Washington RepoRt2010 Results & 2011 Agenda

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MessAge FRoM AcAdeMy secRetARy FoR FedeRAl AFFAiRs

Dear Colleague:

Welcome to the inaugural digital edition of the American Academy of Ophthalmology’s annual Washington Report. The Academy will not be mailing a printed version of this report, choosing instead to provide a look at the Academy’s 2010 advocacy results and what is in store for 2011 through this interactive, cost-effective format. While we as ophthalmologists are focused on providing quality eye care, the Academy’s Governmental Affairs division is at work to ensure our interests — and our patients’— are represented before policymakers. The Academy is your voice in Washington.

I encourage you to stay connected in 2011 through the Academy’s weekly Washington Report Express newsletter and through our online advocacy resources: the Advocacy website and the new “AAO Eye on Advocacy” blog.

Sincerely,

Gregory P. Kwasny, MD

Dr. Kwasny (L) with David W. Parke II, MD, Academy Executive Vice President/CEO.

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Washington RepoRt2010 Results & 2011 Agenda

Washington presented major challenges for physicians in 2010, with health care reform at the top of the national agenda. Not only was a sweeping reform law passed, but physicians also found themselves on a virtual reimbursement roller coaster as Congress intervened multiple times with temporary fixes to Medicare’s flawed sustainable growth rate (SGR) formula. Those challenges carry into 2011 as health care reform law rule making continues and its implementation begins, and as lawmakers search for a permanent solution to fair Medicare physician reimbursement.

2010 AcHieVeMeNts FoR oPHtHAlMology

• Sidelined a 23 percent Medicare payment cut caused by the SGR

• Protected implementation of the new practice expense data that continues to boost payments for ophthalmology, including an increase in reimbursement for cataract surgery

• Obtained less-restrictive Medicare policy for glaucoma eyedrop refills

• Pushed out to later years the Medicare penalty dates for physicians in the final health care reform law

• Ensured that optometrists were not mandated as physicians under Medicaid in the health care reform law

• Gained adoption of additional ICD-9 codes, developed by the Academy and the American Glaucoma Society, to delineate severity levels for glaucoma

Catherine G. Cohen, vice president of Governmental Affairs

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oVeRHAul oF HeAltH cARe ReFoRM lAw toPs AcAdeMy’s 2011 AgeNdA

Repealing egregious components of the 2010 health care reform law is one of the Academy’s top priorities in 2011. Specifically, the Academy will press Congress to:

• Eliminate or push back scheduled penalties on physicians (e.g., 2012 penalty for failure to adopt electronic prescribing and 2014 penalty for non-participation in the Medicare Physician Quality Reporting System in 2013)

• Repeal the Medicare Independent Payment Advisory Board, which seriously undermines Congress’ oversight role in the Medicare payment system and creates another unrealistic SGR-type control mechanism

• Ensure accountable care organizations (ACOs) and resource use feedback reports are fair for ophthalmologists

• Qualify pediatric ophthalmologists as pediatricians for the Medicaid electronic health record incentive program (up to $63,750 over six years)

• Implement medical-liability reforms that will lower health-care costs and strengthen the doctor-patient relationship

• Preserve patient access under Medicare, with a permanent solution to the sustainable growth rate and real options to contract with patients

Top left Russell Van Gelder, MD (left), Niraj Patel, MD, and Richard Mills, MD, meet with an aide to Sen. Maria Cantwell, D-Wash. Second down S. William Clark III, MD (left), with Rep. Michael Burgess, R-Texas, vice chair of the House Health Subcommittee. Third down Rep. Peter Roskam, R-Ill., a member of the House Ways and Means Committee (right) and an aide meet with Mark Krakauer, MD, and Ruth D. Williams, MD, and her son Charlie. Fourth down Rep. Henry Waxman, D-Calif., ranking member of the House Energy and Commerce Committee, with Diana Shiba, MD. Bottom Sen. Ben Nelson, D-Neb., meets with Nebraska ophthalmologists James Gigantelli, MD, and Peter Whitted, MD, JD.

ReiMBURseMent anD QUaLitY oF patient eYe CaRe pRioRities

2010 Results 2011 agenda

Physician Quality Reporting system/ e-Prescribing jAdvocacy Priority

The Academy advocated so that ophthalmologists could have several reporting options under the Medicare Physician Quality Reporting Initiative (PQRI, renamed Physician Quality Reporting System, or PQRS, in 2011). Nearly 60 percent of U.S. Academy members participated in 2010 PQRI, and nearly 50 percent in the Medicare e-prescribing incentive program. However, since less than 50 percent of ophthalmologists succeeded in 2008, we convinced CMS to lower the threshold for success in claims reporting to 50 from 80 percent for 2011. The Academy also achieved a CMS-recognized ophthalmology registry option under 2010 PQRI.

The Academy will work with other medical groups to push out, or eliminate, penalties starting with e-prescribing in 2012. Because of inflexible exclusions, CMS could wrongly penalize some ophthalmologists based on 2011 data.

Heath information technology (Hit)jAdvocacy Priority

The Academy’s fight for relevance for our specialty in the development of new “meaningful use” requirements paid off with improvements in ophthalmologists’ ability to qualify for Medicare HIT incentive payments starting in 2011.

The Academy will continue to work with CMS on the advanced stages of “meaningful use” requirements to facilitate ophthalmology’s success in the Medicare HIT incentive program.

Five-year Review and Ruc RevaluationjAdvocacy Priority

The Academy defended ophthalmology codes in the fourth Five-Year Review before CMS and the AMA/Specialty Society Relative Value Scale Update Committee (RUC) through research, data and a joint survey with dermatology. The Academy battled alongside the retina societies and the American Glaucoma Society to defend intravitreal injection and OCT codes during the rolling Five-Year Review and appealed to CMS when faced with inappropriate value recommendations by the RUC.

The Academy will appeal the interim value for intravitreal injection reimbursement, which was substantially reduced in the 2011 Final Rule when CMS accepted the RUC work relative value. In addition, the Academy will defend new CMS targeted codes, including cataract and glaucoma surgery codes.

Quality eye care in the VA and MilitaryjAdvocacy Priority

The Academy pushed for steps to protect patients from another Palo Alto incident, in which veterans were blinded or suffered severe vision loss through optometric mismanagement of glaucoma treatment. In June 2010, the Department of Veterans Affairs called for and received a cooperative agreement between ophthalmology and optometry from each facility and proposed periodic, pertinent, clinical review of cases by ophthalmology. In addition, Congress passed legislation, long-sought by the Academy, that should help the VA recruit ophthalmic technicians.

The Academy continues the fight for ophthalmology-led eye care teams through the VA system to protect patients and provide high-quality eye care. The Academy is also working to secure adequate funding to expand the potential of the new Vision Center of Excellence.

Left Cynthia Mattox, MD, and Academy Medical Director of Health Policy William L. Rich III, MD, discuss current ophthalmology Medicare payment issues. Middle Pennsylvania ophthalmologists Roger Zelt, MD (left), and Kenneth Cheng, MD, meet with Rep. Jason Altmire, D-Pa. Right Rep. Elliot Engel, D-N.Y., senior member of the House Energy and Commerce Committee, was presented the Academy’s Visionary Award during the 2010 Congressional Advocacy Day.

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oPHtHPAc leAds witH youR suPPoRt

OPHTHPAC, the Academy’s voluntary, non-partisan political action committee dedicated to advancing ophthalmology’s interests at the federal level, achieved a record 20 percent member-participation milestone in 2010. In all, OPHTHPAC raised more than $1.8 million in the 2009-2010 cycle to elect congressional candidates who are dedicated to protecting patients’ vision. With more than 60 percent of OPHTHPAC-supported candidates winning their respective elections, it was ranked third in strategic giving among the top 20 health industry PACs.

Most candidates and members of Congress do not have a background in or history with ophthalmology or the practice of medicine. OPHTHPAC plays a key role in educating them about the issues facing our practices, our patients and the future of our profession. However, this is only possible with your individual support. Join your colleagues — donate to OPHTHPAC today. If every Eye M.D. gives a little, we all gain a lot.

Federal Advocacy forEye M.D.s and Our Patients

Top left Sen. John McCain, R-Ariz. (center), stands with the Arizona delegation of ophthalmologists to 2010 Congressional Advocacy Day. Second down Rep. Earl Pomeroy, D-N.D., greets Fargo ophthalmologist Lance Bergstrom, MD, and his children. Third down 2011 Academy President Richard L. Abbott, MD, and President-Elect Ruth D. Williams, MD, confer during a January meeting of the Ophthalmic Advocacy Leadership Group. Fourth down Dr. Parke greets Rep. Richard Neal, D-Mass. Bottom Sen. Kristen Gillibrand, D-N.Y. (left), meets with Andy Prince, MD (center), and Roger Husted, MD, on physician payment issues.

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cAll to ActioN! AcAdeMy PusHes FoR PAssAge oF tRutH-iN-AdVeRtisiNg Bill

The Academy will work closely with a coalition of medical societies to support passage of the Healthcare Truth and Transparency Act of 2011 (H.R. 451). The bill addresses patient confusion over who is an MD, given the many types of providers in the health care marketplace today. The legislation would make it unlawful to make deceptive statements or engage in any act that misleads patients — whether in person or in advertisements or marketing efforts as to one’s education, training, degree, licensure or clinical experience.

Top right Jim Jackson, MD (left), and his wife meet with Rep. Dave Camp, R-Mich., on the Capitol steps. Second down Andrew Packer, MD (right), addresses from left, Rep. Christopher Murphy, D-Conn., his aide and Joseph Giacometti, MD. Third down Rep. Xavier Becerra, D-Calif., (center) with Lauren Patty, MD; Ron Smith, MD; Reid Wainess, MD; and Ruben Sanchez, MD. Fourth down Rep. Charles Boustany, R-La., with Dr. Parke and Catherine G. Cohen. Bottom Academy Medical Director for Governmental Affairs Michael X. Repka, MD.

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coNgRess PAsses ResolutioNs HoNoRiNg eyecARe AMeRicA MilestoNe

In 2010, the House and Senate passed resolutions recognizing the 25th anniversary of EyeCare America, the public service program of the Foundation of the American Academy of Ophthalmology. The resolutions commend EyeCare America’s nearly 7,000 volunteer ophthalmologists for their work to ensure that eye health is not neglected. Since its inception in 1985, the program has helped more than 1 million patients. Participants in the 2010 Congressional Advocacy Day asked legislators to cosponsor the resolutions honoring EyeCare America.

Top left Rep. Jim Matheson, D-Utah (second from right), with Jeff Pettey, MD, Rachel Benator, MD, and Alan Crandall, MD. Second down Sen. Susan Collins, R-Maine (left), greets Cynthia Self, MD, and Jeff Maltzman, MD. Third down The Maryland delegation of ophthalmologists to the 2010 Congressional Advocacy Day with Sen. Benjamin Cardin, D-Md. (center). Fourth down Rep. Kevin McCarthy, R-Calif., majority whip (left), meets with Ronald Morton, MD, on the Capitol steps. Bottom Sen. John Barrasso, R-Wyo. (left), and his aide meet with Ram Peddada, MD, and Academy Past-President Randolph L. Johnston, MD, and Mrs. Johnston.