6 Tips for Assessing the Opportunity of a PVD Program

Thursday, November 29, 2018 | Ginger Biesbrock & Joel Sauer


In cardiovascular care, opportunities for significant volume growth potential are few and far between. One opportunity that is particularly apparent is the development of a program to assess, diagnose, and treat the peripheral vascular disease (PVD) population.

As obesity trends continue and the US population ages, it’s likely that the incidence of PVD is going nowhere but up. The Centers for Disease Control and Prevention (CDC) estimates the number of Americans with peripheral artery disease (PAD) at 8.5 million, acknowledging that only 25% of those with PAD are actually diagnosed. And, a 2017 study showed that the incidence of peripheral vascular (PV) disease in the Medicare population increased nearly 14% over a 7-year period.

Yet, despite these big numbers, only a fraction of these people are being treated, managed, or even diagnosed at all. There are multiple reasons for this. First, given the current and predicted workforce shortages, we can’t count on the primary care sector to do it. Second, it’s well understood that there is tremendous variability in patient care, begging the need for a more protocol-driven approach. Third, because cardiologists, vascular surgeons, and interventional radiologists all treat the condition, there can be patient confusion about who to see for care. And all of these are exacerbated by the fact that many who have PVD don’t experience symptoms; so, unless they are proactively assessed by a clinician, they remain silent and/or don’t seek care from anyone.

For these reasons, we believe that a focused, programmatic approach to identifying, treating, and following the PVD population can be a bona fide patient volume and revenue enhancing strategy, as well as a way to improve care and decrease cardiovascular events and amputations down the road. That’s a rare win-win in today’s environment.

If you’ve been considering the development of a PVD program, it’s essential to assess the market and quantify the untapped volume of patients that could benefit. Here are 6 tips for such an analysis.

1. Evaluate current programs and referral patterns.

Have you taken inventory of which groups or hospitals are actively focused on assessing and treating PVD patients? Which specialties typically manage PVD patients in your market - cardiologists, interventional radiologists, vascular surgeons? Are there local programs in place already? If so, how are patients typically referred, and by whom?

Understanding referral streams as well as existing program strengths, weaknesses, and gaps is a good way to identify where your group’s opportunity lies. You might even conduct a few mystery shopping calls or visits to take a closer look. And, insights from wound care specialists about the opportunities they see for PVD treatment can also be eye opening.

2. Estimate the number of undiagnosed and untreated PVD patients in your patient base.

Start by reviewing your practice’s PVD identification protocols. How does the clinical team evaluate and diagnose PVD with patients? Do they perform these evaluations consistently, with all patients? If your practice does not have a systematic process to ask about PVD symptoms, examine lower extremities, and provide patient education, you probably have a lot of undiagnosed PVD patients in your database.

Evaluate your intake, exam, and review of systems questionnaires and patient education processes to determine if your team is doing the right things to properly identify these patients. If these systems could use improvement, it’s another indicator that a PVD program could deliver big benefits to patients.

3. Calculate the number of patients who have active coronary artery disease (CAD), against the number with active peripheral artery disease (PAD).

Conduct an electronic medical record (EMR) query or other search. If this ratio is less than 30%, opportunity exists. Estimate the difference and include it in your volume calculations.

4. Review local and regional amputation rates.

If your practice is in the South, Southeast, or other areas of the country where amputation rates are high, it may be an indicator that PVD is not being identified, and/or is being treated too late. Another positive factor for opportunity.

5. Check out your state’s health department data.

Some states require that hospitals collect and submit discharge and outpatient volume data and make it available for purchase. If yours is one of them, you’ve got a goldmine of data nuggets that can help validate your practice volume estimates against statewide trends. The data may also illuminate a regional or statewide market you had not previously considered.

6. Review CMS’ local, associated risk factor prevalence data.

Consider the prevalence of coronary artery disease (CAD), diabetes, and tobacco abuse. All three provide a reasonable estimate of PVD in the Medicare population, which as mentioned, is rising significantly. This risk factor prevalence can provide insights to underdiagnosed or undiagnosed disease.

Assessing the market and quantifying untapped patient volume are essential to determining whether a PVD program is the right option for your organization. The biggest question – are the needs of your community being met? The degree of mortality and morbidity associated with PVD can be great and if the needs aren’t met the opportunity for better patient care and a healthier community is inherent.

Illustration: Lee Sauer


Ginger Biesbrock, PA-C, MPH, MPAS, AACC, is Vice President, MedAxiom Consulting. She is a respected executive, provider and teacher with 20+ years of experience in the health care industry with a concentration in clinical care and operations. Before joining MedAxiom Consulting, Ginger was Director of Operations at West Michigan Heart, a 39 Physician practice with 24 mid-level provider. At West Michigan Heart, Ginger oversaw all operations for ambulatory services, tertiary care and rural health practices. Prior to that Ginger was the COO of the Cardiovascular Group at Centra-Health.

Her areas of consulting expertise include APP Utilization, Care Team Optimization and Transitions of Care. You may contact Ginger at gbiesbrock@medaxiom.com.


 Joel Sauer, MBA, is Vice President of MedAxiom Consulting. Joel consults around the country in the area of value-oriented physician/hospital partnerships preparing health organizations for the value economy. His work includes vision and strategy setting, creating and implementing effective governance and leadership structures, co-management development, joint venture and other innovative partnerships, and provider compensation plan design. Beyond the above, Joel has a wealth of experience in service line development, clinical strategy development, provider workforce planning – including care team creation and physician slow-down policies, MACRA and bundled payment planning, and operational assessments. 

Contact Joel at jsauer@medaxiom.com.


MedAxiom Consulting is the nation’s leading cardiovascular-specific consulting group, working with a range of private practices, hospitals and health systems across the country to improve the delivery of CV health care. To learn more about our team, please visit our website.                     




Leave a Comment

« Back