Advocating for Our Patients Through Better Government Policies

Rep. Dave Loebsack (D-Iowa), left, meets with Academy Advocacy Ambassador Philip I. Niles, MD, MBA, during Mid-Year Forum 2016's Congressional Advocacy Day. This in-person advocacy allows attendees to directly interface with federal lawmakers on behalf of ophthalmology’s patients, discussing topics such as fair Medicare physician reimbursements, relief from administrative burdens, and preserving access to sight-saving compounded drugs.

In 2016, ophthalmology experienced an unparalleled year successfully advocating for our patients and profession. Whether by steering federal policies that ensure access to quality care, or derailing state initiatives that put patient safety at risk, the Academy stood tall on behalf of those who rely on our care.

Our efforts were led by the Academy’s community of ophthalmologists, whose collective advocacy in Washington, D.C., and across the nation deliver victory after victory. Your efforts protected our patients by ensuring they have access to the highest quality of care. They helped remove the administrative barriers that stand in the way of the critical, one-on-one relationship that patients and the physicians need.

Federal Highlights

Preserving fair Medicare reimbursements for glaucoma and retinal detachments

We scaled back substantial cuts to retina and glaucoma reimbursements in the 2016 Medicare fee schedule. Our strategy: Convince the Centers for Medicare & Medicaid Services that the methodology it used failed to consider the entire picture of patient care. The Academy waged an aggressive, multi-pronged campaign to overturn this payment methodology, using legislative, regulatory and legal approaches. Throughout this effort, we stressed that CMS consider all factors—including intensity and time—when it sets reimbursement rates. CMS failed to do that when it cut glaucoma and retina reimbursements.

Easing burdens for reporting electronic health record usage

Federal policies that require physicians to report on their meaningful use of electronic health records remain cumbersome and distract physicians from patient care. The Academy partnered with other medical specialty societies to lighten the burdens of these policies. For instance, convincing CMS to shorten the reporting period for the meaningful use program, the Academy helped ensure that ophthalmologists and other physicians can focus on what they do best—care for their patients—by avoiding penalty-causing administrative burdens.

The Academy also led the winning effort that resulted in a blanket exception from the 2015 program.  This effort, spurred by CMS’ late, irresponsible policy issuance, protected nearly all of the nation’s health care providers from penalties in 2017 for their reporting.

The Academy’s 2016 “Surgery by Surgeons” campaign, underwritten by the Surgical Scope Fund, supported the successful efforts of state ophthalmic societies and medical associations to derail dangerous optometric surgical scope  expansion bills.

Positioning subspecialists for fairer cost assessment under Medicare quality programs

Medicare is shifting to a value-based system for paying physicians for patient care. This program includes measuring and comparing physicians’ resource use. In anticipation of this shift, the Academy successfully secured special, voluntary designations—known as taxonomy codes—that will help ensure CMS measures oculoplastic, retina, glaucoma and uveitis subspecialists against their own set of practitioners. When these designations go into effect, they may help ophthalmic subspecialties stand out among their peers in other areas of eye care.

The Academy continues to seek similar opportunities for other ophthalmic subspecialties, including neuro-ophthalmology, pediatrics and cornea.

Protecting ophthalmology from intrusive national global surgery data collection effort

Months of objections by the Academy and our partners representing other medical specialties led to CMS drastically scaling back its plan to collect global surgery postoperative visit data.

The agency’s proposed approach to this data collection mandate would have added as many as 10 new codes to each patient bill nationwide—which was too broad and inconsistent with what Congress intended when it forced CMS to halt a planned unbundling of global payments for surgical services in 2015.

In the process of impacting this policy, the Academy helped ease the burden on ophthalmologists by convincing CMS that it should reduce the number of ophthalmology procedures impacted from 240 to 33.

The agency also agreed to limit its collection efforts to just nine states while changing the coding process. These changes mean most ophthalmology practices will find relief.

State Highlights

Preserving surgery by surgeons nationwide

The Academy’s community of ophthalmologists waged successful battles in seven states and territories to protect patient safety and keep ophthalmic surgery in the hands of surgeons. Our colleagues in Alaska, California, Delaware, Iowa, Illinois, Massachusetts and Puerto Rico turned back significant optometric challenges, in which lawmakers were asked by optometry to add laser, scalpel and injection privileges to optometrists’ scope of practice.

Giving our patients access to early prescription eyedrop refills

Five states joined the Academy's ongoing, national effort to ensure that our patients have access to the prescription eye drop medication on which they rely. By adopting early prescription refill policies for medicated eye drops, lawmakers are ensuring that patients in Arizona, Colorado, Louisiana, West Virginia and Missouri will no longer risk running out of their necessary, sight-saving medications because of inadvertent spillage or waste.

Winning Advocacy Victories Through Member Investments

The Academy honored Surgical Scope Fund donors at a reception during Mid-Year Forum 2016. Kenneth P. Cheng, MD, Chairman of the Surgical Fund Committee, also recognized past Chairman Thomas A. Graul, MD, at the event. Thanks to donor support, the Academy can provide a louder voice in fighting for our patients’ rights to safe ophthalmic surgery by qualified practitioners.

The resources needed to advocate for our patients are made possible through member support for OPHTHPAC® and the Surgical Scope Fund. In Washington, D.C., and throughout the 50 states, financial contributions are among the ways that Academy members are amplifying our profession’s voice for lawmakers to hear. 

These investments serve to activate staff and monetary resources that can ensure that our lawmakers are well-educated on how their decisions affect our ability to provide quality eye care.

In 2016, both funds experienced unparalleled success, winning relief from administrative and regulatory burdens and staving off challenges by those who do not place a premium on patient safety.

OPHTHPAC (Federal Advocacy)

OPHTHPAC®, Academy’s political action committee, helped build the relationships with Congress that enabled us to advance our position on many of ophthalmology’s federal issues. Because of OPHTHPAC, we were able to call upon our many friends in Congress in our time of need.

In 2016, the relationships that OPHTHPAC helps maintain were instrumental in compelling 100 members in the U.S. House of Representatives and Senate to join our fight to have the Centers for Medicare & Medicaid Services revisit its recent decision to cut retina and glaucoma fees. 

When the Academy fought back against CMS’ ill-conceived Medicare Part B drug pricing proposal, which would have inadvertently barred our patients from sight-saving drugs, Congress again came to our aid, proving that long-lasting relationships make a difference in developing sound federal health care policy.

Without OPHTHPAC investments, the Academy does not have:

• Important leverage to fight bad policy when we need it;
• The ability to take action when Congress forces unfair legislation upon our physicians and ultimately our patients; and
• The opportunity to elect and re-elect those who will give ophthalmology the strong support our profession needs.

Surgical Scope Fund (State-Focused Advocacy)

In each state, the Surgical Scope Fund ensures that physicians on the frontline of our fight to preserve patient safety have access to staff and monetary resources that make a difference.

In 2016, the Surgical Scope Fund won every battle in which it was activated, enabling our colleagues in six states to defeat state legislative surgical-scope proposals that would have placed our patients at risk, including Alaska, California, Delaware, Illinois, Iowa and Puerto Rico. 

Your contribution to the Surgical Scope Fund is confidential, and effectively strengthens ophthalmology’s position when the next challenge to patient safety arises.