September 2018

NEWS & OPINION

Young ophthalmologists reflect on 2018 ASCRS•ASOA/Alliance of Specialty Medicine Legislative Fly-In


Are you interested in getting involved in the political process but unsure how to go about it? Participating in the ASCRS•ASOA/Alliance of Specialty Medicine Legislative Fly-In is an ideal first step. This past July, nearly 40 ASCRS physicians and ASOA administrators traveled to Washington, D.C. to advocate for ophthalmology by participating in the 2018 Legislative Fly-In. The ASCRS and ASOA attendees represented 22 states and included five recipients of the third annual ASCRS/Young Eye Surgeons (YES) Legislative Fly-In scholarship. Taking time away from their practice, these dedicated members descended on Capitol Hill with other physicians from the 15 specialty medical societies in the Alliance to learn more about current legislative and regulatory issues affecting specialty medicine before heading to the offices of their representatives and senators to lobby for our priority issues.
This year’s top focus for ASCRS attendees was urging Congress to maintain a viable fee-for-service option in Medicare Part B and to reject the Medicare Payment Advisory Commission’s recommendation to replace the Merit-Based Incentive Payment System with a value-based program not relevant to specialists. Other issues included asking lawmakers to address various barriers to specialty care, including prior authorization and step therapy, as well as workforce shortages in many specialties that jeopardize access to care.
In addition to their Hill meetings, attendees heard from an impressive lineup of speakers, including FDA Deputy Commissioner Anna Abram; Senators David Perdue (R-GA), Bill Cassidy, MD (R-LA), and Rand Paul, MD (R-KY); House Ways and Means Health Subcommittee Chairman Rep. Peter Roskam (R-IL); 2020 presidential candidate Rep. John Delaney (D-MD); House Ways and Means Committee Ranking Member Richard Neal (D-MA); Charlie Cook, political analyst and editor/publisher of the Cook Political Report; and former Congressman Charles Dent.
Not only does the Legislative Fly-In help advance our advocacy goals, it provides invaluable information about public policy affecting ophthalmology. ASCRS members at all levels of their careers are sometimes hesitant to participate in advocacy activities because they think they do not have an adequate understanding of healthcare policy to be effective so their efforts will not make a difference. However, the personal stories and experiences in practice are often the most powerful motivators for legislative action. Physicians and their administrators who must comply with federal regulations are the best equipped to demonstrate the impacts of those policies and speak for the patients they ultimately affect.
One especially appealing aspect of the Legislative Fly-In is that it offers YES members an incredible opportunity to meet and network with other, more experienced ASCRS members. ASCRS and ASOA leaders are always well represented at the event, and they are eager to meet and provide mentorship to younger members. To give you an idea of what it’s like to participate in the Legislative Fly-In, I asked our 2018 YES scholarship recipients to share their thoughts on the experience. Perhaps their comments will encourage you to “get in the game” and attend next year’s Legislative Fly-In. If you are unable to join us in Washington, you can always meet with your representative and senators in their home office or invite them to visit your office or surgery center. Seizing the opportunity to meet with your legislators on more than one occasion helps to forge a trusting relationship that can influence and help to advance ophthalmology’s agenda.


—Parag Parekh, MD, chair,
ASCRS Government
Relations Committee


Philip DeSouza, MD
Resident, Wake Forest Eye Center
Winston-Salem, North Carolina

The Legislative Fly-In experience underscored how important it is for ophthalmologists to speak directly with their representatives in Congress about issues relevant to specialty medicine. Physicians deal with a myriad of challenges every day. Often, these perceived unnecessary and arduous challenges are attributed to a faceless culprit: “the system.” While this is an easy way to compartmentalize frustrations, a more productive way to confront these issues is by speaking with those who design the very legislation that can offer solutions.
“We rely on you,” said Rep. Virginia Foxx (R-NC) during our meeting at the Legislative Fly-In. “Hearing you tell me your stories in person gives me a whole new appreciation for the challenges you encounter as a physician.” She told me this without realizing how much it inspired me to continue advocating on behalf of ophthalmologists. Rep. Foxx was sympathetic to our needs as specialists and mentioned she would look more into the Medicare fee-for-service option and MIPS.
As a resident, I felt incredibly valued when many of the older physicians talked about the importance of residents and the need to support the Resident Physician Shortage Reduction Act. Legislators and aides seemed to agree on the importance of this, and it was encouraging to see such collaborative, non-partisan support for a measure to directly address the medical needs of our aging population.
The Legislative Fly-In gave me a new appreciation for the work ASCRS does on behalf of ophthalmologists. It was inspiring to see fellow physicians directly addressing issues that I face every day in clinic. For example, I frequently deal with the aggravating process of prior authorization for certain prescriptions. I’ve had patients with non-infectious uveitis get bumped from efficacious medications and tried on a “step-down” medication until they fail and have a flare-up. These encounters are incredibly frustrating. While I’ve lamented over this issue with colleagues, I never thought about contacting my elected officials about it. At the Legislative Fly-In, I learned there are specific bills aimed at improving the prior authorization process and that physician support for these reforms was directly communicated to members of the House and Senate. Physicians telling stories of their patients who have been harmed by prior authorization barriers resonated with legislators and their aides.
Physicians are on the front-lines of delivering healthcare and in many cases are the most qualified to guide healthcare policy. If we as a community of ophthalmologists don’t come to the governing table, critical decisions affecting our practices and patients are going to be made without us. Seasoned physicians, with their immense experience, can offer some of the most valuable insight to legislators, but it is just as critical for young physicians to attend the Legislative Fly-In and learn about how advocacy and policy work in the nation’s capital. I learned about the issues I will face when I attempt to start or join a practice, and I am better prepared for them.


Brian Lee, MD
Resident, University of Minnesota
Medical School
Minneapolis

It is important for physicians to participate in the Legislative Fly-In to learn about pending legislation that will affect the practice of medicine and to be involved in making suggestions and providing anecdotes to help shape that legislation.
I was concerned that the meetings with legislators would be very formal. Instead, we had a lot of lectures and discussions to prepare us to learn about different political ideas, and the meetings were friendly and low key. I learned about how we can provide valuable input into the legislative process by showing up at the Congressional offices and speaking with the members and their aides. I learned that I could advocate for my patients’ needs by sharing stories about how we could provide better care for our patients.



John Liu, MD
Resident, Case Western Reserve University/University Hospitals
Cleveland

Ophthalmology is a specialized field, yet we provide necessary care to everyone, from children to the elderly. At the same time, most people don’t have much contact or knowledge about our field, unless they or someone in their family has an eye disease. As the U.S. population ages, the burden and need for high-quality ophthalmic care increases with every year, yet ophthalmologist face increasing regulatory restrictions that limit our ability to provide care to our patients. This is something that we as physicians and our patients are painfully aware of. Therefore, it is crucial for us to meet our members of Congress to educate them about how we help patients and how their decisions affect our ability to provide care. I think that physicians at the beginning of their career have less “skin in the game.” That is not to say that we don’t care about the future of our field or practice, but rather that we may be seen as less influenced by reimbursement. This is especially true for physicians in training; I think it goes a long way to show legislators that we care about decisions being made on Capitol Hill and to show them how their decisions impact patient care.
I wasn’t sure what to expect for the event, as I had never been before. The experience was fantastic. There was good education and preparation for me to feel confident about representing our issues. There were also interesting talks from various members of government that gave me insight into questions that I had not considered before. There is tremendous value in attending the Legislative Fly-In; it shows that we are so passionate about caring for our patients that we would take time away from our clinics and families to ensure that we are able to continue to provide care for patients.
One memorable experience was meeting with Senator Rob Portman’s legislative assistant, who was a social worker prior to joining the Senator’s office. It was great to see someone with experience in the healthcare system on the Hill to provide her perspective. She was surprised at our request to maintain MIPS; she had not had anyone come to the office to express our perspective on that issue, and I think we were effective in convincing her of our sincerity. We shared our experience encountering difficulties with prior authorization and how it affected our ability to provide prompt care. She reacted with surprise at the fact that patients had to come back for a second visit to receive treatment for their disease.
The most important thing I learned is that decisions are being made that dictate how we practice medicine and care for our patients. The people making these decisions do not have a full understanding of how their decisions affect our patients. The relationships that are formed from these experiences are incredibly valuable in providing service to the field of ophthalmology. The Legislative Fly-In has encouraged me to continue to participate in advocacy efforts.


Dr. Rogers, Dr. DeSouza, Dr. Liu, Dr. Lyons, and Dr. Lee with Sen. Paul
Source: ASCRS


Lance Lyons, MD
Resident, University of Texas
Medical Branch
Galveston, Texas

Residents are in a sort of protected space during their training, in that we don’t have to deal with the red tape, insurance battles, and billing intricacies that hit as soon as we go into private practice. Going to Washington, D.C. early helps residents identify the important issues before entering the real physician workforce and provides an opportunity to network with similar-minded colleagues and ask them how they confront these challenges. If your members of Congress last through election cycles, you have an opportunity to start a real, productive, extended relationship that is mutually beneficial. One day, they’ll say, “I knew you as a resident!”
One touching moment during the Legislative Fly-In involved discussing the Good Samaritan Health Professionals Act with Congressman Randy Weber (R-TX) and his aide. The bill would extend federal liability protections to health professionals serving as volunteers who cross state lines to assist with the response to a national emergency or major disaster. Our district was hit especially hard by Hurricane Harvey, so this issue was one that touched all of us deeply. If all politics are local, this is as local as it gets. The aide’s parents went to my fellow delegate’s rival high school. Rep. Weber recounted how he met his wife not far from where that co-delegate grew up. Harvey had affected each of us; Rep. Weber drove more than 6 hours in his raised pickup truck to deliver water to communities hit the hardest. It was a moment I’ll never forget because even though we already agreed on the issues, politics vanished from the room, and we were real people talking about real solutions to real problems.


Kyle Rogers, MD
Dean McGee Eye Institute
Oklahoma City

Ophthalmology is a small field, and it is important for ophthalmologists to meet with our legislators so they understand the issues that are unique to our specialty. I plan to practice in rural Oklahoma, and it is important to advocate for my patients as well as the profession. Decisions that are made in our nation’s capital will influence my practice, and it is necessary to have a voice.
Becoming involved early in your career allows you to build relationships with others who are passionate about advocacy and learn from their experience. Young/new ophthalmologists can encourage other young ophthalmologists to become involved. This is important because many of the policies made in Washington, D.C. will affect us for the rest of our careers.
The Legislative Fly-In is valuable because it allows interaction with other ophthalmologists who are passionate about advocating for their patients and the field. Many of the ophthalmologists who attend the Legislative Fly-In have years of experience in advocacy and are willing to impart their wisdom to younger ophthalmologists or new advocates. Inspiring others to participate in advocacy is important in building the voice for patients and the profession.
The privileges that come with serving patients through ophthalmology are met with the responsibilities to uphold our profession and to advocate for our patients. The most valuable thing I took away from the Legislative Fly-In was that if you volunteer to advocate for your patients, there are entities that can help you articulate the issues to those making the decisions impacting healthcare. Organizations like ASCRS help educate professionals to speak intelligently with their representatives and impact change for the betterment of patients. I plan to be involved with ASCRS throughout my career to stay up to date on issues and continue representing our profession before the elected officials that will make the tough decisions facing the practice of medicine.
My legislator’s aides seemed receptive to the discussion regarding maintaining Medicare fee-for-service and MIPS. I specifically spoke about the effects certain changes would have not only on my future practice in rural Oklahoma but also on the constituents from my area. The legislative aides seemed most concerned about the effects that changes in policy would have on members of my future community. This helped them understand the importance of the issues for which we were advocating.

Editors’ note: Dates for the 2019 Legislative Fly-In have not yet been announced. Members interested in attending next year or getting more involved in other grassroots advocacy efforts should contact Tami O’Brien, ASCRS manager of PAC and grassroots, at tobrien@ascrs.org or 703-591-2220.

Contact information

DeSouza
: philipdesouza@gmail.com
Lee: brianlee@umn.edu
Liu: johnthelaw@gmail.com
Lyons: lancejlyons@gmail.com
Parekh: parag2020@gmail.com 
Rogers: Kyle-Rogers@dmei.org

Young ophthalmologists reflect on 2018 ASCRS•ASOA/Alliance of Specialty Medicine Legislative Fly-In Young ophthalmologists reflect on 2018 ASCRS•ASOA/Alliance of Specialty Medicine Legislative Fly-In
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