Here, There and Everywhere: Vein Center Treatment

Here, There and Everywhere: Vein Center Treatment

Can Society Continue to Afford Varicose Vein Center Treatment?

Over the past ten years, the number of varicose vein treatments has increased by 1600%.

Why the dramatic increase in varicose vein center treatment?

Before the year 2000, only vascular and general surgeons could do the stripping procedure to treat varicose veins. At that time, that was all that was available.

Stripping was brutal and very painful. It required that you go to sleep with a general anesthetic. It had to be done in the hospital or a surgery center. It often required that you stay in the hospital recovering for many days.

The trauma of the procedure caused new veins to form. These new varicose veins formed around where the varicose veins were ripped out.  The medical term for this process is neovascularization.  It is how your body responds to a severe injury.

These new abnormal veins meant that the stripping operation failed. The veins recurred. The surgeon was unhappy and frustrated. The resulting scarring, pain and new varicose veins were frustrating for the patient.

Everyone was unhappy with these terrible results. The repeated unsuccessful attempts to get rid of the painful varicose veins was tough on everyone.

Fast Forward to the Year 2000

Laser and radiofrequency successfully replaced the stripping operation. Surgeons, hospitals, and general anesthesia were no longer required.

Any doctor could legally treat veins even if they had no training in venous disease or varicose veins.


These new minimally invasive procedures could be done in a doctor’s office under local anesthesia. There are no mandatory regulations on who can perform these procedures as long as they are done outside of a hospital.

In a hospital, there are credentials committees that protect you from a doctor performing a procedure or practicing in a field in which they are not trained.

You do not have that protection when doctors do procedures in their office.

Why are Vein Centers Popping Up Everywhere?

Insurance regulations, governmental mandates and decreasing reimbursements are severely discouraging doctors. The average cost of a medical education is roughly one million dollars. That covers the tuition, lost income, and student loans. That debt is on the mind of every doctor when they graduate from medical school.

Most doctors would not recommend a medical career for their children. Doctors have a higher incidence of alcoholism and depression compared to other professions. Fighting insurance companies every day to try to get their patient’s health care needs covered is having a deleterious effect.

Seventy percent of doctors spent more than one full day per week on computer and paperwork in 2014. This has increased from 58% of doctors in 2013. This is according to the Physician’s Foundation survey.

Spending more time in front of a computer and doing more administrative tasks is very disheartening. That means less time treating and interacting with patients. Treating patients is the reason that most doctors chose to be doctors.

Burnout among physicians is 10% higher than the general population according to James Madara, MD, the CEO of the American Medical Association.

Private practice is disappearing as more doctors have to join hospitals to meet their payrolls. Most doctors find that being a hospital employee has many disadvantages. That leads to more dismay and frustration.

So What Does a Doctor Do who is Unhappy in Their Chosen Field?

There are no rules or regulations that a doctor has to train in veins before they start treating veins.

Doctors who never treated a vein in their lives are opening vein clinics. Vein clinics are on every street corner like nail salons, urgent care medical facilities, and personal fitness gyms.

Entrepreneurial varicose vein doctors are everywhere. Vein franchises are booming.

Many emergency room doctors, family doctors, and radiologists who are sick and tired of practicing in a hospital in the field in which they were trained are switching to treating veins in an office setting.

Vein clinics are totally unregulated. There are no protocols, training requirements, or standards of care. It’s like the Wild West.

Over the past two years, doctors have tried to police their own to stop the abuses.

Venous societies created an accrediting commission called the Intersocietal Accreditation Commission. It is voluntary. Starting in the fall of this year, Blue Cross/Blue Shield of Massachusetts will make accreditation mandatory for reimbursement for treating veins in an office setting. That is a step in the right direction.

This Huge Increase in Vein Procedures is Financially Unsustainable

Medicare reimbursement decreased 20% this year for saphenous vein ablations. This procedure is usually necessary when treating varicose veins. In 2011, saphenous ablations were reimbursed $1700 by Medicare. In 2012, the reimbursement was decreased to $1400. In 2015, reimbursement dropped to $1100.

The reimbursement payment must cover:

  • laser leases
  • laser maintenance contracts
  • ultrasound machines
  • expensive disposable laser fibers
  • disposable laser sheaths
  • sterile equipment packs
  • medical supplies
  • assistant’s fees
  • payroll
  • malpractice
  • continuing education
  • electronic medical records
  • accreditation costs
  • computer systems
  • administrative costs
  • insurance billing costs
  • rent
  • utilities
  • office supplies

Hospitals are reimbursed for these costs while doctor’s offices are not. Eventually, the increasing costs of performing vein center treatment and the decreasing reimbursement will dampen the enthusiasm of those doctors switching into the vein field.

However, to balance these increasing costs, a growing number of unnecessary vein center treatment and unnecessary testing has been the result.


Some doctors have “gone off of the reservation”. Many doctors are not happy in the field in which they trained. They are switching to treating veins with no varicose vein training at all.

Beware of this trend.

It is causing an explosion in the number of vein procedures. Many of these vein procedures and vein testing are unnecessary.

We must all play the insurance game. Legitimate vein doctors must do what is right to try to get their patients proper care.

The backlash from insurance companies denying necessary varicose vein center treatment is overwhelming. We have to jump through more and more insurance company hoops.

The increasing costs of these minimally invasive varicose vein treatments are unsustainable. The burden of these costs is being shifted to the patient in the form of higher and higher deductibles.

What can you do?

Have your varicose veins fixed while it is still financially feasible.

Call us at 724-969-0600 or contact us here to learn more.

About The Author

Dr. John Happel

Dr. John Happel has been in practice as a surgeon since 1986 in the Pittsburgh region. He specializes in vascular surgery and has subspecialized in the treatment of varicose and spider veins since 1999. Dr. Happel is board certified in vascular surgery and recertified in vascular surgery in 2012. He was chosen in 1985 to fulfill the position for the vascular surgical fellowship at the world renowned Mayo Clinic.