No one can advocate for our interests and those of our patients better than we can.
The AAO Advocacy Day and Mid Year Forum were held April 21-24,2010. ASOPRS was well represented by members and leadership. Currently, the AAO and ASOPRS are well aligned on our mutual goals with respect to ongoing events at the Federal level.
WHAT IS HAPPENING?
On the positive side, the RVU practice expense has been increased for ophthalmology codes. This will be worth about $550 million to ophthalmologists over the next several years. Further, several important ophthalmic plastic surgery codes received additional RVU increases.
ASOPRS was again publicly recognized for our ongoing support of the Surgical Scope Fund and specifically for our help in recent legislative battles. In West Virginia, legislation got to a critical stage that would permit optometrists to perform eye surgical and laser procedures, including "eyelid" surgery. Through AAO efforts, with ASOPRS help, the bill was restructured favorably to maximally protect the public, and surgical procedures were removed. At our Executive Committee (EC) meeting during the conference, leadership approved our budgeted $25,000 contribution for 2010 to the Surgical Scope Fund, which historically has placed ASOPRS among the largest contributors. In recognition of our ongoing support for SSF, we were asked to have an ASOPRS member on the Surgical Scope Fund Board. Bryan Sires, MD, PhD has served us well in this capacity for the past 2 years. Our Society is very grateful to Bryan for his efforts on this project.
ASOPRS was specifically thanked by the Academy for our help in removing the Cosmetic Surgery Tax clause from the Senate Health Care Reform Bill. Had we not acted on this, in cooperation with our colleagues in the Physicians Aesthetic Coalition (PAC)*, this discriminatory tax would have become law. We learned a very important lesson in this campaign. We, as physicians, carry very little political clout; rather our patients and their huge collective "votes" can represent our mutual goals far more effectively. We should not be shy in soliciting our patients' help in lobbying legislative bodies on issues that affect their well being. Given the huge number of patients represented by practices of PAC physicians, we have now been provided with a powerful political weapon.
Meetings with legislators and briefings at the MYF were unfortunately highlighted by frustrating discussions of SGR and the health care reform legislation. Many of us had been told by legislators for years that SGR would be "fixed" by health care reform, obviously, this did not happen. Instead, SGR has become a political issue for both parties and is likely to be serially patched until after the November elections. The current "patch" to prevent the 21% pay cut expires June 1. Legislators told us repeatedly that SGR and physicians' concerns about Medicare are not major issues for them as they are NOT hearing of access to care problems from constituents in their districts. Obviously, Medicare rates influence the entire third party reimbursement structure for physicians, so this is a critical point. Many physicians are considering ways to get their patients involved in this process.
The new health care reform law (it is now the LAW), does provide care to millions of Americans who might not have had it. However, as you all know, is does raise many issues. By 2014, there will be approximately 30 million more lives in an under funded system, likely to be reimbursed at Medicaid rates. Given the relatively small pool of physicians who currently take Medicaid, who is going to provide the care? Further, there is a massive shortage of primary care physicians, largely due to poor reimbursement schedules. There are apparently plans to try to improve this. It is clear that Federal health care priorities will move to reimburse for quality of care, rather than quantity of care. It appears that the preliminary programs established to help achieve this will substantially favor primary care over specialty care. PQRI has been stage 1 of this effort. Most of the "quality" measures have been directed toward allowing primary care physicians to capture these bonuses. Nonetheless, specialists have been invited to the "quality" table and oculofacial plastic surgery is no exception. Dr. Elizabeth Bradley has been representing us at these negotiations. At this time, it looks like we will soon have two smoking quality indicators related to thyroid eye disease, as well as ongoing work on a ptosis quality of life measure.
Rules regarding electronic medical records were also discussed. Implementation dates are approaching, and there are incentives up to $44,000 to get onboard. However, criteria for systems to be "certified" and definitions of "meaningful use" are still being worked out. What we have seen so far is that the current EMR criteria will be most applicable to primary care providers, and will be difficult for specialists such as ophthalmologists or oculofacial plastic surgeons to incorporate efficiently into their practices. Again, this will help the funds flow to the primary care physicians.
Given all of these issues, many physicians are reassessing their participation in Federal health programs. Options regarding Medicare participation are available on the American College of Surgeons website www.facs.org.
Finally, there were discussions regarding subspecialty fellowship program accreditation and certification of graduates. As you are all aware, an ACGME program for accreditation of ophthalmic plastic surgery fellowships was approved last September and the ABO has started investigating, with ASOPRS cooperation, the feasibility of a Subspecialty Certificate in Ophthalmic Plastic Surgery. The first program applications for ACGME accreditation will be considered by the RRC of Ophthalmology at their upcoming meeting this Spring. Interestingly, discussions at the MYF reflected "understanding and accepting" of this process, in contrast to the heated debates at this meeting just a few years ago. Now the focus of discussion was on whether ACGME subspecialty program accreditation was appropriate for other fellowships, specifically retina, which has an ACGME application pending. The panel discussion clearly recognized the differences in needs between Ophthalmic Plastic Surgery related to the "greater house of medicine", and specialties that basically provide service within the oversight of "ophthalmology". Some novel solutions to these issues may be forthcoming from the AUPO and the ABO. Stay tuned!
OTHER ADVOCACY ISSUES
We have been informed that "blepharoplasty" will likely be "devalued" in the upcoming review process. Our advisors recommend a "wait and see" approach to this, as there is concern that aggressive comparisons with other codes may result in other devaluations.
On the other hand, ASOPRS has been working with PAC in formulating a position regarding cosmetic (aesthetic) procedures; specifically that reimbursement for cosmetic procedures is driven by a "contract" between physician and patient. Third party payors remove themselves from any contractual authority or influence once the procedure is designated as "medically unnecessary". We feel that it is important to have such an interpretive statement from affected medical specialties, given recent "bundling" policies.
ASOPRS has also started an official dialog with Anthem/Wellpoint regarding their designation of the use of human (Alloderm) and porcine (Tarsys, Enduragen) processed dermal materials in the periorbital area as experimental. We feel that this "experimental" designation for such use is completely inappropriate based on the available literature, misleading to our patients, and places ASOPRS members in potential jeopardy regarding disclosure, etc. We will work aggressively to have this policy modified.
A summary from the AAO of the proceedings at the MYF is below for your information and reference. We hope this update is useful for you .
AAO Mid-Year Forum Report
AAO Mid-Year Forum Report
Jeff Nerad, MD
Stuart Seiff, MD
Past President and Chair, Advisory Board
Rona Silkiss, MD
AAO Councilor - ASOPRS
*The Physicians Aesthetic Coalition (PAC) is a coalition among ASOPRS, derm surgery (ASDS), aesthetic plastic surgery (ASAPS), and facial plastic surgery (AAFPRS). This group grew out of Dr. Roger Dailey's work with the Physicians Coalition for Injectables Safety.
AAO Advocacy Page