Advanced Minimally Invasive Vein Care

Advanced minimally invasive vein care procedures have vastly improved since their inception.  Initially performed in the hospital, most are routinely performed in outpatient centers. The procedures are less invasive, are well tolerated by patients, have lower complication rates and have good cosmetic results. As competition increases in this market it is essential to establish an outpatient clinic that meets the needs of the patient and practice. This article is intended to shed light on the changing dynamics from hospital systems to stand alone vein centers and the key elements to successful implementation of the modern outpatient vein center.

Establishing an effective outpatient vein care center involves decisions about space, marketing, location, equipment, services, staffing, organizational structure and capital equipment.  With these logistical items is the skeletal system of the vein center; however the backbone of your center must be a patient centered approach.

To compete with established and upcoming centers one must focus on the look and feel of the center from the patient’s point of view.  The space should be inviting and comforting using natural elements such as hardwood flooring, granite countertops in reception areas and natural elements such as water or natural plants in the waiting room.  The lighting should be non-florescent in nature and seating should be comfortable. Work areas should not be visible or audible to those in the waiting area. Bottle water or coffee is often complimentary and should be considered.  Depending on the number of attending physicians there should at least be three consultation rooms.  These should offer upscale seating and should we warm and non-threatening.  The use of standard physician exam tables is considered a negative and is discouraged.  Preferably there should be two sclerotherapy and two procedure rooms.  The sclerotherapy rooms should be fitted with dental or orthodontic chairs that the physician can manipulate with the ease of a foot pedal.  This provides seamless movement of the patient during sclerotherapy and is comfortable to the patient.  The location of diagnostic testing should be a key element to planning.  Two to three rooms for diagnostic testing should be included in the initial plan, as the vein center will grow.  The procedure rooms can also be used for diagnostic testing when procedures are not scheduled.  Work flow patterns should be considered to create an environment that protects privacy.  Ample storage is needed to house the catheters, linen, drugs and other supplies.  Restrooms both for the patients, visitors and employees should be planned along with break areas away from patient contact or view.   The outpatient vein center should be located in an area with easy access plenty of parking and ideally in the most affluent area of the city or town.

Marketing is one of the key components of a successful vein practice.  The emphasis should be placed on internet marketing strategies that are patient driven. Eighty five percent of your marketing budget should be internet based. Internet marketing consists of the website, SEO (search engine optimization) both organic and pay per click, memberships in professional groups and listing in national data bases. The existing fifteen percent of the marketing budget should be to referral bases and focused toward community events such as walks and charities.

Often when a physician is considering starting a vein practice he or she has been approached by a manufacturer of one of the endovenous ablation devices.  The initial focus is on one of the two methods of ablation Radiofrequency or laser.  Although I am not going to cover the advantages or disadvantages of each application in this article, offering both provides an advantage in the market place.  Providing both technologies will attract consumers from other providers who only offer one of the devices.  Another advantage is both technologies will have a marketing force behind them, helping to drive patients to your center.  America is the land of options, providing choices allows the patient some control of their care.  Often overlooked initially is the role of sclerotherapy.  It is integral that an emphasis be put on sclerotherapy from the beginning.  The use of sclerotherapy is effective for the management of the distal segments of the ablated veins, tributaries, perforators and ulcerations. Cosmetically it provides the most satisfaction to your client.  Advances in sclerotherapy have changed the use and management of the outpatient vein patient.  It is imperative to have a certified fitter for compression garments if sole in house or a facility close by in which the center collaborates.  Other services to consider are pulsed light therapy, microdermabrasion, Veingogh and various types of vein illuminators.

Equipment in the vein center consists of furniture, medical office supplies, procedure beds, medical devices and diagnostic equipment.  The furnishings should be done with a theme and/or color pallet in mind; it is suggested to use a professional designer and not to leave this task to the corporate purchasing department or practice manager.  The logo of the vein center and thematic elements integrated in the website and advertising should be the same as that of the space.  Diagnostic equipment choices should be made by a seasoned ultrasound technologist and more than one company should be demonstrated.  The purchase of capital equipment should be based on five year needs, it is imperative that you decide on an ultrasound machine that meets your current and future plans. A mid to high level diagnostic system is advised and cheaper systems should be avoided.  Purchasing the wrong diagnostic equipment is one of the most common mistakes made in the industry.

Organizational structure is another key component to a successful center.  There are effectively to components in which the staff is classified, the medical and technical staff. The medical staff consisting of:  Physician(s) Medical Director, extender(s), nurse’s, medical assistants, secretarial staff, pre-certification specialist and the practice manager.  The technical staff consists of a Registered Vascular Technologist and Technical Director of the Vascular Lab. This position is one and the same in a one technologist vein center.  The Technical Director position should be considered when hiring the first technologist, as ICAL accreditation for the center is another key component to success.  For the qualifications of a Technical Director visit the ICAVL.org. and print out the Standards.

The last and most important consideration is that of the focus of the practice.  There are two prevailing practice models in the market. The first and most widely used is what I call the procedure driven approach. The second and more successful is the patient driven approach. In both cases the patient is brought in by marketing, referral or by a free vein screening. The physician assesses the patient based on symptoms, visual appearance and often orders a diagnostic study to see what needs to be treated.  While this is essential to forming a logical treatment plan in both systems, the focus in the procedure driven approach is what veins can we ablate using radiofrequency or laser. The patient might have come in for a particular large varicosity initially, however this gets lost in the process.  The ultrasound usually is much shorter time and focuses on the great saphenous and small saphenous veins. Patients in this type of practice often have all of their appointments set out based on the procedures.   They are told to wait a period of time to allow for the procedures to work and to have sclerotherapy in a month or two. The patients are often not seen again or get lost in the practice as all of the procedures have been performed.  I have talked to numerous patients they either is waiting for the practice to call and set up additional appointments.  The receptionist expects the patient to call and set up sclerotherapy, and the physician is oblivious to all to it all.  The accessory saphenous veins, perforators and complicated venous anatomy often go overlooked or neglected accidentally.  The impact of this limited focus can have impacts that tenfold throughout the practice.  The result is a patient who questions the motives of the practice and the quality of the physician. The nuances are subtle but have a lasting impact on your staff and overall feel of the practice. The truth is the physician usually is unaware that this is happening in his or her practice but wonders why they only perform 20-30 procedures a month.  

The patient centered approach places the emphasis on the patients wants and desires.  The patient desires should be confirmed by the physician and an action plan put in place. This may sound like an unnecessary step; however it keeps the practice on point and reaffirms the commitment to the patient.  Attention should be placed on the reasoning for the initial visit, if the patient was initially complaining of varicosities in the right leg, then the right leg should be treated completely first even if the patient has bilateral problems.  The conventional wisdom is that if you fix only the right leg that the patient will not return for procedures on the left, however this has shown time and time again to be false.  The reason for the second extremity being treated should be because they are so happy with the results of the initial symptomatic leg.  Sclerotherapy is essential to success of the patient and a reasonable expectation of cost and visits should be available up front.  Consideration of the patients time should be considered when scheduling follow up and pre-operative appointments.   The last process should be a consultation with the patient to review the initial plan of action, confirming results and resolving any lasting issues.  This comprehensive approach with a patient driven inflow, constant recognition of the patients needs during treatment and a patient centered outflow will allow the center to make real changes as situations arise in the practice.  This approach also builds a lasting relationship with your clientele that will permeate the community as word of mouth, positive or negative is the lifeline of your practice. 

There are many more technical considerations to be made when opening an outpatient vein center, however having a patient centered approach should guide your offices processes.  Brian Sapp, RVT, RPhS is one of the owners of Registered Vascular Solutions, Inc. He has provided on-site clinical educational courses and consulting for vein centers and vascular labs since 2006.  Brian has been performing vascular testing for over 16 years and is passionate about vein disease diagnosis and treatment.  For more information on how Brian or his staff can assist your vein practice contact registeredvascular.net