News & Information
2018 Quality Payment Program Final Rule
OPHTHPAC Chairman Explains Why He Has Invested Since He was a YO
Written By: Matt Daigle MS
The Academy’s OPHTHPAC fund provides the profession a means of supporting pro-ophthalmology candidates and members of the U.S. Congress, which cannot legally be done using membership dues. Political action committees are fully legal and highly regulated by the Federal Election Commission to assure that all funds are raised and distributed appropriately, as there are limits on how much an individual can invest in OPHTHPAC and how much an organization can contribute to a candidate.
If you’re new to politics, this and other political action committees can be overwhelming. We asked Jeff S. Maltzman, MD, FACS, chair of the Academy’s OPHTHPAC committee, why the PAC should be on every ophthalmologist’s radar, especially at the front-end of your career.
What was your first exposure to OPHTHPAC? Were you immediately compelled to give?
I first learned about OPHTHPAC back in 2003. I had just started practicing the year prior, which happened to be the first year that the sustainable growth rate triggered a 5 percent cut to Medicare reimbursement the following year. As I wondered what I could do to help prevent further cuts in the future, a wise colleague suggested getting involved in the Academy's advocacy efforts, including contributing to OPHTHPAC.
I started investing in 2003 and have done so every year since.
Who ingrained into you why OPHTHPAC is necessary?
S. William Clark, MD, the chair of OPHTHPAC when I initially served on the committee years ago, taught me much of what I know about the necessity and function of OPHTHPAC. It was, however, a member of Congress who actually made me fully understand the impact OPHTHPAC has in advancing our legislative agenda. Gabby Giffords, my Arizona congresswoman at the time, spoke passionately about the need for physicians to be more proactive in advocating for their professions and their patients.
She was grateful to the Academy for our support of her campaign, explaining to me how important and helpful PAC contributions are. Understanding the true impact that our funds have on individual campaigns sealed my commitment to advocacy and to OPHTHPAC.
Knowing what you know now, what do you wish someone told you then about OPHTHPAC?
I wish I'd fully understood exactly how big an impact OPHTHPAC has on advancing ophthalmology's legislative agenda in Washington. The Academy has an active and highly capable staff in D.C. who lobby very effectively on our behalf. OPHTHPAC opens doors for them on Capitol Hill and helps us build relationships that will benefit the profession when important issues arise.
How does one get over the cynicism and malaise that permeates politics these days?
It's easy to feel somewhat confused and overwhelmed by the political landscape today. With approval ratings for all three branches of our federal government at all-time lows, it's clear the American people -- including most physicians -- are frustrated. We feel it in our practices and hear it from our patients every day.
However, it's important that we focus on the positive rather than the negative; the details over the often-messy big picture. Ophthalmology's advocacy efforts have borne significant victories during my 15 years in practice, such as repeal of the SGR formula, reversal of significant cuts in glaucoma and retinal surgical fees, and relief from burdensome electronic health record regulations.
These wins take commitment, hard work and an optimistic approach to the issues. As young ophthalmologists with long, rewarding careers ahead, I hope you'll reject the cynicism and fight for your profession, your practices and your patients.
We call OPHTHPAC an investment. With so much competition for your hard-earned dollars, why should OPHTHPAC be a foremost consideration?
We must think of OPHTHPAC as an integral part of our practice. Investments are made to produce results and provide dividends. That's precisely what OPHTHPAC does for all of us.
I think of OPHTHPAC as a mutual fund, pooling the collective resources of many, contributing to numerous and diverse members of Congress who help us achieve our legislative and regulatory goals. The more ophthalmologists who invest in OPHTHPAC, the more the fund can work for the profession. It really is that simple. Ophthalmology's continued legislative successes are contingent on a strong PAC.
I urge young physicians to start investing even a small amount early in your careers, and increase your contributions as your income allows. Take pride in knowing that you are contributing to a brighter future for all of us and our patients.
Can you call yourself an advocate if you don’t give to OPHTHPAC?
There are many ways to advocate for ophthalmology, and physicians need not participate in every endeavor. You can email or call a member of Congress to support the Academy's position when needed. You might develop a relationship with a member of Congress and discuss important issues with them personally when necessary. You can host or attend fundraisers for Academy-supported candidates, or go to Washington to participate in the Academy’s Mid-Year Forum, which includes Congressional Advocacy Day. That’s when you can lobby your state's legislative delegation. Many of our colleagues participate in one or several of these activities, though some don't have the time or inclination to do so.
An investment in OPHTHPAC, however, takes almost no effort and should be made by all of us. If every eligible ophthalmologist contributed a single dollar per day -- 365 dollars per year -- we would have the largest medical specialty PAC in the country.
Complete this sentence: Without OPHTHPAC...
I wouldn't have a job in the Academy!
Joking aside, without OPHTHPAC we wouldn't be as successful in the legislative and regulatory arenas as we have been, plain and simple. As I mentioned earlier, OPHTHPAC opens doors and gets us a seat at the table. There is, however, a lot of competition for those seats, and nearly every industry, company, and trade organization in this country has a PAC working to promote their interests.
Without OPHTHPAC we would be at a great disadvantage. Conversely, with a stronger OPHTHPAC we would be able to reach more members of Congress and develop more significant relationships.
It’s easy to invest in the Academy’s OPHTHPAC fund. Visit aao.org and click on the “Advocacy” section. Then, click "Join OPHTHPAC" to become an investor. And don’t forget to sign up for the latest advocacy updates directly on your phone or mobile device. Text "OPHTH" to 51555 to enroll, and we'll send periodic messages with the latest on Academy advocacy efforts, information about OPHTHPAC, who we support, how funds are distributed and victories we achieve. We promise not to overwhelm you with messages.
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About the author: Matt Daigle is the Academy’s advocacy communications manager and editor of Washington Report Express.
The Academy’s early analysis of the Quality Payment Program’s 2018 configuration is uncovering troubling changes. In finalizing the payment system for next year, the Centers for Medicare & Medicaid Services is reverting to requirements that will hurt ophthalmologists and other physicians who practice resource-intensive medicine.
In our early analysis of the final rule CMS released Nov. 2, we uncovered major reversals from what CMS signaled in its proposed rule this summer.
Despite our unwavering support for a zero-weight cost category in the Merit-Based Incentive Payment System, CMS has gone against its commitment to change the flawed cost calculations. Instead, the agency will now weight this category 10 percent of your score.
CMS will base cost on the previous flawed attribution and risk-adjustments used in the value-based modifier. This is a major issue for resource-intensive professions like ophthalmology.
Academy-sought exemptions exclude ophthalmologists from non-applicable measuresCMS provides exclusions for two advancing care information base measures. The Academy was instrumental in securing the following exclusions.
Additional exemptions for physicians
CMS increased the low-volume threshold. This will enable more physicians to be completely excluded from MIPS reporting. CMS increased the low-volume threshold of allowed Part B charges to $90,000, from $30,000. The number of beneficiaries seen to qualify for an exemption doubled, to 200 or less.
Relief for small practices
Small- and solo-practitioners (10 or fewer) will earn five bonus points toward the MIPS final scores. This applies to upwards of 80 percent of ophthalmologists. CMS continues to provide accommodations for small practices under the improvement activities category. Small-practice physicians would only have to do half as many activities as larger practices to get full category credit.
Acknowledging complexity of care
CMS will award up to five bonus points on your MIPS final score for treatment of complex patients.
Catastrophic storm relief
For clinicians affected by Hurricanes Irma, Harvey and Maria and other natural disasters, the agency will automatically weight the quality, advancing care information and improvement activities performance categories at zero percent of the MIPS final score.
EHR transition delay
CMS finalized a delay in the transition to the 2015 standard for certified electronic health record technology. This was slated to take effect in 2018. The delay will last at least a year.
The Academy will mobilize this year to compel the agency to fix these unexpected changes. We will enlist Congress if necessary to secure the results that will make you successful in 2018. Stay tuned for comprehensive, ongoing analysis on AAO.org and in Washington Report Express.
Access the Academy’s broad array of resources for succeeding in the Quality Payment Program at aao.org/medicare.
By Debra A Goldstein MD
Dr. Debra Golstein offers clinical pearls on how to identify and manage 2 underrecognized causes of inflammation after cataract surgery. Aside from chronic endophthalmitis, she finds that postoperative inflammation is often caused by undiagnosed preoperative inflammation. She recommends a thorough slit-lamp examination to identify inflammation prior to surgery. Another common cause is irritation from an IOL that is chafing against the iris, often occurring with 1-piece acrylic lenses that are placed in the sulcus. Slit lamp exams or ultrasound biomicroscopy are useful in assessing whether an IOL is mispositioned.
January is Glaucoma Awareness Month
Look to the Future: Get an Eye Exam to Save Your Vision from Glaucoma
More than four million people in the United States have glaucoma, a group of eye diseases that damage the optic nerve and destroy eyesight. Unfortunately, nearly half of those with glaucoma are not even aware that they have it. Are you one of them? You owe it to yourself to find out by getting a comprehensive dilated eye exam that includes having drops put in your eye. With its painless and gradual loss of vision, glaucoma may have no early warning signs, but it can be detected during a comprehensive dilated eye exam.
Paul A. Sieving, M.D., Ph.D., director of the National Eye Institute (NEI), one of the National Institutes of Health, said, "NEI-funded research has shown that treatment during the early stages of glaucoma can control the disease and prevent future vision loss and blindness. This is why NEI encourages people at higher risk for glaucoma to get a comprehensive dilated eye exam every one to two years."
Anyone can develop glaucoma, but those at higher risk for developing the disease include:
If glaucoma is detected early, treatments such as eye drops or surgery can slow or stop vision loss. High pressure inside the eye, which may be associated with glaucoma, does not by itself mean that you have glaucoma. Only a comprehensive dilated eye exam and evaluation of the optic nerve by an eye care professional can tell you that.
If you know someone at risk for glaucoma, let them know you care - send them a glaucoma e-card. For more information, visit www.nei.nih.gov/glaucoma.