President's Corner

Rachel Reinhardt, MD
WAEPS President
[email protected]

Happy New Year!  It's hard to believe that 2015 is here.  WAEPS has a great year lined up for you.  Our legislative session is underway and, as always, we need to be prepared to stand up in Olympia for our profession and our patients.  Watch for eblasts about legislative issues that come up in the next few months. Aaron Weingeist and the Board will need your help. Aaron can't do it all by himself!  Legislative hearings often are scheduled with little warning, so please join us in Olympia when you can. We always welcome your support. 

Our annual meeting in March will once again be a fantastic event. Debra Alderman and the Board work the entire year to make the meeting outstanding for you and your staff. Be sure to send your techs to the tech meeting and don't forget to send your office managers and administrative staff to the Practice Management Program.  And, remember, doctors can attend the Practice Management Program as well.  Buy a “Dual Meeting Pass” if you want to be able to attend both the Scientific Program and the Practice Management Program.  And don't forget to attend the coding program on Thursday followed by the Thursday night physician dinner. 

Finally, in 2015 the Board will once again be looking for motivated ophthalmologists to join the Board.  Being a WAEPS Board member takes your passion for ophthalmology to a different level.  It is very rewarding to have a say in the future of our profession.  Please give some thought to throwing your hat in the ring.  We would love to have you! If interested in stepping onto the board in March, please contact me no later than January 26.

Happy New Year to one of the best state societies in the country!

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Public Education

David Epley, MD, Chair

RAM Clinic
Thanks to all who participated in the Seattle/King County RAM medical clinic! The clinic was an unqualified success. 1,450 volunteers from all specialties volunteered, including 20 ophthalmologists and ophthalmology residents, 5 technicians, 16 opticians and 11 opticianry students, and 33 optometrists. 98% of patients seen felt that they were well-treated, and a total of 1,050 patients received vision care. More than 80 patients were diagnosed with cataracts, 10 with diabetic retinopathy and 40 with glaucoma needing follow up. More information can be found in the full report here.

The Public Information Committee is seeking volunteers to be on the committee. The time commitment is minimal, but the impact is tremendous and rewarding! We are also seeking someone to take over as Chairperson of this committee starting in March at the Annual Meeting. Please email David Epley at [email protected] if you are interested.

WAEPS board member Atma Vemulakonda, MD, examines a patient at the RAM clinic.

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New Website launched in November

WAEPS implemented a website/database overhaul during the fall and now has an easy-to-navigate website with separate sections for the general public, ophthalmic personnel and ophthalmologists.  There are members-only features, some of which are already available and some which will roll out in 2015.  We invite you to spend some time exploring the new site and taking a few minutes to log in and update your profile.  Your login credentials were emailed to you in mid-November.  If you have any questions or need help with the website, contact Debra Alderman:  206-956-3650 or email her at [email protected]

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Monthly Scientific Meetings

Bryan Lee, MD, Chair

We have now held the first three sessions of the 2014-15 Monthly Meeting series.  Each was very successful and incorporated in-person participants as well as physicians participating via the web from across Washington State and Alaska.

The meetings are held at the Research & Training Building at Harborview Medical Center from  6:30 to 8:30 p.m. Registration and light refreshments begin at 6 p.m.  Please register ahead of time, especially if you plan to participate by webinar so you can be provided with login credentials.  Contact Debra Alderman in the WAEPS office:  [email protected]

Schedule for January through May:

January 21, 2015
Presenter: Natalie A. Afshari, M.D.,F.A.C.S.
Professor of Ophthalmology
Stuart I. Brown M.D. Chair in Ophthalmology in Memory of Donald P. Shiley
Chief, Division of Cornea and Refractive Surgery
Director of Education, Shiley Eye Center, University of California - San Diego
Topic 1: Video Grand Rounds of Challenging Cases in Cataract and Corneal Surgeries
Topic 2: A Journey Through Cornea from A to Z

February 18, 2015
Presenter: Constance West, MD
Associate Professor of Clinical Ophthalmology, University of Cincinnati College of Medicine
Director of Pediatric Ophthalmology, Service Chief of Ophthalmology, Cincinnati Children’s Hospital Medical Center
Topic 1: Ten Things I Wish I’d Learned in Residency
Topic 2: My EPIC Adventure: Six Years After Go-Live

March 18, 2015
Presenter: Eissa M. Hanna, MD
Assistant Professor, Ophthalmology, University of Washington School of Medicine
Topic 1: Initial Management of Eye Trauma
Topic 2: Surgical and Medical Reconstitution of Vision in Post-Traumatic Eyes

April 8, 2015
Presenter: Kuldev Singh, MD, MPH
Professor of Ophthalmology, Stanford Byers Eye Institute, Stanford University Medical Center
Topic 1: The Landmark Gaucoma Trials: What We Have and Have Not Learned
Topic 2: Should Modern Cataract Surgery Be Considered an IOP Lowering Procedure

May 20, 2015
Presenter: Bonnie An Henderson, MD
Clinical Professor, Ophthalmology, Tufts University School of Medicine
Topic 1: “Doctor, I still can’t see”
Topic 2: Complication Management: It Could Happen To You

Accreditation:
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the University of Washington School of Medicine and the Washington Association of Eye Physicians and Surgeons. The University of Washington School of Medicine is accredited by the ACCME to provide continuing medical education for physicians.

The University of Washington School of Medicine designates this live activity for a maximum of 16.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. (Each session is 2.0 credits).

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Annual Meeting 2015

Paul Griggs, MD, Chair

Save the Date:  March 19 and 20
This year’s physician program will again offer nationally known experts presenting on a variety of topics.  Thursday evening there will be a reception at 6:30 followed by a physician dinner featuring speakers from OMIC as well as two lectures by our guest speakers. 

Friday’s full-day physician program will feature a variety of talks, as well as the annual WAEPS membership business meeting at the lunch hour.

In addition, the Coding and Reimbursement Conference on March 19 and the program for Ophthalmic Personnel and the Practice Manager’s programs on the 20th are shaping up to be excellent, as well.

Brochures will be going out soon and online registration will open January 12. Visit: www.waeps.org/annual-meeting

Coming from out of town?  We have a limited number of rooms reserved at a discounted rate at a nearby hotel.  This link will take you directly to the reservation page for our group.

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Health Plan Relations News

Michael L Gilbert, MD, Chair

MEDICARE NEWS, AND MORE!

Medicare Holding 2015 Payments Due to Technical Errors
CMS is delaying payments to providers scheduled to begin Jan. 1 with what should be the published 2015 Physician Fee Schedule. The promised short hold is being implemented reportedly to make technical corrections to the payment rates as published. CMS indicates that it “expects carriers to have revised payment rates available no later than Jan. 20.”  Encouraging, yes?

CMS has adopted a reduced conversion factor to 35.7547 instead of 35.8013. Physicians will see a slight downward payment adjustment for most services, as you would expect.

Practice-Changing ICD-10 CM Will Be Imposed 2015! 
The ICD-10 implementation approaches.  The long-anticipated and much-feared requirement for the use of the ICD-10 diagnostic coding set is now almost assuredly October 2015.  This new diagnosis code set replaces the long-familiar and comfortably simpler ICD-9 system. Make sure you are developing a plan for implementation.  WAEPS has developed ICD-10 training programing to ensure staff and physician readiness for this major practice change. We are teaming with AAO to bring the CodeQuest—Conquering ICD-10-CM training to Seattle the morning of Monday, May 11.  More details and online registration will be available soon on the WAEPS website.

New CMS Policy Allows Scribes to Enter HER Data for Meaningful Use
CMA will now permit “certified ophthalmic scribes” to enter electronic medication, laboratory, or radiology orders into electronic health record systems. This positive change reduces burdens for ophthalmologists attempting to satisfy the EHR Meaningful Use Program’s Computerized Provider Order Entry measures in Stage I and Stage II.  Absent this change, CMS would only allow licensed health professionals and certified medical assistants, certified ophthalmic assistants and certified ophthalmic technicians to enter orders. ASCRS and AAO have been advocating for this enhanced guidance.  CMS emphasizes that physicians must maintain a comparison document enumerating the responsibilities of certified ophthalmic scribes and certified medical assistants that are the same.

OIG Reports Medicare Paid Millions for Potentially Inappropriate Ophthalmology Claims
The OIG Office of Inspector General continues to focus attention on ophthalmology service utilization.  A recent report asserts that Medicare paid a potentially inappropriate $22 million in 2012 for ophthalmology claims.  This compares to total claims of over eight billion for this period.  OIG opinion continues to conclude that ophthalmology services for screening, diagnosis, evaluation or treatment of cataracts, wet age-related macular degeneration, and glaucoma are vulnerable to fraud, waste and/or abuse.

WAEPS Coding Reimbursement Seminar March 19, 2015:
The March 2015 Reimbursement Conference is not to be missed. The seminar offers a concentrated, full-day presentation due to the increasing importance and challenge of major practice changes in 2014.  Kevin Corcoran will lead us in this information-packed seminar to be held in the Washington Convention Center.  The program features:

• What’s New and Necessary in 2015
• Coding and Compliance Challenges and Opportunities of Electronic Medical Records
• Getting and Keeping Meaningful Use
• Crucial Coding Concepts
• Managing a Chart Audit
• Refractive Cataract Surgery, Rules and Opportunities
• Local Coverage Policies for Washington State
• Q&A—Get Help from Experts
   

This program is specifically paced for physicians, by physicians, AND for broad levels of ophthalmic staff, novice to expert.  Bring your biggest questions, or better yet mail or email them ahead for the definitive answers to be included in the program. They can be sent to Debra Alderman in the WAEPS office:  [email protected]

Registration opens the week of January 12. Visit the WAEPS website for full information and to register.

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AAO Councilor’s Report

Brian Bowe, MD

The AAO Council has its Fall meeting during the AAO meeting in Chicago this October.  There were no real items of contention that occurred at this time.  The AAO2AAO (American Academy of Ophthalmology to American Academy of Optometry) initiative which I spoke of in previous issues of InFocus, is progressing along at the dialogue stage between the two groups on how to proceed with this.  In addition, our academy has a task force that is also looking at this issue and its impact on us.  There are several  items being discussed at the present time.  There are plans for a joint symposium between the two groups in the next couple of years.  Also discussed with this initiative was having Optometrist authors of papers accepted for presentation at the annual meeting, be present at the annual meeting.  The authors and the content would be screened by State Affairs and there would be no access granted to the exhibit floor to the optometrists in attendance.  As there is projected to be a shortage of eyeMD’s by 2020, having a dialogue and a professional relationship between the two AAO groups is going to be essential in positioning Ophthalmology as the leader of an integrated eye care team. 

The IRIS registry is doing better than initial expectations.  The registry has already generated large numbers and amounts of data.  Most EMR’s are able to integrated into IRIS.  There are a few exceptions, the most notable is EPIC, but work is ongoing to include them.  I encourage you to check it out if you have not already done so. 

On the political front, California beat back a scope bill (performing scalpel surgery, SLT, ALT, YAG Cap, and injection of medications) in the last year with a grassroots effort and a good contribution from academic involvement to counter the academics that the optometrists were taking to Sacramento.  That was a major lesson that we might keep in mind the next time a scope battle appears in our state.  In Alaska, the optometrists passed a hydrocodone bill in the last year.  Hawaii is trying to develop a community based training program for COA’s.  We will be keeping our eyes on this to see how it progresses.  Oregon has started a pediatric screening program in the public libraries.  We will hear more about this at the Mid-Year Forum this April.

Next up for the council is the Mid-Year Forum in Washington DC this spring (April 15-18, 2015).   As in past years, there will be a “Congressional Advocacy Day” starting Wednesday night and the day on the hill on Thursday.  I would encourage any of you who have not taken the trip to Washington to visit members of Congress and their staff to consider the trip this year.   For details, visit the website.

If there are any questions about the AAO Council or their activities I would encourage you to contact me and we can discuss them in greater detail.  [email protected]

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Membership

Robert R. Francis, MD, Chair

Welcome to our newest members, who have joined since summer 2014:

Michelle Cabrera, MD, Seattle Children’s, Seattle
Heidi Eiseman, MD, Rockwood Eye Clinic, Spokane
Matthew Hauk, Allure Laser Center and Medispa, Seattle
Cecilia Lee, MD, University of Washington, Seattle
Sharel Ongchin, MD, Retina Consultants of Seattle
Hubert Pham, MD, Eye Associates Northwest, Seattle
Brice R Nicholson  DO, Evergreen Eye Care, Federal Way
Kasra Rezaei, MD, University of Washington, Seattle
Joanne Wen, MD, University of Washington, Seattle

Reminder—it’s time to renew your WAEPS membership! 
In November all members were emailed an invitation to check out our new website, update their profiles and pay their dues.  Many of you have taken a few moments to do so—thank you!

For those of you who work at a large practice with quite a number of WAEPS members, feel free to have your office manager contact Debra Alderman in the WAEPS office to make arrangements for the dues for all the member physicians to be paid at one time. 

Be sure to renew your membership as soon as possible so that you and your employees can benefit from discounted  member rates for the 2015 WAEPS Annual Meeting!

PAC Contributions—we’ve made it easy to give!
Just a reminder that we encourage all members to make a PAC donation each year. We understand that many practices pay dues on behalf of their member physicians, but not PAC contributions.   We’ve now made it easy for you to go online at any time and make a PAC donation of any amount with your personal credit card.  Just visit this page of our website to do so.

Members—help us reach out to your colleagues to promote membership in WAEPS.  Let other ophthalmologists  know about the importance of WAEPS as a strong advocate for the profession and for public access to quality eye care.  You can mention member benefits like discounted registration fees for physicians and their staff members to attend the annual meeting and other important training opportunities.  Professional networking, listing in the WAEPS online database, and a variety of other benefits are available to WAEPS members.  For more information, please refer your colleagues to the of the WAEPS website for all the information and an easy to fill out online application: www.waeps.org/membership

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Legislative/Government Relations Report

Aaron Weingeist, MD, Chair

2015 is upon us, and that means the beginning of a new legislative session.  This year we are slated to have a 120 day session commencing on January 12. 2015.  The legislature will have to implement a new education plan and find new funding sources related to the McCleary decision (in 2012, the Washington Supreme Court ruled that the legislature has failed to fulfill its duty to provide adequate education to the children of Washington State), and Initiative 1351 mandating smaller class sizes.

The Democrats remain in control of the House, and the Republicans the Senate.

Beyond those very expensive and challenging educational issues, we will certainly see others that affect our practices more directly.

WAEPS will again be submitting a proactive bill that will permit patients to obtain early prescription refills of their ophthalmic medications.  This is important for our patients with chronic disease who often run out of drops before they can obtain a refill at 30 days.  The bill is based on language proposed by the AAO and already passed in Oregon.

We have been advised that the national Surgical Technologist organization will once again be submitting a bill that would require Surg Techs to be formally educated and licensed to practice in hospital ORs and physician-owned ASCs.  A Washington State Department of Health Sunrise Review already determined that there is no need for this legislation.  In the new version of the bill, there is language that allows ASCs to hire non-licensed surgical assistants if they make a good faith effort to hire licensed ones but are unable to find qualified personnel.

This fall, the DEA rescheduled hydrocodone-containing combination medications (e.g. Vicodin) from Schedule III to Schedule II, in an effort to better control drugs with high abuse potential.  This change will place these medicines outside the prescribing authority of our optometric colleagues.  Last year, the OPW ran a bill that would permit optometrists to continue to use these medications despite their prohibition from prescribing Schedule II controlled substances.  It is unclear why the use of this medication is so crucial as to require a change in state law.  In the rare event of non-surgical eye pain requiring a narcotic, other medications (e.g. Tylenol #3) continue to be available to optometrists as Schedule III alternatives.   The purpose of rescheduling hydrocodone-containing medications is to reduce patient access to a frequently abused substance.  Changing the law to permit optometrists on-going use of these medicines is unnecessary, and countermands the intent of the DEA.

Other issues that may appear concern ophthalmic assistants (MA-Rs), PAs in ophthalmology, compounded drugs, and ASC licensing.  We will be on the look-out for new taxes and fees that impact our ability to deliver needed services to our patients.

From a regulatory standpoint, WAEPS is still looking into a June decision by the Board of Optometry that the use of diamond burrs and the removal of sutures is allowed when optometrists do these things in conjunction with permitted procedures (e.g. removal of superficial ocular foreign bodies).   WAEPS continues to believe that these are SURGICAL procedures that were prohibited when the definition of ophthalmic surgery was written in 2003.

Finally, please give generously to Physicians EyePAC, the AAO Surgical Scope Fund, and OPHTHPAC so that we can continue our legislative efforts on your behalf.  When you interact with candidates and politicians, please be sure to identify yourself as an Ophthalmologist and help educate them about our practices and issues.

Feel free to connect about any concerns you may have out WAEPS legislative and political activities.

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Washington Eye Foundation (WEF)

David Epley, MD, Chair

WAEPS application to form a 501(c)(3) non-profit foundation to support the educational and scientific missions of our organization is under way.  The paper and legal work has been completed, and the approval process may take up to 18 months.  Donations to the WEF will be tax-deductable, and the WEF grants back to WAEPS will help support our educational and CME activities, public education efforts, patient screenings, resident education and other important functions of our society.

Donations to WEF can be made now, however, tax deductions cannot be claimed until the organization is approved.  If you wish to make a contribution, please contact Debra Alderman at the WAEPS office.

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View from the U

Russell Van Gelder, MD, PhD, University of Washington Liaison

The basic structure of ophthalmology residency training – an independent, one year internship followed by three structured years of ophthalmology training -- has not changed in over 40 years.  Yet the practice of ophthalmology is radically different from what it was in the 1970’s (anyone out there still doing intracapsular cataract surgery or Xenon arc photocoagulation?).  Is it time for a change?

The American Academy of Ophthalmology and the Association of University Professors of Ophthalmology (AUPO) are tackling this question during the coming year.  The impetus for this re-evaluation came out of an AAO Board retreat in 2013.  The AAO Board voiced its concerns that: 

1)  Fewer residents are going into comprehensive ophthalmology,
2)  The knowledge base required to practice ophthalmology is increasing rapidly, and
3)  The scope of practice of the individual finishing residency today is far more limited than 20 or 30 years ago. 

Are comprehensive ophthalmologists not as well trained coming out of residency as they were a generation ago? Do graduating residents feel the need to do fellowship in order to practice with competence?  How can we address these issues?

In many areas of medicine, there is a belief that the duty hour restrictions imposed by the Accreditation Council of Graduate Medical Education (ACGME) 10 years ago have provided less net training time during residency, and as a result have left residency graduates less well prepared than in previous eras.  While no one wants to see a return to the days of every other night in house call for residents, it is true that residents today put in fewer working hours than those of the 1980’s or 1990’s.  Can we use our training time more efficiently?  Or do we need more time?

The AAO/AUPO task force working on this issue is exploring a number of possibilities.  One entails linking internships to ophthalmology residency, as occurs in most other residencies (i.e. the resident matches into an integrated intern/residency program), and shortening the general medical or surgical training to 6 months.  The gained six months could be added to the ophthalmology residency.  This could result in six additional months in the PGY4 year for residents to pursue mini-fellowships within the residency.  Other proposals include looking at ‘tracked’ residencies, where the training might be different for those planning on going into certain specialties or career paths (such as a research track).

Nothing is likely to change soon – it is not clear there will be consensus amongst the stakeholders – and in any case there will be a long regulatory process which would include the ACGME and the American Board of Ophthalmology.  Finances play a major role, too – it is unlikely ophthalmology as a whole will see more dollars from CMS to pay for increased residency time.  But it is invigorating to do a deep analysis of our training and think of ways to improve. 

This issue has deep implications for all WAEPS members (as your future partners are our current trainees).  Please let me know if you have thoughts or concerns about this question.  I can always be reached at [email protected]

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Young Ophthalmologists Section (YOS)

Chair:  Janet Chieh, MD

The most recent YOS event was on December 1st at the cozy Italian restaurant Cuoco in the hip South Lake Union neighborhood.

The topic of the program was “Patient Reviews:  Good or Bad for Business?” featuring guest speaker Erik Hough of Allergan.  The group of new and prospective WAEPS members learned about:

• The  importance of patients’ reliance on peer reviews
• What are the sites where patients review providers
• Tips on managing negative reviews
• Strategies to encourage happy patients to review your business
• Tools for tracking patient reviews

It was an excellent program and the participants also enjoyed networking with their peers. 

We are planning a YOS program for the week of February 24.  Details should be announced next week via email and on the website’s YOS page.

If you’d like to be notified about upcoming YOS activities, be sure to check the YOS box on your profile when you log in on the new WAEPS website.

The WAEPS Young Ophthalmologists Section  (YOS) welcomes ophthalmologists in their first 10 years of practice as well as those new to Washington State.

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What physicians need to know about properly structuring management agreements

By Emily R. Studebaker, WAEPS Legal Counsel

In a recent unpublished opinion, the Washington Court of Appeals held that a management agreement between a dentist and a consulting service company was illegal in its entirety and unenforceable as a matter of law because it violated Washington’s prohibition on the corporate practice of dentistry.¹ This decision emphasizes the importance of properly structuring management agreements, not only for dentists, but for other health care professionals as well.

Dr. Choong-hyun Lee, a licensed Washington dentist, and Thaheld/Lee-01, LLC, a consulting service company, entered into a management agreement for the purpose of allowing Dr. Lee to focus on practicing dentistry, while the service company managed “the day-to-day administration of the non-dental aspects” of his practice.  Johann Thaheld, who was the sole member and owner of Thaheld/Lee-01, LLC, was not a dentist.

In its decision, the court explained that, under Washington law, corporations may not own, operate or maintain dental practices.  RCW 18.32.675(1) specifies:

No corporation shall practice dentistry or shall solicit through itself, or its agent, officers, employees, directors or trustees, dental patronage for any dentists or dental surgeon employed by any corporation: PROVIDED . . . [that this prohibition shall not] apply to corporations or associations furnishing information or clerical services which can be furnished by persons not licensed to practice dentistry, to any person lawfully engaged in the practice of dentistry, when such dentist assumes full responsibility for such information and services.

Under RCW 18.32.020(3), any person who “owns, maintains or operates an office for the practice of dentistry” is engaged in the practice of dentistry.  Accordingly, a contract that gives a non-dentist the power to influence a dental practice’s operations and share in its profits is illegal. 

In Lee v. Thaheld/Lee-01, LLC, the court noted that the prohibition “extends to most other learned professions that affect public health and welfare, such as … medicine … .”  Like the prohibition against the corporate practice of dentistry, the prohibition against the corporate practice of medicine disallows a non-physician or a corporation that is not owned and controlled by a physician from interfering with the professional judgment of a physician.  It prohibits those non-physicians or corporations from employing physicians to practice medicine and also restricts the types of management agreements physicians can enter into with such non-physicians and corporations.

In determining whether an illegal business relationship exists, courts consider: (1) the extent to which the corporation exercises control over the practice’s operations and (2) the nature of the payment scheme between the practice and the corporation.

The court found in Lee, that several aspects of the business relationship gave the service company the power to exercise significant control over Dr. Lee’s practice.  Among others, the court noted the following:

• The service agreement created a two-member policy board consisting of Dr. Lee and Thaheld.  A majority vote was required for all decisions.  Therefore, Thaheld’s vote was necessary to decide on matters such capital improvements and expansion, marketing and advertising, establishing and maintaining contractual relationships with other providers and third-party payors, setting patient fees and collection policies, patient concerns and claims, workplace health and safety, strategic planning, and approving or disapproving any merger with or acquisition of another dental practice.
   
• The service company had the power to negotiate and enter into contracts with third parties it determined were reasonably necessary and appropriate for Dr. Lee’s provision of dental care.  Dr. Lee was required to execute these contracts at the service company’s behest.
   
• Dr. Lee was required to sign all leases and intellectual property over to the service company.
   
• For an initial term of the service agreement, Dr. Lee could not voluntarily terminate his employment without finding a replacement dentist.
   
• Thaheld had the power to terminate the service agreement, which, if exercised, required Dr. Lee to sell the practice and give the service company 50 percent of the net proceeds.

The court found that the service agreement gave Thaheld a substantial beneficial interest in Dr. Lee’s practice.  The agreement provided for the service company to be paid an annual service fee equal to the highest paid dentist’s salary or $120,000, whichever was greater.  In addition, the service company was to receive a formula-based monthly performance fee from 10 percent up to 50 percent of the practice’s profits, along with a bonus of one-half the practices’ net profits.

The court acknowledged that Thaheld was not involved in the delivery of dental services, but said that “Washington law is clear that noninvolvement in the delivery of professional services is not determinative.”  The court found the above aspects of the agreement resulted in Thaheld being substantially in control of Dr. Lee’s practice, even if he was not practicing hand-in-mouth dentistry.

In light of the decision in Lee v. Thaheld/Lee-01, LLC, health care providers should review their consulting service agreements to ensure those agreements are legal and enforceable.

____________

1.Lee v. Thaheld/Lee-01, LLC, Wash. Ct. App. No. 68417-5-1/3 (unpublished, March 10, 2014).

____________

This article has been prepared by Emily R. Studebaker of Garvey Schubert Barer, who serves as WAEPS legal counsel.  For more information, you can contact Ms. Studebaker at [email protected] or (206) 816-1417.  This article is not a substitute for legal advice or individual analysis of a particular legal matter.  Transmission and receipt of this article does not create an attorney-client relationship.

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Genetic testing in the field of ophthalmology –your help is needed for a research project

WAEPS has been contacted by Michelle Jacobs, a graduate student in the Genetic Counseling Program at the University of Michigan.  Michelle is hoping that members of WAEPS, (along with other state ophthalmic societies), will help her with her research.  Below is her request.

Dear WAEPS members,
Your input is needed! A research team at the University of Michigan is examining the use of genetic testing in the field of ophthalmology- specifically; this novel study seeks to understand how ophthalmologists are currently using genetic testing and their opinions of this technology. An understanding of current practices will help us develop tools to support the integration of genetics and genomics into ophthalmic practice. This study was reviewed by the IRBMED board at the University of Michigan (HUM00089332).

This survey should take approximately 15 minutes to complete.  Your participation in this study is voluntary and you are free to withdraw your participation at any time. All participants who complete this study will have the opportunity to enter a drawing to win one-of-four $25 gift cards.  You will be contacted following the close of the survey if your name was selected for a gift card.

Please complete this survey by January 26, 2015.  Only surveys completed by this date will be eligible for the $25 gift card drawing.  If you have already completed this survey through the eyeGENE or Kellogg Eye Center research studies, please do not complete the survey a second time.

You may access this survey by clicking on this link

We hope that you will consider helping us with this study. You may contact the researchers at 734-936-8638 or at [email protected] if you have additional questions.

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Upcoming Events

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Have Questions? Need Information?

Feel free to contact WAEPS Association Executive Debra Alderman by phone:  206-956-3650 or by email:  [email protected]

Our office is located at: 2001 6th Ave. Suite 2700, Seattle, WA  98121

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President's Corner

Niraj Patel, MD, FACS
WAEPS President

What a great organization we have.  I am continually surprised by our amazing WAEPS members and the efforts they put forward to make ophthalmology such a great specialty.  I touched on this at the WAEPS annual meeting when I pointed out some of our members that volunteer countless hours to making the profession great.  Every ophthalmologist on the WAEPS Board is a volunteer.  They donate their time to making sure you have a great Annual Meeting, Coding trainings and the Monthly Scientific Lecture Series.  They donate their time to make sure your voice is heard in Olympia and across the country.  They donate their time to create events that provide free medical care for the public.  They donate their time to create networks for young ophthalmologists.   They donate their time to help the people and communities of Washington State. 

Many of them have taken off clinic days at the last minute to make sure you are well represented in Olympia as various bills come up for debate and discussion.  In a perfect world, every one of our members should donate their time to these activities, but it ends up that the majority rely on the minority to carry the torch.  Not everyone is willing or able to donate their clinic time.  However, one thing that EVERY member must do is donate to the PACs.  Actually, donate is not the right word.  It should be a mandatory contribution, essentially the cost of doing business to promote our profession and more importantly, to make sure our voice is appropriately heard.  If we don't have a seat at the table, we will be the meal.  It's that simple. 

The volume of bills targeted at medicine and in particular, ophthalmology, were numerous this year, and it takes a lot of energy to make sure our voices are heard.  There were quite a few bills this year that could have become law and trust me, you would NOT have liked many of them.  In each instance, it would have added additional burdens to your daily practice from what you do in a surgery center, to which employees in your clinic are permitted to place dilating eye drops and how these medications are logged and secured, to surgical technologist certifications, etc, etc.  It's an extensive list.  Without a strong voice and the funds to educate policy makers about the likely negative consequences of these bills, we would be in serious trouble.  This year we were able to defeat quite a few of these bills, and, with a lot of effort, we managed to get one bill passed that will have a positive impact on our patients!

WAEPS members gathered at the state capitol on April 24  to witness Governor Inslee signing SB 5268 into law. The successful passage of the legislation was largely due to the tireless efforts of WAEPS volunteers and lobbyists.

On April 24, 2015, the early refill eye drop bill became law in Washington State.  A few of us took the day out of our clinics to join Governor Inslee at the signing ceremony.  Now if any patients run out of their medication after 70% of the expected duration of usage has passed, they can get an early refill.  This will be really helpful for our glaucoma patients that run out of medications early which as you all know, happens quiet frequently.  This is the power of WAEPS, and this is why you need to contribute the PAC.  We can accomplish great things if everyone chips in and volunteers their time, makes a phone call to their representatives, and of course, donates their $300 to the Washington Physicians EyePAC.  We are talking about less than $1 a day.

I know you feel inundated with requests to contribute, but it's really a no brainer.  These are nominal contributions that are really important to allow you to practice ophthalmology and protect your patients.  The three contributions you should do each and every year:  Washington Physicians EyePAC, AAO OPHTHPAC, and the AAO Surgical Scope Fund.  Consider it an investment in your profession like a medical license fee that you need to have renewed each year to practice ophthalmology.  So I'll make it really easy for you.   Go to these sites below (make sure you are signed into your account to make your contribution):

1) WAEPS PAC
2) AAO OPHTHPAC
3) Surgical Scope (AKA Surgery by Surgeons) Fund

As WAEPS president, I have already had the opportunity to interact with  presidents of other state ophthalmic societies. I am proud to say that we have a very strong and active membership.  You should be very proud of this fact as well.  It takes hard work to create a strong society with engaged members that want the best for the profession and our patients. 

As you can see, WAEPS has some amazing, engaged ophthalmologists.  If you have never served on the board, you should consider getting involved and learning how you can help your profession.  If you like the idea of helping others and making your specialty great, consider volunteering for the board.  I may be calling you soon to get you started!

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Membership Report

Robert Francis, MD, Treasurer/Membership Chair

Welcome to the many new members who have joined WAEPS since our last newsletter in January:

• Kelly Bui, Eye Associates NW
• Jeanne Cubanski, The Eye Clinic at Valley Medical Center
• Jason Dettori, Group Health
• Andrew Edwards, Eye & Laser Physicians
• Ernesto Golez, Specialty Eye Care Centre
• Susan Hoki, Northwest Eye Surgeons
• Hoon Jung, Veteran’s Administration
• Rufina Kamilchu, Whatcom Eye Surgeons
• Meng Lu, Northwest Eye Surgeons
• Kathryn Pepple, University of Washington/Puget Sound VA
   

UW resident/fellow members:

• Erika Brewer
• Ingrid Chang
• Thomas Chia
• Marc Comaratta
• Alex Foster
• Divakar Gupta
• Jason Kam
• Narae Ko
• Yungtai Kung
• Thae Le
• Rebecca Lindsay
• Naomi Odell Lundstrom
• Trucian Ostheimer
• Mark Prendes
• Solomon Shaftel
• Jack Sychev
• Adam Sweeney
• Kathleen Williamson
• Oliver Yeh
   

Madigan Army Medical Center resident/fellow members:

• Okezie Igboeli
• Nathan Jordan
• Christopher Ochieng
• Morohunranti Oguntoye
• Ryan Roberts

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Washington Eye Foundation

David Epley, MD, Chair

Thank you all for your generous donations to the Washington Eye Foundation (WEF) at the WAEPS Annual Meeting. Thanks to your generosity, we raised an additional $4,450 in donations and pledges to help support the WEF in its efforts to help WAEPS better public health and education in Washington State.

The Washington Eye Foundation was formed to support the charitable, educational, and scientific activities of WAEPS through its activities, which may include:

• Creating and distributing public service announcements regarding eye and vision care;
• Arranging for free Glaucoma screenings to individuals who are unable to afford such screenings;
• Developing and conducting education programs for members of WAEPS and the public;
• Arranging for free vision screenings for children whose families are unable to afford such screenings;
• Creating educational materials for use by WAEPS’ members;
• Conducting charitable events supporting eye research or disease research related to conditions that may affect the eyes;
• Funding scientific research into ophthalmic diseases;
• Engaging with medical students and residents regarding WAEPS and eye and vision care;
• Connecting patients in need of care to local ophthalmologists; and
• Making grants to WAEPS to support WAEPS’ charitable, educational, and scientific purposes.

The WEF is a 501(c)3 and donations to the Foundation are fully tax deductible. If you’d like to contribute, please click here.

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Public Education Committee

David Epley, MD and Jim Stroh, MD, co-chairs

The Public Information Committee is seeking new members! Jim Stroh has volunteered to lead the committee when David Epley steps down to become a Director at ABO. Jim is hoping to have a group of members to form a committee to explore how to use money from the newly-formed Washington Eye Foundation to help aid the public in Washington State. Please email Jim if you’d like to be on the committee.

We are planning to participate in the Seattle/King County Medical Clinic the Seattle Center is hosting again this year. Last year’s effort, coordinated with the Remote Area Medical (RAM) group was extremely successful.  For information on the program, visit their website.

This year, Seattle is taking this on without RAM’s dental and vision support, and we’ll need to help them with examination equipment and more. The dates for the clinic are below, and volunteer registration begins in early June.

The organizers are encouraging volunteers to register via their website starting in early June.  For more volunteer information, click here.  From that page you can sign up for the program’s email list or contact the organizers via email with any questions.

SAVE THE DATES:

• Tuesday, October 20 & Wednesday, October 21 – SETUP
• Thursday, October 22 – Sunday, October 25 – CLINIC
• Monday, October 26 – TAKEDOWN
• With additional opportunities in the weeks before and after to help with preparation and wrap-up.

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Monthly Scientific Meeting Series

The 2014-15 series will conclude on May 20, 2015 with a presentation by Bonnie An Henderson, MD, Clinical Professor, Department of Ophthalmology, Tufts University School of Medicine/Ophthalmic Consultants of Boston.  Dr. Henderson’s topics will be: “Doctor, I still can’t see” and “Complication Management:  It Could Happen to You.”  There is still time to register for this program either as an in-person attendee or to participate via webinar.  Contact Debra Alderman in the WAEPS office:  [email protected]

As Dr. Bryan Lee, chair of the 2014-15 series, will be moving out of state, we thank him for his great work on this year’s very successful seminar series and wish him the best of luck in his future endeavors.  Dr. Russ Van Gelder is planning the series for 2015-16.  If you would like to help out, feel free to contact him. 

For those who have been participating in the Monthly Meeting program this year, don’t forget that you need to fill out a CME documentation form and submit that to Debra no later than the end of May. She will verify your attendance and request a CME certificate for the series for you from the UW CME office.  If you need a copy of the form, pick one up at the May 20th session or request one from Debra.

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Legislative/Government Affairs Report

Aaron Weingeist, MD, Chair

Legislative Session
As of April 29th, the legislature has been recalled for a special session to finish its work.  In the 2012 McCleary decision, the Washington Supreme Court ruled that the legislature has failed to fulfill its duty to provide adequate education to the children of Washington State. Last year, voters approved Initiative 1351, mandating smaller class sizes. During the special session, legislators in Olympia will be trying to fulfill these mandates while at the same time attempting to minimize fiscal impact on the state.  It is not going to be easy.

Two bills of note to WAEPS passed during the regular session.  The first, SSB 5268, is a WAEPS initiated bill that permits early drop refills for our patients, helping to ensure that they can complete a treatment course without disruption.  The second is SSB 5293 which allows optometrists to prescribe hydrocodone containing medications (e.g. Vicodin) as a Schedule II controlled substance.

A WAEPS delegation made a special trip to Olympia on April 24, 2015 to witness Governor Inslee sign SB 5268 into law.  The new law allows for early eye drop prescription refills.  WAEPS leaders and lobbyists worked closely with legislators throughout the session to support the bill’s passage.  WAEPS representatives also met with State Senator Linda Evans Parlette, who was a primary sponsor of the bill, to thank her for her support. Pictured (left to right):  Steve Reck, MD; Penny Reck, MD; Senator Linda Evans Parlette; Niraj Patel, MD (WAEPS President); and John Samples, MD.

Other bills of interest that did not pass include:  formal education requirements for surgical technologists, a bill permitting the Secretary of Health to intervene when health care boards increase scope of practice without legislation, the mandatory reporting of LASIK post-op infections, and a bill regarding contact lens price agreements.

AAO Congressional Advocacy Day / Mid-Year Forum (MYF) / Council Meeting
MYF was well attended by Washington ophthalmologists.  Attendees were Brian Bowe, MD (WAEPS Councilor);  Russell Van Gelder, MD, PhD (AAO President and UW Dept. of Ophthalmology Chair); Michael Gilbert, MD, OCS (OPHTHPAC Committee Member and WAEPS Committee Chair); Niraj Patel, MD, FACS (WAEPS President);  David Epley,  MD,  (AAO Committee on Medical Information Technology and WAEPS PAC/Public Education Chair, WEF Secretary); Aaron Weingeist, MD (AAO Leadership Development Program Director, WAEPS Legislative Chair and WEF President); Craig Wells, MD (WAEPS Past President and AAO Invited Guest); Ingrid Chang,  MD (UW Resident and AAO Advocacy Ambassador);  and Debra Alderman (WAEPS Executive Director).  This year, after passage of “The Doc Fix,” our visits with legislators and their health care staff members were less intense.  What, no faulty SGR formula to beat them over the head with?  Instead we discussed NIH/NEI and Dept. of Defense vision research funding, and national health-care provider marketing transparency legislation.  Once again, Senator Cantwell was very generous with her time and met with us for more than 30 minutes.

Senator Maria Cantwell along with Drs. Wells, Epley, Chang, Gilbert, Patel, Bowe, and Weingeist, and Debra Alderman.

Board of Optometry
Recently the BOO was asked to determine whether the use of AmbioDisc amniotic membrane grafts are within the scope of practice of Washington optometrists.  This agenda item was withdrawn, and not addressed.  It is WAEPS’ opinion that under current law optometrists in Washington State are not permitted to use tissue transplants.

WAEPS is still looking into a June 2014 decision by the Board of Optometry that the use of diamond burrs and the removal of sutures is allowed when optometrists do these things in conjunction with permitted procedures (e.g. removal of superficial ocular foreign bodies).   WAEPS continues to believe that these are SURGICAL procedures that were prohibited when the definition of ophthalmic surgery was written in 2003.

Thanks to many donations that were made before and during the annual meeting, we raised nearly $13,000 to replenish the Physicians EyePAC! 

Please contribute generously to Physicians EyePAC, the AAO Surgical Scope Fund, and OPHTHPAC so that we can continue our legislative efforts on your behalf. 

When you interact with candidates and politicians, please be sure to identify yourself as an Ophthalmologist and help educate them about our practices and issues.  Why not offer your legislator a tour of your office or ASC?  WAEPS legislative team would be happy to brief you on current issues.  Feel free to connect about any concerns you may have out WAEPS legislative and political activities.

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Health Plan Relations News

Michael L Gilbert, MD

MEDICARE NEWS, AND MORE!

SGR Repealed; The Cost & The Potholes
The recent historic repeal of the Sustainable Growth Rate, SGR marks the end of another failed health care policy. The "doc fix" includes subtle positive updates for physicians and important financial predictability & stability for practices that are dependent on Medicare revenues.

Physician payment increases are token at 0.5% annually. The new merit-based incentive payment system introduces as much complexity as opportunity, when it finally kicks in 2019.  The new law provides one update for all physicians dodging a differential update scheme for primary care doctors that would be funded by cuts to specialists.

Importantly, yet lesser noted, CMS is disallowed to pursue a planned policy to eliminate all 10- and 90-day global periods long incorporated in current surgical fee schedules. This proposal would have affected more than 4,200 codes. This change would have had a significant negative impact on ophthalmic reimbursement.

Practice-Changing ICD-10 CM Will Be Imposed 2015! 
On Monday, May 11, WAEPS presented a half-day CODEQuest ICD-10 training for WAEPS members and their employees featuring top AAOE trainer Sue Vicchrilli.  The program, held at the Bellevue Hyatt, was attended by 150 eager learners.  Dr. Sam Seto, who participated in the program, said he appreciated that Sue “really put a positive spin to the daunting ICD 10 conversion.”

Sue Vicchrilli, presenter for the CODEQuest Program held on May 11, made the four-hour program fly by with her humor and positive spin on the challenges that lay ahead for practices in their transition to ICD-10 this year.

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News from the Academy

Brian Bowe, MD, Councilor

Academy members from all across the country met in Washington DC on April 15-18 for Congressional Advocacy Day, the Mid-Year Forum, and the Spring Council Meeting.  The Washington delegation was well represented by Drs. Bowe, Epley, Gilbert, Patel, VanGelder, Weingeist, Wells.  Our sponsored Advocacy Ambassador, Ingrid Chang MD, from the UW residency program, attended and participated with us. 

Aaron Weingeist, MD, WAEPS legislative chair; Niraj Patel, MD, WAEPS President; and Ingrid Chang, MD, UW resident and Advocacy Ambassador, on their way to meetings with legislators during the Day on the Hill, an annual part of AAO’s Mid-Year Forum in Washington DC.

Congressional Advocacy Day was first up and our delegation met with Senator Cantwell and Representative DelBene personally and with the staffs of Senator Murray, and Representatives Smith, Heck, Reichert, and McDermott.  For the first year in a long time the SGR was not at the top of the agenda.  Thanks were given to all members of Congress and their staffs for their work on repeal of the SGR.  ThE devil is in the details of what if to follow but it looks like movement away from a fee-for-service models to a Merit-Based Incentive Pay System (MIPS).  No one that I talked to had a real solid grasp on where this was going but at the present time MIPS seems to be what people in Washington are thinking.  Other topics discussed were Meaningful Use reform in the EMR,  Truth in Healthcare Marketing Act, and NEI and DOD funding for research.  If you get the chance, please take the time to thank your Representatives For their support in repeal of the SGR.

The Mid-Year Forum was pretty quiet this year.  There were interesting discussions of global surgical periods, EHR's, quality reporting, and access to ophthalmic pharmaceuticals.
   
The Spring Council meeting was also on the quiet side.  The most interesting was discussion about how to incorporate optometrists which are employed by EyeMD's into an organization that would be different from the usual optometric professional organizations.  This is in response and a next step to the AAO-AAO educational venture which will present itself at the AAO meeting in Las Vegas.  The basic idea is to create avenues for OD's employed in EyeMD led practice models to train their OD's within an organization that is aligned with the structure of an EyeMD led integrated team.  There were two CAR's (Council Advisory Recommendations) regarding this topic that were referred on to the AAO Board of Directors. 

If anyone has any questions regarding the Council, or the topics mentioned above feel free to contact me.

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View from the U

Russell N. Van Gelder, MD, PhD, University of Washington Liaison

I would like to extend a big thank you to the WAEPS membership for its continued support of the Academy Ambassadors program.  This year, with WAEPS and UW support, PGY3 resident and Washington native Ingrid Chang, MD attended the AAO mid-year forum, including Congressional Advocacy Day, mid year forum itself, and Council. Ingrid joined a great group of WAEPS leaders for visits with congressional representatives, senators and their staff members.

Our group met with Senator Murray's health aid, and (as has become almost routine) had an extended face-to-face meeting with Senator Cantwell.  (for details of our discussions with legislators, see Aaron Weingeist’s article, above.)

The Ambassadors participated in a half-day 'LEAP' program (Leadership, Engagement, Advocacy, and Practice Management).  This is a new program this year, geared directly at the Ambassadors and introducing them to concepts of professional leadership.  The hope is that this program will ensure that our trainees become the pipeline for membership and leadership in our state and subspecialty societies going forward.  The program was excellent and very inspirational -- made me want to be an Academy leader myself!  The power of the Ambassador program was brought home when a Council Advisory Recommendation from the New Jersey state society asked the Academy to provide hard data on the 'return on investment' of the Ambassador program.  Councilors, state society leaders, and Academy leaders, all alumni of the Ambassador program, flocked to the microphone to offer examples of how the program had made a real difference in the function of state and subspecialty societies, particularly in legislative battles.

Ingrid gave a great recap of her Mid-Year Forum experience for our other residents and faculty at the end of April.  Three of our current 14 residents have now been able to participate in this program.

We are fortunate in Washington to have a very strong state ophthalmology society, and to have very strong ties (past and present) to the AAO.   Continued participation in the Ambassador program will ensure this will continue to be the case for many years to come.  On behalf of our trainees, I thank WAEPS for its continued support of this program.

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YOS Report

Janet Chieh, MD, Chair

There was a well attended reception for YOs and the University of Washington residents and fellows at the Blue Acre Seafood restaurant following the annual meeting on March 20. The guest speakers and board members were also in attendance which created a nice atmosphere for all to discuss and mingle. Look for our next YOs event, which will be a happy hour this summer.

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Military Liaison Report

Travis Frazier, MD

At the Annual Meeting in March, several Madigan residents attended the physician programs and also assisted with the Ophthalmic Personnel Program.    Dr. Barton Blackorby gave a lecture on “Optics: The Science Behind Sight.” Some of the other residents helped with the slit lamp workshops for techs.  We anticipate continued involvement from the residents in future WAEPS Annual Meetings. 

Several military residents from Madigan Army Medical Center participated in the WAEPS Annual Meeting on March 20.  From left to right:  CPT Chris Ochieng, MD; MAJ Ryan Roberts, MD; CPT Barton Blackorby, MD; CPT Okezei Igboeli, MD.

We are continuing to emphasize that Madigan Army Medical Center (MAMC) is willing to receive civilian ocular trauma.  We have an ocular trauma policy that we can disseminate.  The challenge is ensuring that the MAMC Communications Center is called initially and that the patient is transported via ambulance.  Hopefully, those South Sound patients that were sent to Harborview, can be kept in the South Sound for their care. 

We have some significant turnover in the military ophthalmologists here with retirements and those that have moved elsewhere.  We will have some new incoming that may potentially join.

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Announcements

Congratulations to Dr. Michael Cunningham of Moses Lake who was the winner of the raffle at the Annual Meeting member business lunch.  The raffle was open to members who had made EyePAC donations.  A second prize of a two-night stay at the Hyatt Olive 8 in downtown Seattle was won by Dr. Brian Bowe, of Wenatchee.

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Regulatory Affairs and Legal Information

WAEPS legal counsel, Emily Studebaker, JD, has written an article on Medicare conditions for coverage for ambulatory surgical centers and she wanted WAEPS members to have access to it.  To read the article online, please click here.

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Calendar

October 22 – 25, 2015  Seattle/King County Clinic. Healthcare organizations, civic agencies, non-profits, private businesses and volunteers from across the State of Washington are joining together once again to produce a giant free health clinic at KeyArena at Seattle Center. The four-day volunteer-driven clinic will provide a full range of free dental, vision and medical care to underserved and vulnerable populations in the region. WAEPS will once again participate.  For more information, contact board member/public education chair Jim Stroh:  [email protected] or Executive Director Debra Alderman:  [email protected]

Nov. 14-17, 2015: AAO Annual Meeting, Las Vegas, Nevada. For more information, visit: http://www.aao.org/annual-meeting/

Save the date:  March 31 and April 1, 2016    WAEPS 2016 Annual Meeting, at the Conference Center at Washington State Convention Center, downtown Seattle.

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Have Questions? Need Information?

Feel free to contact WAEPS Association Executive Debra Alderman by phone:  206-956-3650 or by email:  [email protected]

Our office is located at: 2001 6th Ave. Suite 2700, Seattle, WA  98121

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President's Corner

Rachel Reinhardt, MD
WAEPS President
[email protected]

The Domino Effect
According to the Merriam-Webster Dictionary, the term Domino Effect is defined as a "cumulative effect produced when one event initiates a succession of similar events."  This simple concept carries serious implications for your professional future and the safety of your patients.  Please, listen up. 

Despite a massive effort on both the state and national level, two more states have fallen in our battle to protect our patients and our professions.  On June 1st in Louisiana, Governor Bobby Jindal signed into law a bill that allows optometrists to perform scalpel eyelid surgery and glaucoma laser surgery.  Similarly in Tennessee, Governor Bill Haslam signed a law that authorizes optometrists to perform scalpel surgery with injectable anesthesia.  The momentum is building. Oklahoma and Kentucky can no longer be thought of as just "flukes."  The domino effect is taking hold.

This is not an abstract issue out there in the ether. This is not someone else's problem. This is our problem.  Your problem.  Our patients' problem.  Never before has it been so critical for all of us to be involved in our state societies.  The AAO cannot fight this battle alone. 

Here is one step you can personally take to help defend our profession and patients. Call your state representatives, either based on your home address or your work address. Invite them to visit your clinic for an hour.  You don't have to have a complex set of goals for the meeting, just politely state a few of our concerns about our level of training and how that makes us uniquely qualified to perform surgery. 

If this topic makes you feel a little itchy under the collar, then you will be happy to know that I feel the same way.  But, it doesn't stop me from facing our new reality.  Please stand with us in our attempts to put a stop to the Domino Effect. Only 15% of ophthalmologists donate to PAC funds. In WWII can you imagine if 85% of American soldiers put their weapons down and sat on the ground?  Only 15% of us can't protect our patients all alone.  Join us. 

To find your legislative district representatives, visit this link. Once you click on your state senator or representative’s name you can quickly email him or her a message.

If you would like to contribute to EyePAC, you can mail a check made out to "Physician's EyePAC" to the WAEPS office, Attn: Debra Alderman, 2001 6th Ave, Suite 2700, Seattle, WA 98121.  You may also make an EyePAC contribution by credit card.  Contact Debra at  206-956-3650.  It’s also very easy to include an EyePAC contribution when you renew your WAEPS membership this fall. 

Learn more about OphthPAC, and make a contribution.

Learn more about the AAO’s Surgical Scope Fund and contribute,

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Public Education

The Public Information Committee has been hard at work!

Diabetes Expo--Last May we participated at the Diabetes Expo. Thank you again to volunteers Janet Chieh, Loren Vesselle, Jeanna Hoyt, Sam Seto, Michael Brush, Denise Lugo-Caman, Laura Periman, and Deepa Abraham for volunteering to staff the booth. Thanks also to Aaron Buch from Zeiss for donating the fundus camera and OCT.

RAM--This fall, WAEPS is organizing the efforts of ophthalmologists across the state to participate in a Remote Area Medical clinic at the Seattle Center. Remote Area Medical is an organization that holds clinics across the country to provide free care to the indigent or working poor who can’t otherwise afford or access health care. The clinic comes to Seattle from October 23-26 this year, and we need your expert services as an ophthalmologist to help care for these patients! This will be a day of caring for others like we were trained to do without the hassle of insurance, EHR, or paperwork!

More information about the event and registration can be found here.

A FAQ can be found here.

Register here. Please also let us know you are going by registering here so we can coordinate our efforts, keep you informed, and properly recognize you!

Please email me ([email protected]) if you have any questions!

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WAEPS has entered the digital age!

We now have a Facebook and Twitter page!

Please Like Us  on Facebook and Follow Us on Twitter. The larger audience we reach, the better community service we can provide. Currently, the WAEPS Public Education Committee is running the AAO’s EyeSmart press releases and other useful information for patients.

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Monthly Scientific Meetings

Bryan Lee, MD, Chair

For the 2013-14 series of Monthly Scientific Meetings, 57 total attendees participated.  Twenty two of those participated at least once using the webinar system.

The CME application for the 2014-15 Monthly Scientific Meeting Series has been submitted to the University of Washington and as soon as it receives approval we can publicize speakers and topics.

The new speaker series begins Wednesday evening, October 8 at the Research & Training Building at Harborview Medical Center at 6:30 pm.  Watch for e-blasts about the series in September and be sure to RSVP, especially if you will be participating by webinar.  For more information, contact Bryan Lee, program chair, [email protected].

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Reimbursement/Health Plan Relations

Michael L Gilbert, MD, Chair

MEDICARE NEWS, AND MORE!

New CMS Statement Codes for PQRS Claims-Based Reporting
Beginning July 1, those using claims reporting for Physician Quality Reporting System (PQRS) bonus program should expect two new codes on their CMS statements. These new codes confirm PQRS reporting was received.

It is generally recommended to include a $0.01 charge for quality data information submitted, increasing the likelihood that CMS carriers register the code. Adding $0.01 for the quality-data code appears to reduce claim rejection however will generate an expected denial of reimbursement.

New Remittance Advice Codes:

• N572 – Providers billing $0.01 on the quality-data code (QDC) line item for PQRS will see this code in the CMS remittance statement. This code, along with claims adjustment reason code 246, indicates that the procedure is not payable, unless non-payable reporting codes and correct modifiers are submitted.
   
• N620 – This code is a new indication that PQRS codes were received by CMS. Providers billing a $0.00 QDC line item will receive this code. It replaces the N365 code, which will be deactivated.

Save the Date:  September 17 , 12:30-1:30PM--Free WAEPS/Noridian CMS Joint Webinar:
“What You Want to Know, What you Need to Know, Your FAQ”
Noridian representatives and WAEPS will hold a first ophthalmology-specific webinar hosted by a CMS carrier, and co-moderated by WAEPS on September 17 from 12:30-1:30PM.  The anticipated successes of this program will likely be offered to other Noridian states.

The webinar will begin with answers to the most frequently asked questions posed to CMS carriers, and those we are afraid to ask.  If time allows, the final segment of the program will allow authoritative answers from Noridian on pre-submitted questions. Live questions may be submitted however to ensure the most authoritative response, answers may be distributed after any indicated research.

Do not miss the real answers to perennial “hot” issues such as: “What do we do with no cataract policy?”  “What does it mean that a policy is ‘retired,’ can it be ignored?”  “Who gets audited?”  “Who wins audits?”  and so much more!  Watch for program updates and details.

Headline Topics:

• How does Noridian flag for audits?
• Audit results: Who prevails, who Fails.
• What modifiers and why?  Which are over or under used?
• Pit falls of EMR.
• E & M vs. Eye codes, is there an “expected” distribution within or between these code groups?
• Correct use of ABN and waivers?
• OIG work plan; the map for audits?
• Protective and diagnostic value of Compliance Programs.
• Can we ignore “retired” LCD Policies (eg the retired Cataract Policy)

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AAO Councilor’s Report

Brian Bowe MD, WAEPS AAO Councilor
 
The American Academy of Ophthalmology held its annual Congressional Advocacy Day/Mid-Year Forum/Spring Council meeting in Washington DC on April 9-12, 2014.  WAEPS was well represented at the various events by Drs. Brian Bowe, Michael Brush, Michael Gilbert, Bryan Lee, Richard Mills, Rachel Reinhardt, Aaron Weingeist, and Russ Van Gelder. We were joined by two Advocacy Ambassadors from the University of Washington residency program, Dr. Mark Prendes and  Dr. Kathleen Williamson  and our Executive Director, Debra Alderman. Many thanks to those who gave their time and talents to come to Washington DC and to meet with our Congressional delegation on behalf of the interests of the Academy and our profession.

The meeting started with the Congressional Advocacy Day.  We were able to have face-to-face meetings with Senator Cantwell and Representative Smith.  We met with the staffers of Sen. Murray and Representatives DelBene, McDermott, and Reichert. The issues discussed were Medicare Physician Pay, including repeal of the SGR or lack thereof by the current congressional session, the Electronic Health Records Improvements Act (HR 1331), the Truth in Healthcare Marketing Act (HR 1427), funding issues for NIH/NEI for restoration back to 2013 levels, and a final funding issue for the Department of Defense Vision Trauma Research Program. The congressional delegation was receptive to our presentations and there was some vigorous discussion regarding the congressional actions in relation to the SGR.  There was a mixed response from the congressional delegation as to whether or not SGR repeal could have a chance for passage in the upcoming lame duck session this year. 

The Mid-Year Forum was next and the lead session was a panel discussion of the transition we about to experience in reimbursement going from volume based to value based. Currently, our wRVUs are tied to time and not the intensity of the visit.  CMS is looking at shared savings in the new ACO models and an extremely unpopular talk was given regarding physician profiling within the UnitedHealth plan. The current sentiment in Congress is movement away from paying for volume to paying for value.  Other sessions included discussions of managing the risks in electronic health records (complying with Meaningful Use, electronic security issues, and the relationship between EHR and malpractice issues), healthcare integration (ACO's, patient centered medical homes, and regional integration), international ophthalmology, and the results of an AAO member biennial survey.  The last session was regarding the IRIS registry.  This is the new specialty-specific registry that the AAO has built for Ophthalmology.  From what I have seen of it, it looks fantastic.  I urge you to check it out.  Those who are in the re-certification process, this will make it much simpler to do a portion of your re-certification process.

The final section of the meeting was the Spring Council meeting.  The regional State section meeting was well represented by the Washington delegation.  It is really amazing to see your representatives present at this meeting.  Thank you to all who come and represent us. WAEPS members may not realize the strength of WAEPS as a state society until they witness the leaders in action at a national meeting.  As a matter of fact, Alaska, Nevada and Hawaii are currently struggling to recruit board members for their state society.  In addition to leadership challenges, Hawaii is also dealing with the issue of non-mydriatic retinal cameras in primary care offices. Oregon ophthalmologists are coping with the aftermath of the ACA mess in that state which recently closed down its exchange.  California is still embroiled in a scope of practice battle with an optometrist legislator that is spearheading the legislation in that state. 

There were four Council Advisory Recommendations (CAR) brought to the floor for Council deliberation. 

The first involved patient health information protection.  This would ask that the Academy send to manufacturers a request that all ophthalmic diagnostic, therapeutic and imaging devices comply with the HITECH Act and its requirements.  It further would ask the Academy to update its website to indicate and identify those companies which comply with this standard.  This was given a split medium/high priority recommendation to the Board of Directors. 

The second CAR concerned revenue sharing for Subspecialty Day at the AAO Annual Meeting.  With the advent of the policy of one ticket admitting attendees to all subspecialty courses, it was felt by the smaller subspecialties that there was an inequitable split in the revenues generated from the course fees.  An "NFL revenue-sharing model" was suggested to allow for a more equitable split of the revenues generated.  This was passed on to the Board with a high recommendation. 

The third CAR addressed board transparency and Council relevance. What brought this issue to head was the meeting of American Academy of Ophthalmology leadership with the leadership of the American Academy of Optometry exploring ways in which the two organizations could work together (AAO2AAO). All WAEPS received notification by letter of these meetings after the fact from our academy's leadership.  This has been a heated topic at the Council for the last two meetings.  The Council was upset that it was kept out of the loop in the advisory process and the lack of free and open debate prior to reversing existing organizational position and  the adoption of new policy. After several fairly extensive open debate on the Council floor regarding this issue, a straw poll was taken which essentially revealed that there was not stiff opposition to exploring avenues in which the two AAO's could work together.  There was more resistance to the idea of having optometrists present at our annual meeting and even more resistance to allowing the presenters access to the meeting and exhibit hall.  I am sure there will be much more debate and discussion on this at subsequent Council meetings.  This specific CAR was passed on to the Board with a high level of importance.

The fourth CAR concerned broadening the scope of “Scope Of Surgery By Surgeons”  fund. The authors of this recommendation felt that the AAO should be more outspoken in opposing any form of optometric practice expansion (oral and topical medications) not just surgery.  Opinions on this issue among the council members were varied.  Ultimately this CAR was not approved by the Council to be passed on to the Board of Directors. 

As always, if there are any specific items you would like to discuss or items which you would like brought up at the Council level, do not hesitate to contact me.  I would encourage all of you to go to Chicago to the AAO Subspecialty Days (October 17-18) or the AAO Annual Meeting from October 18-21.  The Council will meet on Sunday and there will be regional meetings that day as well.  Stop by and check out what is happening in your Academy. Note that Registration is now open.  You are encouraged to book your hotel reservations in the room blocks at Chicago hotels as soon as possible, as they are beginning to fill up. For more information on AAO 2014 in Chicago, visit the official website.

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Membership

Robert R. Francis, MD, Chair
Welcome to our newest members, who have joined since the beginning of 2014!

• Michelle Bermingham, MD, Confluence Health of Wentachee
• Darrel Carlton, MD, MSPH, Ophthalmology Service, Madigan Army Medical Center, Tacoma
• Heidi Eiseman, MD, Rockwood Eye Clinic, Spokane
• Arthur Giebel, MD, Lifestyle Eye Care Center, Walla Walla
• Maylon Hsu, MD, Pacific Medical Centers, Seattle
• Soo Yeon Kim, MD, The Everett Clinic, Everett
• Morohunranti Oguntoye, MD, Ophthalmology Resident, Madigan Army Medical Center, Tacoma
• Patrick Munson, MD, Ophthalmology Service, Madigan Army Medical Center, Tacoma
• Sharel Ongchin, MD, Retina Consultants of Seattle
• Hee-Jung Park, MD, Virginia Mason Issaquah
• Hubert Pham, MD, Eye Associates Northwest, Seattle
• Solomon Shaftel, MD, PhD, Fellow in Oculoplastic Surgery at UW

Members—help us reach out to your colleagues to promote membership in WAEPS.  Let other ophthalmologists  know about the importance of WAEPS as a strong advocate for the profession and for public access to quality eye care.  You can mention member benefits like discounted registration fees for physicians and their staff members to attend the annual meeting and other important training opportunities.  Professional networking, listing in the WAEPS online database, and a variety of other benefits are available to WAEPS members.  For more information, please refer your colleagues to the membership page of the WAEPS website.

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View from the U

Russell Van Gelder, MD, PhD, Chair

It is my favorite time of year -- the new residents and fellows have arrived.  We have an excellent first year class of five residents joining us, along with two new fellows (retina and uveitis).  We remain fortunate in ophthalmology in having intense competition for our training slots; this year we had nearly 400 applicants for our five residency positions, and we filled our class from the upper 5% of this pool.  We know from AAO surveys that these new ophthalmologists are highly likely to find outstanding satisfaction in their careers.

However, we cannot be complacent that the natural charms of ophthalmology will continue to ensure we bring the best and brightest medical students into our field.  Several currents are working against us.  There is a large push from many medical schools to direct students toward primary care specialties.  As practicing ophthalmologists, I think many of us consider ourselves primary care physicians -- many of our patients are self-referred or do not have a primary care provider.  However, the medical establishment views us as specialty surgeons, and many medical schools (particularly state schools) feel a mandate to produce more primary care physicians to serve rural and underserved communities.

Along with this, many medical schools (including UW starting next year) have adopted new curricula.  The proposed UW curriculum changes from department-based coursework (i.e. anatomy, pharmacology, pathology) to systems-based coursework (i.e. 6 weeks on the nervous system, including all biochemistry, genetics, anatomy, etc.).  Ophthalmology and the eye have very little time in the existing curriculum, and we may potentially be limited to 1 or 2 hours of coursework for the medical students in the new curriculum.  As a result, I think many medical students will leave school without any exposure to the eye or to ophthalmology.

How can we ensure we continue to have a full pipeline of excellent residents to serve our patients in the future?  By engaging  students early.  We have an ophthalmology interest group among our students.  We would be most interested in engaging our community ophthalmologists throughout the state who would be willing to show our students what life as a practicing ophthalmologist is like.  Only by being highly proactive in recruiting students to our field can we ensure a continued stream of outstanding physicians to join our practices and care for our population.

Coming later this year:
Our  'Gained in Translation' symposium will be on September 13.  This all-day meeting will feature talks on translational vision science and features faculty from Oregon Health Sciences University, UW, and University of British Columbia.  Questions re: the meeting should be directed to Michele D’Alessandro, [email protected]

Russ
Russell N. Van Gelder, MD, PhD
Professor and Chair
Boyd K. Bucey Memorial Chair
University of Washington Department of Ophthalmology
[email protected]

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Young Ophthalmologists Section (YOS)

Janet Chieh, MD, Chair

The most recent YOS event was a program at Wild Ginger on June 3. The topic of the evening was “Manage Your Online Reputation: Critical Strategies in Today’s Marketplace” and it featured guest speaker  Erik Hough of Allergan. 

Coming up, there will be a casual YOS get-together on Monday evening, August  18 from 7-9:30 p.m. at The Garage, 1130 Broadway, Seattle, WA  98122 (Just south of E. Pike St.) garagebilliards.com

WAEPS will pick up the tab for refreshments and beverages, plus cost of bowling and pool.

Please RSVP by Thursday, August 14 at 5 p.m. by contacting Rachel Perkins in the WAEPS office:  206-956-3646 or by email: [email protected]

The WAEPS Young Ophthalmologists Section (YOS) welcomes ophthalmologists in their first 10 years of practice as well as those new to Washington State.

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Ophthalmologists Needed for Project Access Patient Care

By Sallie Neillie, Executive Director, Project Access

With the implementation of the Affordable Care Act, many more people have insurance, but there still remain many people who do not qualify for Medicaid or who can’t purchase health insurance in the Exchange.  Project Access Northwest needs your help in assuring that these people in King, Kitsap or Snohomish County have access to eye care services when they have diseases of the eye (not vision exams).  We ask you to volunteer to see one or two new patients each month.  The patients will have family practice physicians who manage their ongoing care and make the referral to Project Access NW. Project Access assures that the patients are low income, don’t have insurance and works with the patient to build his/her understanding of the importance of using your time and resources well. We have a low no-show rate of less than 5%. Should the patient be a non-English speaker, we will provide and pay for an interpreter.  As stated by one of our current volunteer oncologists, “It’s very popular to go some far-away place and go on a medical mission somewhere.  Project Access NW is a way to do medical mission work on a regular basis right here at home.”  Please consider helping.  Contact Sallie Neillie, Executive Director, at 206-496-2590 or [email protected].

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Upcoming Events

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Have Questions? Need Information?

Feel free to contact WAEPS Association Executive Debra Alderman by phone:  206-956-3650 or by email:  [email protected]

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Our Office Has Moved!

New WAEPS address is: 2001 6th Ave. Suite 2700, Seattle, WA  98121

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