InFocus WAEPS Member Newsletter - July 2018

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

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

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

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

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

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

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

WAEPS Annual Meeting 

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

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

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

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

AAO Councilor Report
Mike Brush, MD

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

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

Issues discussed with legislators included:

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

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

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

Advocacy Ambassador thanks WAEPS for opportunity to attend MYF

Marcela Estrada, MD, (PGY-3)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

WAEPS Members Make a Difference at Special Olympics

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

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

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

Health Plan Relations Headlines
Michael Gilbert MD, Payer Relations Chair

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

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

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

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

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

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

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

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

(Please note that Bold emphasis is mine!) 

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

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

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

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

Young Ophthalmologists Section 
Janet Chieh, MD, chair

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

In Memoriam:

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

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New Member Welcome

Welcome to our newest WAEPS members!

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

Save these Dates:

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

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

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

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

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

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]

InFocus WAEPS Member Newsletter - December 2019

President's Corner

Rebecca Dale, MD,

WAEPS President 2019-20

Last month, I had the opportunity of joining 20,000 runners for a marathon in Las Vegas. I don't run quickly, so this provided me a lot of time to think. I realized that there were a few powerful lessons the marathon could teach ophthalmologists.

First, training matters. I don't need to belabor this point to this audience. But it's clear to me that the hours spent carefully training, building experience, and learning from mini-injuries, fatigue and set-backs are key to successful completion of a marathon. And the more than 18,000 hours of training ophthalmologists receive is both important for successful patient care, and something we should be proud of.

Second, persistence is key. It's easy to become discouraged with prior-authorizations, step-therapy hurdles, exorbitant drug costs, vanishing generics, scope of practice battles, and declining reimbursements. But if we refuse to stop, we can experience successes.

Third, our mental game is crucial to success as we persist against these frustrations. Once we believe our voice doesn't matter, it doesn't. But if we shush the voice that says to just quit, we'll find that we can exceed our own expectations. If we believe in our ability to make a difference against these frustrations and we take actions grounded in the belief we can succeed, we will.

Finally, we can go farther together. There is an African proverb about running that speaks to this. "If you want to go fast, go alone. If you want to go far, go together." We have some outstanding servant-leaders in WAEPS who have put in countless hours for advocacy for our profession. But the power of many is needed if we want to go the distance in advocating for our patients. Every one of us can and should be contributing to our Washington Physicians EyePac, the Washington Eye Foundation, the AAO surgical scope fund and Ophthpac. Even more gratifying, I ask that you also raise your hand and get involved. Our patients need fresh perspectives and many minds considering how to meet the eye care challenges of our future. It may just be your idea -- for a new collaborative practice model, a creative way to use technology, or a legal action to protect patients -- that brings a win for our patients. But if you don't slip into your sneakers and take the first step of getting involved, you'll never know how many marathons we could have completed together. Please reach out to me or any WAEPS board member, and we'll be happy to help you get involved.

Fall AAO Council Update

Mike Brush, MD

The Fall Council Meeting occurs every year during AAO. I encourage all WAEPS members to take the time to attend at least once to help understand some of the big issues facing our profession.

The morning session was dominated by discussion regarding the Academy’s relationship to organized optometry – AAO2AAO. This was in follow up to a summer council webinar that reviewed the history of this relationship and the question of where to go from here.

Although many of us have strong and collegial individual relationships with optometrists the two professions have spent over $250 million in legislative battles regarding scope of practice. While ophthalmology has won over 90% of these fights, currently 8 states have expanded scope of practice for optometry into the surgical realm.

The AAO2AAO initiative began in 2013 and has led to four successful joint symposia at each organizations Annual Meeting. Topics such as Cosmetic Contact Lenses and Prevention of Myopia Progression have resulted in collaborative statements.

In January 2020 all AAO members will receive a survey to help guide the council on the question of where to go from here, in regards to the status of optometry at our Annual Meeting. I encourage everyone to complete this as it will give voice to our opinions.

In our regional breakout sessions, the Washington delegation heard from other Pacific/Mountain states about the status of their state societies and any potential legislative battles that may be forthcoming. We continue to be one of the strongest state societies – this is only possible through active membership. If you know of colleagues that are not WAEPS members, please reach out and encourage them to join.

Finally, we received updates on several Council Advisory Recommendations (CAR). Of note, WAEPS sponsored a CAR that resulted in updating of the AAO’s sexual harassment policies.

Please feel free to contact me with any questions regarding the AAO Council.

Respectfully submitted,

Michael Brush MD

2020 WAEPS Annual Meeting

March 19 & 20, 2020

Paul Griggs, MD, Chair

Venue: Washington State Conference Center, Seattle, WA

Join your colleagues for another outstanding program with tracks specifically designed for ophthalmologists, their medical personnel, practice managers and administrative staff.

This year we return to the spacious Seattle Conference Center facility in downtown Seattle, WA.

Our Annual Meeting program includes the following components:

• All day Coding and Reimbursement Seminar - Thursday the 19th.
• Physician Program begins Thursday evening and continues all day on Friday the 20th.
• Ophthalmic Personnel Program for techs - Friday the 20th.
• Practice Management Seminar - Friday the 20th

The 2020 line-up of outstanding guest faculty for the physician program is as follows:

• Donald Bundenz MD, Glaucoma speaker, University of North Carolina, Chapel Hill, NC
• Mitchell Jackson, MD, cataract speaker, Jackson Eye Founder, Lake Villa, IL
• David Plager, MD, pediatric ophthalmologist speaker, Riley Hospital for Children, Indianapolis, IN
• Sunil Srivastava, MD, uveitis and retina speaker, Cole Eye Institute, Cleveland, OH
• Hans Bruhn, Risk Manager, OMIC, on malpractice prevention

Registration Fees:

The cost to participate in each program is based on whether participants are employees of a WAEPS member practice. In order to take advantage of the significant member discounts, the member’s 2020 dues must be paid prior to January 30, 2020. Some of the programs also have an early-bird registration discount. Check the individual program pages for details.

Overnight accommodations:

A room block at a discounted rate of $249.00 per night (single or double occupancy), plus tax including free wi-fi and discounted parking has been reserved at a convenient nearby hotel, the Seattle Sheraton Grand located one block from the Conference Center. You may book your room at the discounted rate by clicking this link.

The room block is limited so make your reservation today.

Registration for all components of the meeting will open in January. We encourage all participants to register themselves via their own personal profile. The exception is the coding program-where we prefer to have the practice managers register the entire group coming from their practices. More details will be coming in late January on the annual meeting page of the WAEPS website.

Level Up at Codequest 2020

Michael Gilbert, MD

2020 WAEPS Annual Coding Seminar with Sue Vicchrilli!  March 19, 2020

The best way to protect your practice from claim denials and audits.

Join the most knowledgeable coding experts in ophthalmology for a half-day of professional instruction in your area. We’ll map out the latest coding updates and steer you through the complex maze of payers’ rules, arriving at successful solutions for preventing claim denials and avoiding penalties.
 Save the date: Thurs. March 19, 2020.

Fundamentals of Ophthalmic Coding (3hrs)

• New cataract/glaucoma codes and criteria for the new codes for extended and subsequent ophthalmoscopy
• Additional 2020 updates:  Modifier -50, ICD-10, HCPCS, CCI, MUE, LCDs and payment changes.
• What happens to claims when you don’t follow and apply CCI edits
• Modifier mastery, Part One

• Implementation of the new E/M documentation guidelines
• For physicians and physician extenders
• Modifier mastery, Part Two
• Coding competency challenge
• Stop claim denials.  Causes and repairs
• MIPS reporting updates for 2020

BONUS: Each attendee will receive fact sheets on important topics:

• Testing bundling edits
• Frequency of testing
• Premium IOL Dos and Don’ts for out-of-pocket expenses
• Refractions
• A-scan and ultrasound billing
• Blepharoplasty and ptosis guide
• Cataract and complex cataract surgery
• Skilled nursing facility
• Strabismus add-on codes

Best of all, Codequest is ophthalmology-specific and region-specific to focus on the coding information you need most. Join us March 19, 2020 at the Washington State Conference Center.

Have a specific coding conundrum? Email questions to [email protected] before the course and get answers to your personal coding challenges. Registration will open in late January. Watch your email for registration information.

Public Information / Education:

 David Epley, MD

The public information committee is working on developing “pop up” eye clinics in Washington state, the first being in the Bellingham area. The idea is to partner with a local business, sports teams, or charities to host the clinic and to recruit volunteers to staff the clinic to provide eye exams for those in need. WAEPS Board Member Stephanie Cramer is organizing the development of this project, collaborating with the Department of Ophthalmology at UCLA to learn from their experience in doing these types of clinics.

WAEPS Board Member Matthew Weed, along with colleagues Jeffrey Colburn and David Epley (Chair of the Public Education Committee) collaborated with school nurses to survey how they have changed vision screening procedures following a change in the screening regulations several years ago. They found that many schools adopted instrument-based screening as a loophole in the language that allowed them to avoid having to do near vision screening which was added in the new regulations. School nurses view the technology positively because it is a time-saver. Unfortunately, this is leading to instrument-based screening of older children who can read a chart. As ophthalmologists, we know that the instruments can auto refract, and can detect anisometropia, some strabismus, anisocoria and asymmetric red reflexes, and sometimes ptosis, but do not test vision and can fail to catch some kids with posterior pathology who cannot see well (macular scar, optic nerve hypoplasia, etc.). You can read the abstract here or download the full poster here.

WAEPS, the Washington Eye Foundation (WEF), and local charity Violet Sees to explore having an ophthalmology presence in a “medical home” concept that Lowell Elementary is developing. Planning is in the early stages, but if you are interested in helping out on this project, or any of the other Public Information Committee Projects, please email David Epley at [email protected].

Payer Relations

Michael Gilbert, MD

NEW Medicare Recovery Audits Target Ophthalmology.

Medicare has announced that their Recovery Audit Contractors, RAC, will be uniquely targeting Ophthalmology as the specialty most frequently billing for a new patient exam incorrectly. New-patient exams pay at a higher margin than established patient exams at all levels of complexity. While the rules for describing a patient as “new” are straight forward, there are many nuances and situations which can lead to error. It is not apparent why ophthalmology has an error rate beyond other specialties. However, knowing this would encourage WAEPS members to conduct practice review of billing policies. Should errors be identified, it would be advisable to correct the error rather than hope it will go undetected.

Because ophthalmology practices somehow have a disproportionate error in determining new vs established WAEPS will add this as a focus of the upcoming WAEPS CodeQuest March 2020, below. RAC audits are disruptive and potentially expensive as these auditors work on a bounty system. It is time for a review of the basics!

Executive Summary When an established patient is submitted as new by claim: commercial payers deny an erroneous claim so it can be submitted with the appropriate level as established patient exam. Medicare pays as submitted, and then recoups going back three years through RAC audits.

Noridian Developing MIGS LCD Policy

Noridian has published a draft LCD, Local Carrier Determination, policy on MIGS. The content of the policy is in line with Medicare policies in other carrier regions. The proposed policy would cover only one stent of the newer iStent Inject technology. Should the policy be published and finalized in this form, the second stent, CPT 0376T, could by used in patient care however would require an ABN, Advanced Beneficiary Notification, and patient responsibility.

Find those Medicare/Noridian LCDs

To review or download Noridian LCD policies; Start with the disclosure/agreement page:

https://med.noridianmedicare.com/web/jfb

RVS Fairness, E/M & Surgical Codes

Since its inception the RVS, Relative Value System, was touted as a fair and equitable basis of compensation such that all specialties, medical and surgical ,would be treated fairly and equally. Currently Medicare CMS intends to change that uniformity choosing to apply different rates depending on whether the values are part of a surgical 10 or 90-day global compensation for the postop care. If implemented as proposed this will adversely impact reimbursement of surgical codes in addition to and compounding adverse revaluations in RVUs, Relative Value Units, such as the pending decrease in cataract reimbursement. Supporting your national organization PACs (AAO, ASCRS, etc) and your own contacts to Congress are our best chance to influence these changes.

Legislative Update

 Washington Medical Commission 

Edited to update incorrect links.

Dear Interested Party:

The Department of Health (department) has adopted amendments to WAC 246-918-990 Physician Assistant fees and renewal cycle and WAC 246-919-990 Physician and Surgeon fees and renewal cycle. These rules will increase the fees for license renewal and late renewal penalty. The amended fees were adopted on October 10, 2019 under WSR # 19-21-052 and become effective February 1, 2020. Attached you will find the adopted rules, the Concise Explanatory Statement, and other relevant documents as referenced below.

What has changed from the proposed rule filed April 2019?
The final adopted fees have decreased by the following:

	Physician			Physician Assistant
	Current	Initial proposal	Final Proposed	Current	Initial proposal	Final Proposed
Renewal (every 2 years)	$525	$880	$824	$70	$265	$247
Late Penalty	$262.50	$300	$300	$50	$130	$124

*Fees listed do not include University of Washington (UW) HEAL-WA annual surcharge of $16 or Washington Physician Health Program annual surcharge of $50.

How did the department and the Washington Medical Commission (WMC) respond to comments provided during the open public comment period and the hearing?
Attached is the Concise Explanatory Statement outlining the comments received and the department and WMCs response to those questions.

Where can I find out more information about the budget?
Attached is a document showing the financial forecast and costs that are driving the fee increase. This document has been updated from the proposal to reflect changes as a result of the final adopted rule.

Who has authority for setting fees?
The WMC does not have authority to establish fees or make recommendations for a fee change. The fees for every health profession fall under the jurisdiction of the Secretary of Health. (WAC 246-12-330). RCW 43.70.250 requires that each health profession’s budget must be self-sustaining and borne by the profession. Therefore, costs associated with the medical professions come directly from the profession’s budget. This applies to all health professions.

What factors have contributed to the need for the increase?
The main reason for the fee increase is high disciplinary and litigation costs for the medical professions. Costs associated with disciplinary spending include investigations, legal services, and attorney general services. Costs have also increased for credentialing, case management, and call center functions. You can find more detailed information about disciplinary actions in the 2015-2017 Uniform Disciplinary Act Biennial Report.

We hope this information is useful in understanding the necessity for a fee increase. The department has implemented procedures to avoid an even higher increase. In addition, the department and WMC have increased efforts to assist with finding ways to keep costs down.

The department and the WMC remain firmly committed to its mission and mandate of public protection. If you have any questions, you can contact Cori Tarzwell at [email protected] or 360-236-4981.

Any person may petition the adoption or amendment of these rules in accordance with RCW 34.05.330.

---

 Wenatchee's Dr. Brian Bowe connects with Sen. Brad Hawkins

WAEPS Board Member Dr. Brian Bowe with Sen. Brad Hawkins

"A fund raiser for Senator Brad Hawkins (R-12) was held in Wenatchee on Saturday, November 16, 2019. There was a large number of medical providers and administrators from Confluence Health in Wenatchee present. I was able to deliver a check to Sen. Hawkins from the WAEPS EyePAC personally. We had a interesting discussion of medical issues and it was a nice informal time to re-establish a connection with our representative in Olympia."

 Washington State Licensure: Ambulatory Surgical Facility 

State regulations overview and checklists from WAEPS legal counsel, Emily Studebaker

State Regulations Overview & Checklists

Monthly Meetings

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 Eye Institute on floor 7 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-in to each session you attend and track your attendance and submit a credit claim form at the end of the series.

On December 18th, Dr. Matthew Zhang, MD Assistant Professor, Department of Ophthalmology at University of Washington will be presenting two lectures. The first will focus on thyroid eye disease: and the utilization of orbital radiotherapy. The second will provide a review canalicular injury and reconstruction.

To receive login instructions, be sure to register online 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. Contact [email protected].

Seattle / King County Clinic

Seattle/King County Clinic Needs Vision Care Volunteers February 13-16, 2020

 WAEPS invites all ophthalmologists and technicians to support the King County Clinic scheduled for February 13 – 16, 2020 at Seattle Center.

Seattle/King County Clinic reported that only 18% of the vision volunteer support has been filled. Can you help?

What is filled to date:

• 58% of Medical assignments
• 51% of General Support assignments
• 42% of Dental assignments
• 18% of Vision assignments
• 11% of Healthcare Resource assignments

Do you know someone who intends to volunteer? Have you asked your healthcare providers to participate? Have you signed up? Thursday and Sunday are the days we experience the most difficulty getting volunteers. Please help us with recruitment! You can find information and sign-up at seattlecenter.org/volunteers

Dr. Aaron Lee receives the AAO Secretariat Award!

The secretariat award recognizes special contributions to the Academy and to ophthalmology.  Dr. Lee has been selected for his outstanding support of Secretariat for State Affairs' Big Data efforts. Russell Van Gelder, MD, PhD, Professor and Chair of Ophthalmology at University of Washington and WAEPS Immediate Past President notes, “Dr. Lee has put his prodigious data analysis skills to use in mining databases such as IRIS to improve patient care throughout the country.  His work has revealed the current state of ophthalmic care in our state and our country, and highlighted the outstanding access to ophthalmic care available to the vast majority of the population.  Dr. Lee is highly deserving of the Secretariat Award of the AAO, and we are very fortunate to have him as a WAEPS member and ophthalmologist in our state."