InFocus WAEPS Member Newsletter - June 2019

President's Corner

Rebecca Dale, MD, WAEPS President 2019-20

It has been my privilege to learn about WAEPS in my last few years on the board. I recall tentatively standing as a new member of WAEPS at my first annual meeting 11 years ago, not entirely sure of what WAEPS was. I now have a better understanding of the many ways in which WAEPS serves its’ two aims: to serve the educational and professional needs of its member ophthalmologists and promoting the health and well-being of the citizens in Washington. I now have the brief privilege of serving as President for the upcoming year and make my own small contribution to a long legacy of dedicated service to this organization by my fellow colleagues.

We have been active, and we have much to celebrate. We’ve successfully worked with our optometric colleagues to protect Washingtonians from the dangerous fad of scleral tattooing. We’ve joined our colleagues in Olympia for the WSMA for the legislative summit and in Washington DC for the AAO Mid-Year Forum to speak up for our patients and our profession. We’ve enjoyed another fantastic annual meeting with not only outstanding clinical education for ophthalmologists, but also the coding, technician and practice management meetings that are the envy of other states. We’ve welcomed an energetic executive director, Kim Conn, who has smoothly accepted the reins from Debra Alderman. And we continue to innovate, with the advent of donation by text for the Washington Physicians EyePAC and the Washington Eye Foundation (if you missed this at the Annual Meeting, give it a try now: Text the word “give” to (206) 202-2089).

As I reflect on all of this activity, I am grateful for colleagues who have strengthened and enriched WAEPS with their contributions of time, talent and resources now and in the past. To continue refining and strengthening our organization, I’m asking you to raise your hand and get involved. Drop me an email -- [email protected] -- and let me know what you have a passion for, and how our group can better serve our patients in Washington. Please mark your calendar and join me and your fellow WAEPS members for an informal dinner at AAO in San Francisco on October 14th. Above all, let’s connect. Our connections form the deep roots of our organization and taking the time to nurture these connections will keep us healthy and thriving.

AAO Councilor Report

Mike Brush, MD

Nine WAEPS members had a successful trip to the AAO’s Annual Mid-Year Forum in Washington DC. Rebecca Dale, Aaron Weingeist, David Epley, Aaron Lee, Cecelia Lee, Ariel Tyring, Joanne Ho, Nicholas Chan, and myself met with Senator Cantwell as well as legislative aides from Senator Murray, Rep Smith, DelBene, and Jayapal to help bring to their awareness several issues critical to the AAO. Patient safety and access were key messages as well discussed the following areas:

• Prior Authorization Burdens
• Step Therapy affects the timely access to sight-saving medication
• Rising Drug Costs and Persistent Shortages
• NIH and NEI Funding
• Department of Defense Vision Research Program

By going to DC, we help to build strong, sustainable relationships with our federal lawmakers so that when they need our knowledge, they look to us as their best resource for information. Highlights from 2018 advocacy include:

• Preserved access to compounded drugs and ensured proper physician reimbursement for Part B medications
• Averted a congressional mandate for additional cuts to “mis-valued” codes
• Increased funding for vision research

I encourage every WAEPS member to join us in DC at some point during your career. Advocacy is part of the lifeblood of our profession and we need every member’s participation – this can occur in many different forms such as donations to the state and national PACs or contacting your local legislators about issues critical to medicine. Look to aao.org/advocacy for more information.

Mid-Year Forum 2019

David Epley MD

A number of colleagues attended the AAO’s Mid-Year Forum and Congressional Advocacy Day in Washington DC this April, along with the WAEPS/UW jointly sponsored Advocacy Ambassadors (Nick Chan and Joanne Ho). Joining the Advocacy Ambassadors were Drs. Rebecca Dale (your WAEPS President), Michael Brush, Aaron Weingeist, David Epley, Ariel Tyring, Aaron and Cecilia Lee.

The group lobbied staff from Representatives Jayapal, Delbene, Larsen, and Dr. Schrier offices, along with a representative from Senator Murray’s office and Senator Cantwell herself.

The AAO’s mid-year forum (MYF) is an advocacy, practice management, and trends in ophthalmology conference that is unique and engaging. There are sessions for young ophthalmologists and the Advocacy Ambassadors called the LEAP Forward Sessions (Leadership, Engagement, Advocacy, and Practice Management). Pictured here is David Epley engaging in a conversation during the LEAP program on Private Equity.

This year’s MYF also had sessions on reigning in the costs of drug spending, social media training, private equity, the IRIS registry, cross-cultural challenges for practices, and emergency preparedness. The whole report can be found here if you’d like to dig deeper.

The mid-year forum is held in the spring of each year. If you’re bored with typical CME and want to learn more about the cutting edge in practice and evolution of ophthalmology, this conference is worth the trip!

2019 WAEPS Annual Meeting was a success!

Paul Griggs, MD, 2019 Physician Meeting Chair

The Annual WAEPS Physician Meeting was held at the beautiful Meydenbauer Conference Center in Bellevue, WA. There were over 165 physician attendees from around the State. We heard from five leading Ophthalmologists from around the country: Dr. Angelo Tanna, Dr. Jay Duker, Dr. John Holds, Dr. Dan Briceland and Dr. John Berdahl on a variety of topic from New approaches for Glaucoma Medical Therapy to Implementing MIGS into your practice to Upper blepharoplasty and how to do it. It was a fascinating two days of learning.

2019 Ophthalmic Medical Personnel Program

Anndrea Grant, COMT, OSC, Program Chair

As chair of the WAEPS annual Ophthalmic Personnel Program, I am very pleased to report another highly successful and well-attended meeting held this past March in Bellevue. We were joined by ophthalmic personnel from practices across the Pacific NW, including several from outside Washington state. Once again, we achieved our goal of providing one of the largest award-winning continuing education programs in the country. It has been my honor and privilege to be approached by several other state societies this year, including New York, Arizona and California, for advice on how to achieve this level of success at their annual meetings. I am frequently asked this question: what makes the WAEPS Ophthalmic Personnel Program such an exceptional meeting every year? Here is my answer:

Strong Curriculum. Each year we make every effort to offer an unparalleled educational experience for our attendees by providing new, relevant and comprehensive courses that are usually only found at national ophthalmology meetings. We hold to a standard of selecting an elite faculty of highly skilled and dedicated ophthalmologists from the very best centers and practices in the Pacific NW and the top clinical application specialists from within the industry to share vital new clinical information, the latest research and study results and the best clinical practices currently being utilized across the country, through thirty unique lectures and eighteen clinical hands-on workshops. In addition, many of our lectures are interactive, with audience participation through-out the course to help engage attendees to better learn the material being presented. This combination of in-depth courses, interactive lectures and hands-on workshops provides a level of learning that is not readily available online or anywhere else.

Firm Connections. We strive to keep our program relevant to our members by staying connected with our attendees and member practices through-out the year in order to effectively meet their educational needs. Every year we conduct a survey of our attendees after the meeting to evaluate the program and we adjust our courses, speakers and workshops accordingly. This keeps our program versatile and responsive to the ever-evolving needs and requests of our members and allows our attendees to be actively involved in their own education. Is there a course that you would like to see added? Is there a skill set that you would like us to offer training for? Please let us know as we are always open to new ideas and suggestions.

Active Participation. We strongly believe in the value of involving attendees in their own education and that teaching others helps increase an individual’s own abilities. That is why we encourage experienced technicians to participate in the education of newer technicians by volunteering during the program as workshop instructors, co-instructors and moderators. This gives these attendees an opportunity to hone their communication, teamwork and leadership skills, enabling them to become the team leaders, clinical trainers and supervisors that our member practices need. Thus, our program not only provides a thorough clinical education, but also offers the interpersonal skill training that is necessary for attendees to become valuable assets to our members’ practices. In addition, we are very pleased and proud to have technicians with over 20 years of experience in the field as part of our faculty who gladly pass on their vast clinical experience and knowledge to newer technicians just entering the field. The value of the experience they share is priceless, and our program provides the platform for it to be used by others rising to take their place.

Longstanding Support. We are very fortunate to have a core of dedicated leaders who recognize the importance and value of the program and remain committed to its success every year. I am very thankful for the support of Drs. Russell Van Gelder, Rebecca Dale, Mike Gilbert, Aaron Weingeist, Paul Griggs, Rachel Reinhardt, Jackie Wong, David Epley, Yewlin Chee, Jim Stroh and Mike Brush among others who have been an immense help in recruiting exceptional speakers and instructors and providing new ideas and advice for course content. Their long-standing dedication is the strength of this program, providing a level of commitment not seen in many other state society organizations. Most importantly, we are very grateful for the continued support that you, our members, give us by sending your staff to attend the program each year. We recognize and greatly appreciate the trust and confidence you have in us to consistently provide a program that will help your staff become and remain some of the most highly skilled and knowledgeable clinicians in the field. Thank you so much for your continued participation and support!

I am excited to once again serve the WAEPS membership this year as chair of the 2020 Ophthalmic Personnel Program and I look forward to seeing you and your staff there! Please feel free to reach out to me directly at [email protected] if I can help you or your practice in any way.

Coding Seminar 2019

Michael Gilbert MD, Coding Chair

Once again, we welcomed nationally recognized Coding Specialist Sue Vicchrilli, COT, OCS back to Seattle to lead the CodeQuest Ophthalmic Coding Course. Sue is the Director of Coding and Reimbursement for AAO. She is the content director for the Academy’s entire line of coding products. She taught our group two classes: Strengthen your Audit Armor, Strategy & Skills and Evolving Fundamentals of Ophthalmic Coding. With over 145 attendees coming from all over Washington State and even as far away as the East Coast, the Coding Meeting was a great success!

Practice Management Seminar

Rachel Reinhardt MD, Chair

The Practice Management seminar had a full slate of exceptional speakers this year. We were honored to have Dr. Robert Wiggins Jr. MD MHA come to town and join us for two sessions on Improving Quality & Lowering cost of Healthcare and Disruptive Innovations on how new technology affects care. The attendee surveys rated the seminar as highly useful and informative.

SAVE THE DATE: WAEPS ANNUAL MEETING 2020

March 18- 20, 2020
Washington State Convention Center

Monthly Scientific Meeting Series 2019-20

Yewlin Chee, MD, Chair

WAEPS members gather monthly for educational sessions in our award winning Monthly Scientific Meeting Series, co-presented by the University of Washington Department of Ophthalmology. These programs are presented by experts in a variety of ophthalmology sub-specialties. For those who are able to attend in person, the lectures are held in the auditorium at the Harborview Medical Center Training and Research building in Seattle. In addition, the series is available to members throughout the state via live streaming webinar. Category 1 CME credit for the series is an exclusive WAEPS member benefit and is free of charge. Note that to earn credit you must sign into each session you attend and track your attendance and submit a credit claim form at the end of the series.

We are finalizing the speaker line for the 2019-2020 year and will send out an announcement to WAEPS members in the summer announcing the topics and dates.

When you plan to attend a meeting in person or via webinar, be sure to register online at www.waeps.com on the Monthly Meeting page of the WAEPS website. Your automatic confirmation email will contain the webinar login information for that month's session. If you need assistance with registration or do not receive your confirmation, please contact the WAEPS office no later than 3 p.m. on the day of the session you plan to participate in. If you have questions about the monthly series or want to make a topic/ speaker suggestion, please email Chair, Yewlin Chee.

WAEPS EyePAC & Washington Eye Foundation

Donating to the Washington Eye Foundation & The Washington EyePAC is now easier than ever! Where does your donation go? It allows the EyePAC to make meaningful connections with legislators on the state level who share our passion for quality, safe eye care for all Washingtonians but this relationship must be built consistently over time. This includes campaign contributions from the state level PAC. It is noted that Optometrists consistently out donate ophthalmologists in our state and nationally. We need your help now. Click here to make a donation.

Ways to help: Please make a donation today to the Surgical Scope Fund, WAEPS EyePAC or Washington Eye Foundation. You can make a difference by donating today to support our PAC efforts.

Donating is now easier! Text to Give option is available.

Reimbursement & Payer Relations

Michael Gilbert MD, Chair

What Cataract Surgeons Need to Know Today: Cataract Surgery Cost Measure Essentials for MIPS

Does the acronym MIPS cause you to skip to the next WAEPS article? STOP! MIPS, the currently active Merit-based Incentive Payment System is looking to judge, and to compensate you based on their assessment of Merit, …which we all know means “Cost.” Starting 2019 MIPS includes a cataract surgery cost measure which summates total costs directly, and indirectly associated with cataract surgery. Cost will account for 15% of the final MIPS score for 2019, with annual increases in that percentage weighting. Thus, cost becomes an increasing measure of your “Merit.”

Does this mean more reporting, you ask? For good or ill, no indeed. CMS will determine scores through claims submission singularly of uncomplicated cataract surgery, 66984. The cost measure is not invoked if there are any significant co-morbidities such as amblyopia, cornea edema, diabetic retinopathy, or glaucoma. If you do not code for such co-morbidities, the surgery episode will be included in your data. Complex cataracts, 66982 are excluded.

As noted, this episode-based metric seeks to measure the cost of care related to a specific procedure or condition— Here cataract surgery.

CMS considers the following costs to be included in a cataract “episode:”

• Pre-operative testing,
• The physician’s professional fee for the surgery itself,
• The facility fee,
• Some drugs separately payable under Part B, including only one on pass-through administered during surgery, intraoperative Omidria.
• Anesthesia, and
• Additional post-operative care billed separately from the surgery, such as additional procedures as a result of a complication.

As a critical note, the measure includes costs 60 days prior to the surgery and 90 days following it.

The cost of surgery performed in an ASC will only be compared to others performed in ASCs, and those performed in HOPDs will only be compared to others in HOPDs. To further sub-divide the surgery types, there are sub-groups for whether one surgery was performed within the 90-day window of the measure “unilateral” or if the second eye was operated on within the 90-day global of the first surgery, “bilateral”.

CMS then compares the physician’s or group’s average cost to a benchmark and assigns the measure a score of 1 to 10 points. The benchmark will be determined based on cost data from the performance period. The lower the average cost of the cataract episode, the higher the measure score will be. Physicians or groups will not lose or receive negative points for higher costs, but their measure score will be lower.

There are some troubling perversions currently in the calculations. If a patient has not seen a primary care physician, then he or she — and the total cost of medical & surgical care — is attributed to the physician who billed the majority of E/M service, which could even be you, the hapless ophthalmologist.

In short, the MIPS Merit vs Cost reimbursement system is chock full of pitfalls worth noting. Anesthesia costs, Omidria and other expenses will count against your relative cost compared to benchmarked colleagues. Ultimately our compensation will be influenced by comparative costs of our delivering care. This is the first swing toward that end. Clearly there is more to be learned on navigating this system which will increasingly influence our compensation in coming years. Stay tuned.

Renton Technical College Ophthalmic Program needs our help!

The Ophthalmic Assistant Program at Renton Technical College is undergoing review and in fear of closing. Enrollment has dropped but demand has not. The program has been successful for 15 years and had hoped to grow and offer COT options. For more information or if you can help, please contact Larry Bovard COT, Program Director, at 425-235-2352 x7926 or [email protected]

YOS Event coming June 8th!

Janet Chieh MD, Chair

Join the YOS fun with your colleagues at the Flatstick Pub on Lake Union. 4:00-6:00 PM on Sat. June 8th. Come join us for pizza, salads, drinks, golf, socializing and more. Please RSVP to Janet Chieh at [email protected]. We would love to see you there! Guests welcome!

WAEPS Legislative Update Q2 2019

Aaron Weingeist MD, Chair

The “long” legislative session ended on time April 28th. Thank you to Susie Tracy and Cliff Webster, WAEPS lobbyists, who keep our organization effective in Olympia every year. Thank you also to Katie Kolan and the WSMA for working so hard to defend the House of Medicine every year. Big thank also to Rachel Reinhardt MD, David Epley MD and Russ Van Gelder MD PhD for their active participation on the legislative issues. And, a special thank you to WAEPS members who took the time to prepare for, and testify on behalf of our organization this year: Michael Gilbert MD, Rebecca Dale MD, and Aaron Lee MD. It takes a team to do this work!

WAEPS Initiated Proactive Legislation Win:

The language of any of the following bills can be viewed by going to, https://app.leg.wa.gov/billinfo/ and typing the bill number into the search field.

House Bill 1856, the ban on the practice of scleral tattooing, was signed into law and will be in effect starting July 1, 2019.

WAEPS initiated the process that led to Senator Tharinger sponsoring the bill. The bill was supported by WAEPS, the OPW and WSMA. There was no organized opposition to the bill. HB 1856 will protect citizens of Washington from the dangerous practice of scleral tattooing.

The Scleral Tattoo Bill elicited positive media coverage in the Spokane Spokesman Review. Click here to read the article.

Other Wins:

ASCs:

HB 1777, a bill that amends Washington’s Certificate of Need (CON) law and will once again permits single and group practice ASCs to be exempted from the CON process, passed the legislature and was signed by Governor Inslee April 17. There is no longer ambiguity related to legality of operating or transferring an exempted ASC. Contact your practice attorney to see how this bill applies to your ASC.

Optometry/telemedicine:

Senate Bill 5759, the OPW’s bill that would prohibit on-line telemedicine technology in Washington State, returned and was again defeated.

Naturopaths:

HB 1630/SB 5752 propose to increase naturopath scope of practice to include Schedule III-V drugs and “minor office based procedures” was defeated.

Other Legislation:

B&O Tax:

HB 2158 will increase B&O tax by 20% from 1.5% to 1.8%.

Please connect with me if you have questions, concerns or would like to get involved with WAEPS legislative or regulatory issues. [email protected]