Thursday, April 30, 2015

Advocating for all of us

To start this editorial, I want to thank several POA members for taking two days away from their offices to travel to Washington, D.C. and advocate on behalf of all POA members at the AOA Congressional Advocacy Conference. Drs. Mark Margolies, Steven Eiss, Lori Gray, David Evans, Paul Lobby, James Deom, Michael Mittleman and Mark Dalton spent Monday learning the details of the current issues facing optometry in Washington, and Tuesday visiting legislators and their staff on Capitol Hill to make sure optometry’s voice is heard. This was no small sacrifice from a group of doctors who are already giving significant time to advance our profession, and protect optometry from losing access and privileges. We were accompanied by a diverse and enthusiastic group of 12 students from PCO and SUNY College of Optometry, who took time away from their classes and studies to advocate on your behalf, and on behalf of the future of optometry.

Many of you may not be aware of all the issues facing optometry on the federal level. Even those of us who have participated in the last few conferences needed to be updated on the issues. I apologize for the length of this article, but there are several issues, and some are complex. I hope you can take a few minutes to get yourself up to date on these important national issues. 

One of the bills we were discussing with legislators was HR2. This bill addresses Medicare payment reform and the flawed sustainable growth rate formula. As you may have already heard, our timing couldn’t have been better. This bill passed the House before we went to Washington, and passed the Senate on the evening of the day we were on Capitol Hill. This is the bill that has resulted from the threat of significant reductions in the Medicare Fee Schedule for many years, and has required a large number of temporary patches that kept pushing the issue off without solving the underlying problem. The AOA has been working tirelessly during the process of getting to this point to ensure that optometry is treated fairly in the new law. You can expect small increases in the Medicare Fee Schedule over the next few years, followed by the potential for significant increases if you meet certain quality measures. Thanks to the AOA, you have the opportunity to participate in those incentive programs. Also thanks to the AOA, you will be able participate in a more streamlined fashion with less administrative effort.

This bill will combine the current PQRS, EMR Meaningful Use, and Value-Based Modifiers into a new program called MIPS (Merit-Based Incentive Payment System). Each provider will get a MIPS score, which will determine their bonus (or penalty) versus the standard Medicare Fee Schedule. One of the ways you can meet these requirements is to be connected to a registry. With a registry you will get instant feedback about your practice. You will be able to see, for example, how many of your glaucoma patients have had a visual field done in the last year. You will also be able to compare your performance against benchmarks and other practices. This functionality will enable you to meet many of the MIPS requirements seamlessly, without additional tracking or reporting. The AOA has developed an eye care registry for optometry that will be rolled out at Optometry’s Meeting in Seattle. This will be a free member benefit for all members. The registry will also enable AOA to collect aggregate data that will be very useful in evidence-based research and advocacy efforts, just like other medical professions using registries to track things like childhood immunizations. Expect to hear a lot more about the registry and MIPS over the next few years. The AOA will be your source for information and guidance on these programs.

Another bill that we lobbied for addresses Health Service Corps inclusion for optometry. This bill has been reintroduced for a few years and hasn’t passed mainly due to congressional gridlock. It would allow optometrists to practice at community health centers and have access to scholarships for students who commit to providing service after graduation, as well as loan forgiveness for recent graduates who decide to work there. This bill has significant support among legislators, and hopefully with the SGR fix finally behind them, and the progress they made by cooperating and comprising on that issue still fresh in their minds, we have a chance to move forward on this issue as well.

The third piece of legislation that we addressed is the Expanded Veterans Access to Primary Eye Health and Vision Care Act. As part of the recent VA reform legislation, additional residency slots have been created within the VA system. This bill would set aside 20 of those new slots for optometry. The students who accompanied us to Washington were very enthusiastic about this bill, as selection for VA residencies can be quite competitive. Adding more slots gives them additional opportunities to gain valuable experience. This bill does not limit optometry to only 20 additional slots, it only sets that as a minimum number of additional slots above the current level. It will also help to reduce wait times for needed eye health and vision care for our nation’s veterans.

There is also a new effort on the federal level to pass legislation to combat some of the abuses by vision benefit plans. This would be a complementary bill to our state effort, and would ensure that plans couldn’t use exceptions like ERISA to circumvent the state rules. This legislation is still in early discussions and hasn’t reached the point where we were ready to talk to legislators about it, but our leaders at AOA are certainly aware of the issue and working on your behalf to strengthen our state efforts.

As you all undoubtedly encounter every day, there are many people who don’t really understand what an optometrist is and does. Not surprisingly, this is also true of legislators and their staff. We took time during our visits to educate them about optometry, our scope of practice, optometric education, and AOA programs like InfantSEE.

We also learned that Congress will be in session for significantly more days in 2015 than it was in 2014. This, combined with an increasing impetus to take action and a slightly more cooperative atmosphere, will likely result in more laws being passed. This is a positive thing for us in our efforts to move favorable legislation, but it is also a challenge, in that we have to be vigilant for any legislation that would result in a negative impact. This could come as the result of a purposeful attack on our profession, or as a result of an unintentional oversight. On a positive note, the efforts to repeal the Harken Amendment to the Affordable Care Act received almost no support in the last session, and that legislation appears to be dead for the short term. The other attack on optometry that has been losing steam over the last few years was formerly known as the Sullivan Bill. This was an effort to undermine optometry’s scope of practice and confuse the public about our abilities and training. It has been repeatedly defeated, and also looks like it will not to be reintroduced thanks to efforts over the last few years. Our leaders, staff and lobbyists are also acutely aware of the actions of 1-800-CONTACTS in state legislatures over the last few months. Fortunately those efforts have been stymied for the most part. The AOA is vigilant in watching for any similar legislation being introduced on a national level, and will take appropriate action if that should occur.

Of course, a day of discussing legislative priorities at the federal level wouldn’t be complete without an AOA-PAC update. The good news is that Pennsylvania has moved from the last place in giving compared to other states, to the second to last place. While this is a move in the right direction, we still have a long way to go. Nationwide AOA-PAC donations for 2014 were just under $1,000,000. This was an increase versus 2013, but still short of the AOA’s goal of $1.25 million. That means that our leadership has to be very selective about which candidates they support because the funds to support every one of the desired candidates are non-existent. They have established a new website, www.aoapac.org, just for AOA-PAC to make the process of giving very simple. You can make a donation using a credit card very easily. You can also see who in Congress the donations were able to support in the last cycle.

Some of the money is also spent to pay for telemarketers to call AOA members to ask for donations. This is necessary since the telemarketers generate a large percentage of the donations that are received. I encourage you to go to the website now and make a donation, or set up recurring donations, so the AOA can save the cost of calling you and you can avoid receiving the calls.

As additional motivation, ophthalmology has two PACs. One is a basic PAC to address all issues that affect their members, and the second is an “Ophthalmic Surgery Containment Fund,” which, as the name implies, is a fund specifically designed to limit optometric scope of practice. That first PAC raises more money than AOA-PAC, and the second one is almost as large as AOA-PAC. If we are going to maintain our current scope and participation with insurance plans, we need to maintain our strong relationships with legislators. Whether you like it or not, part of that is supporting their campaigns. AOA-PAC is currently receiving the vast majority of its funding from a very small number of older doctors, who are each giving a large yearly donation. We would have a more sustainable PAC if the AOA received a small donation from every member. For your own sake, and for the sake of the next generation of optometrists, if you aren’t already donating to AOA-PAC, go right now and make either a one-time or recurring donation. If we all do a little, no one has to do a lot.










Richard Christoph, O.D.
POA President