InFocus WAEPS Member Newsletter - July 2018

President's Corner
Russell Van Gelder, MD, PhD, WAEPS President 2018-19

It is my honor to serve as President of WAEPS for the 2018-19 year, and I thank the membership for electing me to this position.  I joked at the annual meeting that my year serving as President of AAO was good preparation for serving as President of WAEPS – but it’s true!  So much of the advocacy we need to do for our patients and our practices is done at the state level.  And we are fortunate to have a great state society.

What makes WAEPS an exemplary state ophthalmology society?  Having visited with many state societies, and having chaired AAO Council I’ve had the chance to interact with many states’ groups.  I have a basis for comparison.  WAEPS benefits from high participation – over three-quarters of the state’s ophthalmologists belong to the organization.  In contrast, several larger states such as California and Florida struggle with membership, with fewer than half the state’s ophthalmologists choosing to join.  WAEPS is fortunate to have a core of dedicated leaders who remain committed to the organization.  When I joined WAEPS in 2008, Mike Gilbert, Aaron Weingeist, David Epley, and Paul Griggs were all regulars at the quarterly Board meetings, and all remain highly active with the group.  Rachel Reinhardt, Jackie Wong, Jim Stroh, and Mike Brush among others have been long-standing Board participants and provide a level of continuity not seen in many organizations.  At the same time, WAEPS is developing new leaders for the future, including Janet Chieh (head of our young ophthalmologists group), president-elect Rebecca Dale, and trustees Hubert Pham, Matthew Weed, Courtney Francis, Devin Harrison, and Kristi Bailey.

WAEPS offers a real value proposition to the membership.  The annual WAEPS meeting, under the excellent leadership of Paul Griggs, Mike Gilbert (coding meeting), Rachel Reinhardt (practice management) and Anndrea Grant (tech meeting) is one of the largest and most successful meetings in the country.  The partnership with UW’s department for our monthly seminar series brings an additional slate of eight great speakers each year to Washington.  These lectures are webcast live  for CME credit for any member throughout the state.  And so WAEPS members can earn up to 22 hours of CME credit through the society’s programs. 

WAEPS is also truly fortunate to have Aaron Weingeist as the longstanding legislative chair.  Aaron works closely with our staff to ensure that our patients’ safety is protected in Olympia.  As our membership knows, in other states scope of practice has been legislated to allow under- and un-trained professionals to perform surgery.  To date we have been successful in convincing our legislators that this is a very bad idea.  Unfortunately our neighbors in Alaska recently saw a scope bill pass, and I suspect our members and our colleagues in Alaska will soon be working to fix problems caused by untrained surgeons.  We are committed to not letting such a thing happen in Washington state.

Finally, no state society functions well without an excellent executive director, and we are very fortunate to have Debra Alderman working with us.  Debra has strong ties to our state medical society as well, which leads to opportunities to leverage our impact with WSMA. 

I look forward to serving the WAEPS membership this year and to keeping you apprised of our progress.  Please feel free to reach out to me directly – [email protected] – if I can help you or your practice in any way.

WAEPS Annual Meeting 

This year's WAEPS annual meeting was in a new venue and we heard many attendees saying  this year's educational programs and opportunities for networking were exceptional. Please save the date for next year's meeting:  Thursday and Friday, March 28-29, 2019. Keep an eye on our Annual Meeting page of our website for details as they develop later this year. 

Outgoing board trustee Dr. Rachel Reinhardt (center) was presented with an award of appreciation by  incoming president, Dr. Russell Van Gelder (left) and Dr. Jim Stroh, WAEPS outgoing president, (right).

Dr. Sonia Yoo, corneal and refractive expert from Bascom Palmer Eye Institute, presented several  fascinating lectures during the physician CME program at the 2018 Annual Meeting.

WAEPS members from around the state enjoyed the annual physician dinner and CME program at our new meeting venue, Meydenbauer Center in Bellevue.

AAO Councilor Report
Mike Brush, MD

Mid-Year Forum is AAO Congressional Advocacy Day combined with the spring Council meeting held in Washington DC every April.  WAEPS attendees this year included Michael Brush MD (AAO Councilor), Niraj Patel MD (OPHTHPAC Committee), Michael Gilbert MD (Payer Relations), Aaron Weingeist MD (Legislative Chair), Rebecca Dale MD (President-Elect), Courtney Francis MD (Trustee) and Linda Day MD (Member at large).  Two PGY-3 Advocacy Ambassadors (Marcela Estrada MD and Gautam Vangipuram MD) from the University of Washington were also in attendance. 

The Washington contingent had meetings with Senator Cantwell, as well as Representative Adam Smith.  We also met with the health care legislative assistants of Senator Patty Murray, and Representatives Pramila Jayapal and Dave Reichert. 

Issues discussed with legislators included:

1. Physicians need regulatory relief from burdensome prior authorization requirements.
2. Sponsoring the Preserving Patient Access to Compounded Medications Act to ensure timely access to compounded drugs for office use.
3. Simplifying the Merit-based Incentive Payment System (MIPS) by expanding credit for participation in qualified clinical data registries
4. Supporting for National Institutes of Health and National Eye Institute funding.
5. Supporting the Department of Defense Peer Reviewed Vision Research Program.
6. Supporting  the Technology-based Eye Care Services (TECS) program in the Department of Veterans Affairs

At the Spring Council meeting, WAEPS co-sponsored a Council Advisory Recommendation (CAR) to improve the AAO Policy on Sexual Harassment. This was well supported by members of the Council and the Academy Board of Trustees has approved a change in the policy on the prohibition of sexual harassment.

WAEPS Advocacy Ambassadors were funded by an educational grant from the Washington Eye Foundation.  Upon return, the Ambassadors made a presentation about their experience to their fellow UW residents and fellows.  The AAO Advocacy Ambassador program brought nearly 200 residents and fellows from around the country to participate in MYF.

Advocacy Ambassador thanks WAEPS for opportunity to attend MYF

Marcela Estrada, MD, (PGY-3)

The following is a note we received from one of the two  UW residents whose participation as an Advocacy Ambassador at the AAO MYF 2018  was underwritten by WAEPS’ educational non-profit:  the Washington Eye Foundation. Marcela is pictured below (second from right).

Thank you kindly for sponsoring my participation in the 2018 AAO Mid-Year Forum.  I cannot tell you what an enlightening and educational experience it was for me.  In medical school I was a strong advocate for minority and underrepresented physicians in medicine and was fueled to get through my academics and ophthalmology applications by staying passionate about these causes. Since starting residency, I’ve prioritized my clinical education but have missed the advocacy part of my clinical training.  Participating in the Mid-Year Forum reignited this passion and has given me new causes to advocate for in support of ophthalmology specifically.  THANK YOU!!  I feel reinvigorated to share this wealth of knowledge and experience with my co-residents when I return. 

WAEPS members and members-in-training participated in the annual Mid-Year Forum
Day of Advocacy on Capitol Hill in Washington DC in April 2018. 

Ramping up involvement at any stage of our careers
Rebecca Dale, MD, WAEPS President-Elect

Five years ago, I still qualified as a young ophthalmologist (YO), and although I was happy to be a member of both AAO and WAEPS, I really didn’t understand the appeal of going to the AAO’s Mid-Year Forum.   Those email invitations were archived without a thought in the never-ending treadmill of my email queue.  Fast forward a few years, and I’ve had the privilege of serving on your WAEPS board and participating in the Academy’s Leadership Development Program (LDP) - thanks to the support and encouragement of WAEPS. 

Attending MYF is a part of the LDP experience, but I’ll admit it was the piece I found least exciting.  Leadership?  Communication skills?  Adding my own small improvement project for the benefit of our profession?  Sign me up.  These parts of the LDP program resonated.  Politics?  Hmmm, not so much.  And my perception was that MYF was all about politics and not about patients.

Now I’m flying somewhere between the two Washingtons  - DC and our fair state -  and musing about my shifting perspectives.  Politics has become unpalatable to many of us.  Or perhaps it’s not a new phenomenon, but an ingrained belief.  Politics in my lifetime has rarely had a positive connotation.  PAC money, attack ads, unethical behavior, mud-slinging, pork, wasteful government spending, cover-ups, severe-memory-deficit-in-front-of-congress disease.  In retrospect, I think these negative connotations also led to me deleting emails imploring me to donate to the state level Physicians EyePAC and the AAO’s OphthPAC in my YO days.  But apparently age and first-hand experience have had the unusual effect of modifying my previously cynical view of politics.

I now think of politics as being a really complex system that may not be easy to navigate but is extremely important.  I think this concept will resonate with many of your personal experiences.  Do you run a large practice and have new employees think it should be “easy” to make a change that seems obviously better to them?  Have you served in a leadership position on a charity board, a hospital, a research IRB…even the PTSA, and discovered that leadership positions do not confer the ability to make rapid decisions or significant change?  I think this is the bind that our Academy leaders and even our elected officials find themselves in.  To the outsider, the required actions may be smack-your-forehead obvious.  But the tricky part of complex systems is those pesky unintended consequences.  The more complex the system, the higher the risk and the more carefully the possible outcomes of the decision need to be considered.  And few would argue that there are any systems more complex than the US healthcare system and the US government.  Put these two in a petri dish together, and you have complexity to the Google-plex power.

There are three distinct parts to AAO’s Mid-Year Forum (MYF): 

1. Congressional Advocacy Day: where ophthalmologists come from around the country to talk face-to-face with our Congressional representatives and senators and members of their staff regarding topics of importance to ophthalmology.  This was remarkably easy and even fun.  
2. Mid-Year Forum:  where members from around the country hear detailed explanations and insights about the issues our profession faces.  For example:  Think it should be easy to get drug companies to go back to acetazolamide for a nickel a pill?  Gain some perspective from experts who are thinking hard about the causes and potential solutions for these problems.
3. The AAO Council sessions.  Each state and US territory sends one representative to the Council.  This is our own version of the Senate, with a refreshing twist: simplicity.  During MYF, Council Advisory Recommendations (CARs) are proposed and discussed.  Any of us can put forth an idea for a change, write it up in collaboration with our own state society, and ask the Council to consider the proposal.  Ideas that get enough traction with the Councilors move forward for further consideration and action by the AAO Board of Trustees.  Any AAO member (including members-in-training) can speak their mind on the issues presented and there’s no excessively formal procedures or finagling.  

There’s WiFi on this plane, and I could be running on that email treadmill rather than one-finger typing these thoughts on an iPad.  But I suspect that more than a few of you share my initial aversion to the two Ps:  Politics and PACs.  But I’ll tell you what I shared with my spouse yesterday: “it’s really eye-opening to be at the sausage factory.  It’s not always pretty, and it takes an amazing amount of time, money and personal effort on the part of hundreds of cooks to make a little bit of sausage.  But I love our country and I love our patients, so I’d rather join in to do my part to help cook it.  Plus, I have no plans to defect.” 

Have you ever had a patient impacted by an onerous prior authorization?  Have you ever had a patient benefit from NEI research?  Are you confused by MIPS?  Do you think it’s unreasonable for a patient with endophthalmitis to wait 24 hours so that a compounding pharmacy can create a patient-specific intravitreal injection?  If you answered no to any of these, then I’m pretty sure you aren’t an ophthalmologist in Washington state.  If you answered yes, I challenge you to:  

1. Mark your calendar for April 10-13,2019, block your clinic schedule now, and join your colleagues at Mid-Year Forum.
2. Go to our online donation page and donate to our state-level Physicians EyePAC and keep donating every. single. year.
3. Get more involved in WAEPS. There are lots of ways to contribute and we’d be happy to find a project or activity that’s the right fit for you.

My sincere appreciation to you for reading.  If you are a YO, a MO or a SO and have questions about the two Ps, I or any of your board members would be happy to chat further.   Just get in touch with Debra Alderman, our executive director, and she’ll put you in touch.  Her email is [email protected]

WAEPS Members Make a Difference at Special Olympics

Our members are hard workers, but even in their spare time they volunteer to help out at local charity clinics and major events like the Special Olympics.  If you're interested in getting involved, visit the Volunteer Opportunities page of our website or contact our office. 

WAEPS members, Dr. Ingrid Chang and Dr. Jason Kam, set up for the vision clinic at the Special Olympics here in Seattle in July.

Dr. Jason Dettori and Dr. Michelle Carle, both WAEPS members, served as the coordinators for the Special Olympics vision screening center here in Seattle earlier this month.

Health Plan Relations Headlines
Michael Gilbert MD, Payer Relations Chair

MIPS Bonus
Did You Get a MIPS Bonus? First Year Scores Available
Physicians can now check their MIPS, Merit-Based Incentive Payment System, performance scores for the year 2017. CMS is making this information available through the Quality Payment Program data website; https://qpp.cms.gov/login. Your score will indicate whether you are to receive a negative, neutral or positive MIPS payment adjustment in 2019. It also allows you to start the appeals process, if the reported performance does not reflect your expectations.

Coming Medicare RAC Audits; Adult Cataract Surgery; How Would You Do?

Medicare finds it useful to “offer” numerous kinds of audits.  Amongst those are the audits performed by The RAC or Recovery Audit Contractors.  These auditing contractors are given direction for audit “targets.” Current RAC audit targets include “Cataract Removal- Reasonable and Necessary Requirements and Coding Requirements.”  Documentation requirements to pass these RAC audits will be based upon the most recent Noridian LCD Policy, Cataract Surgery in Adults (L37027).  It has been many years since Washington had an active Cataract policy.  Such policies specify criteria and expectations for surgery to be reimbursed, as well as required documentation for which the practice will be held responsible upon any such audit.  The new policy includes specific criteria required for standard cataract surgery, 66984, as well as for complex cataract surgery 66982.

Changes from previous guidelines, active or retired are many.  Anyone billing Medicare for adult cataract surgery must review the LCD language for the detailed documentation expected on audit.  An example of such language from the new policy requirements includes,

For Visually-Symptomatic Cataract:
a. A statement indicating that specific symptomatic (i.e., causing the patient to seek medical attention) impairment of visual function resulting in the patient's inability to function satisfactorily while performing Activities of Daily Life. Such activities would typically include, but are not limited to, reading, viewing television, driving, or meeting vocational or recreational expectations. The patient’s own words should be included in the statement where possible.

d. An attestation supported by documented symptoms and physical findings in the medical record indicating that the patient's impairment of visual function is believed not to be correctable with a tolerable change in glasses or contact lenses.

e. When one or more concomitant ocular diseases are present that potentially affect visual function (e.g., macular degeneration or diabetic retinopathy), the attestation should indicate that cataract is believed to be significantly contributing to the patient’s visual impairment.

f. A statement that the patient desires surgical correction, that the risks, benefits, and alternatives have been explained, and that a reasonable expectation exists that lens surgery will significantly improve both the visual and functional status of the patient.

(Please note that Bold emphasis is mine!) 

It is clear from this section alone that we will be held to a new level of detail and rigor in documentation and potentially to exact wording. 

Finding the Noridian Cataract LCD:
The AAO has begun an area in AAO.org website dedicated to listing active LCDs, by state.

To review or download the LCD policy directly from Noridian; Start with the disclosure/agreement page:

https://med.noridianmedicare.com/web/jfb   Search for the policy by name, or by number L37027

Young Ophthalmologists Section 
Janet Chieh, MD, chair

In early June members of WAEPS' Young Ophthalmologists' Section (YOS)  had the opportunity to socialize with young optometrists at the first ever joint event sponsored by WAEPS and the Optometric Physicians of Washington. The event was held at Lunchbox Laboratories in Bellevue.  We have an August event planned and information about that will be coming out soon. Keep an eye on the YOS page of the website for details. 

Young opthalmologists and optometrists mingled and networked during a recent joint social event sponsored by WAEPS and OPW.

Seattle/King County Clinic Needs Vision Care Volunteers Sept. 20-23 
Julia Colson, SKCC Project Director

 As of the end of June, the Seattle/King County Clinic was one month into volunteer registration and we had 1,702 unique volunteers signed up for 2,658 assignments during the week of the Clinic.  We had filled:

• 67% of Medical assignments
• 60% of General Support assignments
• 36% of Dental assignments
• 24% of Vision assignments
• 14% of Healthcare Resource assignments

While this is a great accomplishment, this year we have one month less to fill all the roles, so we can’t relax yet.  Do you know someone who intends to volunteer?  Have you asked your healthcare providers to participate?  Have you signed up?  Thursday and Sunday are the days we experience the most difficulty getting volunteers. Please help us with recruitment! You can find information and sign-up at seattlecenter.org/volunteers  

In mid-July, we began patient outreach efforts. Flyers and posters have been translated into multiple languages and we have a great roster of community-based organizations and media sources ready to help spread the word. The webpage for patient information is seattlecenter.org/patients. This includes detailed FAQs and flyers available for download.  Once again, your assistance sharing this opportunity with people who struggle to access and/or afford healthcare is appreciated!  

 If you’ve never been to the Clinic before, you may not be aware of the extent of our services. (Click here to see a favorite of both patients and volunteers) The patient flyer reflects many of the offerings, but I’d like to highlight a few additions this year. 

• Dermatologists will provide skin cancer screenings and assist in evaluating skin conditions discovered during exams.
• Occupational Therapy will join our popular Physical Therapy area to focus on hand, wrist and elbow issues.
• Working with King County and Public Health, we will be making naloxone (medication to rapidly reverse an opioid overdose) available to those who may require it or have a close relation who does. 
• UW Medicine is partnering with SKCC to expand the use of a mobile phone app that helps people with mental and behavioral health needs to remember to take medications, address voices, or deal with depression and anxiety.  Studies have shown that patients are more likely to utilize the FOCUS app than visit a clinic or attend a counseling session. The tool will be installed for free on the phones of patients who may benefit from it.

Community participation is especially valued as the Clinic nears (only 2.5 months)!  From volunteer recruitment and patient outreach, to procuring and organizing large quantities of supplies and equipment from multiple sources, we couldn’t do it without each and every one of you. On behalf of the people we are preparing to serve, I thank you for your continued assistance, support and compassion! 

Dr. Mike Brush and Dr. Denise Dudley screen patients at the 2017 Seattle King County Clinic.

WAEPS members and their practice employees  join together to make the vision care area of the SKCC extremely effective.  It's a great way to have fun and give back to the community. Put the 2018 dates on your calendar and sign up !

Physicians EyePAC Report
Aaron Weingeist, MD, Chair, WAEPS Physicians EyePAC and Government Affairs

In political circles, there’s a well-known adage: “If you’re not at the table, you’re on the menu.”

In our representative government, presence, visibility and voice are essential for any group wishing to influence decision-makers. Our Washington State Physicians EyePAC is here to help assure Ophthalmology has a seat at the table when healthcare policy is being decided at the state level. Over the past several years, consistent progress has been achieved, and member support of the EyePAC has been an instrumental component.

EyePAC funds amplify our efforts to support the advancement of common sense measures that protect our practices and our profession and more importantly, ensure patient safety and access to the highest quality eye care.

At this point in the year we assess our members’ contributions to the EyePAC and reach out to offer them an opportunity to make a difference in our legislative advocacy if they have not already done so.  We recently sent out a letter to those members. 

Particularly in this election year where the foundations of health care policy appear to be constantly shifting, please consider leveraging your voice and your impact by making a donation.  There are three easy ways to do so:

1.  By mailing  a check made payable to “Physicians EyePAC” to the WAEPS office:  2001 6th Ave, Suite 2700, Seattle, WA  98121
2.  By making an online donation at: http://www.waeps.org/donate-to-eyepac
3.  By calling our office and making a donation over the phone.  Debra Alderman, our executive director, can be reached during business hours at 206-956-3650.

Thank you so much for your support for the Physicians EyePAC.  I look forward to reporting on our advocacy efforts in upcoming WAEPS newsletters and at the WAEPS Annual Meeting on March 29, 2019.

In Memoriam:

Our condolences go out to the family of John (Jack) Chandler, MD.  He was a long-time member and former WAEPS president, and passed away in Wisconsin in late May.   

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New Member Welcome

Welcome to our newest WAEPS members!

Dr. Bryan Kim, of The Everett Clinic
Dr. Irene Lee, of Washington Permanente Medical Group
Dr. Erin Seefeldt, of Madigan Army Medical Center
Dr. Donald Stone of Spokane Eye Clinic

Save these Dates:

YOS August Event 
Watch for an email soon with details about our annual social event in late August. More info available on the WAEPS website YOS page. 

WSMA Annual Meeting, Spokane, October 13-14, 2018

AAO Annual Meeting, Chicago, October 27-30, 2018
Note that early registration deadline is August 15. 

WAEPS Annual Meeting 2019 at Meydenbauer Center, Bellevue, WA
Coding and Reimbursement Seminar - Thursday, March 28, 2019
Physician Dinner and CME Program - Thursday, March 28, 2019
All day Physician Program and members' luncheon - Friday, March 29, 2019
Practice Management Program - Friday, March 29, 2019
Ophthalmic Personnel Program - Friday, March 29, 2019

AAO Mid-Year Forum, Washington DC, April 10-13,2019