs for nearly 20 years, providing equally complex endovascular aortic repairs to their partnering academic institutions.2 The direct impact on care of a hybrid OR for veterans is easily appreciated, but just as important is the impact on training the next generation of vascular surgeons, with more than half of VA vascular surgeons providing direct teaching to vascular surgery trainees.2,3

Unfortunately, the lifetime of a hybrid OR is not indefinite, and several of the early hybrid ORs in the VA system are undergoing—or have already undergone—upgrades and replacement that are equally as involved as installing a new system. Just as the U.S. military is constantly evaluating its technology to ensure access to the optimal equipment, we as vascular surgeons should continue to advocate for the best equipment within our VAs to optimize care for veterans and enhance training. When undertaking such a planning project, start early and anticipate a lengthy, involved process.

References

1. Spenkelink IM, Heidkamp J, Fütterer JJ, Rovers MM (2022) Image-guided procedures in the hybrid operating room: A systematic scoping review. PLOS ONE 17(4): e0266341. https:// doi.org/10.1371/journal.pone.0266341

2. Flannagan CP, Gasper WJ, Caring for the veteran, training the surgeon: The role of the VA in vascular surgery training. Vascular Specialist. 2021 Aug 23 through advocacy. In the 1970s, both patients and physicians passionate about eradicating cancer made a concerted effort to lobby government representatives to support passage of legislation that increased National Institutes of Health (NIH) spending, rallied bipartisan support, and ultimately landed successes such as passage of the National Cancer Act of 1971. The latter intended “to amend the Public Health Service Act so as to strengthen the National Cancer Institute in order to more effectively carry out the national effort against cancer.”

3. Longo WE, Cheadle W, Fink A, Kozol R, DePalma R, Rege R, Neumayer L, Tarpley J, Tarpley M, Joehl R, Miller TA, Rosendale D, Itani K. The role of the Veterans Affairs Medical Centers in patient care, surgical education, research and faculty development. Am J Surg. 2005 Nov;190(5):662-75. doi: 10.1016/j. amjsurg.2005.07.001. PMID: 16226937.

COURTNEY MORGAN is a member of the VA Vascular Surgeons Committee.

Because of these actions, cancer therapies have exploded onto the scene, and the public and our government understand the basics of the disease process and the need to support actions to manage it. This understanding of what is needed and how to achieve it has resulted in significant support through funding and education to ambitiously plan to rid the world of cancer through scientific discovery.

We vascular surgeons now need to turn this tactic towards our patient population. Our patients are dying from cardiovascular diseases that have undiscovered genetic underpinnings and treatments that need to be studied and financially backed.

We must understand that our legislators cannot be expected to be passionate about supporting bills when they do not fully understand the relevant clinical outcomes and how policies can impact the vascular population.

It is our job to use advocacy to educate our lawmakers about the serious problems in the vascular surgery world so they can get behind the solutions that are best for our patients. For example, in some parts of the country, 50% of the amputations that take place for CLI occur without an angiogram!

Wouldn’t it be nice if our lawmakers understood the relationship between an angiogram and potential limb salvage, and then advocated for a bill that said Medicare won’t pay for an amputation unless an angiogram is performed in a patient without sepsis? And wouldn’t it be nice if our lawmakers understood the labor and skill we put into an angiogram, and the subsequent distal tibial bypass, so we vascular surgeons can be appropriately reimbursed for

Anahita Dua

our work? This is where education through advocacy can truly steer positive change for the next generation of patients and vascular surgeons.

So, I implore you, my fellow vascular surgeons, please support the breadth of SVS’ advocacy programs—including the SVS Political Action Committee (PAC), grassroots advocacy via REACH 535, and whatever other opportunities are available—as these combined efforts are our strongest tools for educating our lawmakers about the diseases that kill our patients and the importance of our specialty.

Without the right legislation in place, we will make little to no progress, as dollars will be funneled to other groups that do make the effort to educate. We have to make our own case; no one will do it for us. We owe this to our patients who need us to advocate for them on the national stage.

For more information on how to help educate with the SVS’ advocacy programs, visit vascular.org/advocacy or contact svsadvocacy@vascularsociety.org