1. Congressional Advocacy Day 2018
Kevin Lowder, MD
May 18, 2018

2. Special Thanks
KAEPS for sponsoring the trip and coordinating logistics
LAO for providing financial support
University of Louisville DOVS for allowing me the time away from clinical duties

3. Mid-Year Forum
Washington D.C.
April 18-21

4. Mid-year Forum 2018 April 18 April 19 April 20 April 21
Congressional Advocacy Day Briefing
April 19
Congressional Advocacy Day
April 20
Advocacy Ambassador Program/L.E.A.P Forward
April 21
Council Meetings/Elections
Leadership Engagement Advocacy Practice Management

5. What is Advocacy? Voice for our patients Protect our profession
Safeguard public health
Ensure access to care
Speed access to innovative treatments

6. Advocacy Ambassador Program
Collaboration between:
American Academy of Ophthalmology
State Ophthalmology Societies
Ophthalmic Subspecialty & Specialized Interest Societies
Training Programs

7. Goals: Advocacy Ambassador Program
Learn about current legislative issues
Meet with legislators
Network with colleagues
Learn about the impact of state ophthalmology societies

8. Congressional Advocacy Day
More than 400 ophthalmologists went to Capitol Hill to meet with Members of Congress & their health care staff
Over 175 residents & fellows served as 2018 Advocacy Ambassadors to support patients & our profession
AAO President Keith Carter, MD

9. Our Representatives
U.S Congressmen Andy Barr of 6th Congressional District

10. Our Representatives
U.S Senator Dr. Rand Paul

11. U.S. Senator Mitch McConnell
Our Representatives
U.S. Congressmen John Yarmuth
of 3rd District
U.S. Senator Mitch McConnell
Majority Leader
Yarmuth Health Legislative Assistant: Zack Marshall
McConnell HLA: Natalie McIntyre
Photo courtesy of votesmart.org
Photo courtesy of biography.com

12. Congressional Advocacy Day Issues
6 Top Priority Issues Presented to Members of Congress

13. 1. Access to Compounded & Repackaged Drugs
FDA’s implementation of the Drug Quality & Security Act threatens timely access to compounded & repackaged drugs
Restrictions placed on compounding pharmacies secondary to an outbreak of fungal meningitis in 2012
Created a new class of large-scale “outsourcing facilities” which must meet the highest standards set by the FDA
Set strict beyond-use dates for repackaged Avastin
Dec. 2016: FDA released a prescription requirement for traditional compounding pharmacies (not for biologics, but for antibiotics and antivirals)
Killed 55, sickened >700; pharmacy in New England that wasn’t following the standards in place

14. 1. Access to Compounded & Repackaged Drugs
Ophthalmologists want access to safe & effective compounded drugs for use in their practices – critical for treatment for a variety of blinding eye diseases
SUPPORT: Preserving Patient Access to Compounded Medications Act (H.R. 2871)
Morgan Griffith (R-VA) and Henry Cuellar (D-TX)

15. 2. Department of Defense: Peer Reviewed Vision Research Program
Deployment-related eye injuries & blindness have cost the U.S. $45.5 billion
Traumatic eye injuries and TBI tied for #2 most common (hearing loss #1)
Only 20% return-to-duty rate for eye injuries (compared to 80% for other trauma injuries)

16. 2. Department of Defense: Peer Reviewed Vision Research Program
Advancements made from prior VRP funding include:
A portable, hand-held device to analyze pupils
An “ocular patch” which is a nanotechnology-derived reversible glue that seals lacerations and perforations on the battlefield while the soldier is transported for surgery
A validated computational model of the globe that has allowed for superior protection
A vision enhancement system using modern mobile and wireless technology to assist visually-impaired veterans undergoing vision rehab

17. 2. Department of Defense: Peer Reviewed Vision Research Program
The Vision Research Program (VRP) is the only dedicated funding source for extramural vision research into DOD-identified research gaps (non VA / NIH / NEI)
SUPPORT: Fiscal Year (FY) 2019 VRP Funding at $20 Million
For FY 2018 and FY 2017, Congress approved $15 million

18. 3. National Institutes of Health / National Eye Institute
2014 study released by Prevent Blindness:
Estimated the annual U.S. cost for vision disorders at $145 billion
Estimated cost will grow to $717 billion (inflation adjusted) annually by 2050
Concluded that direct medical costs associated with vision disorders are 5th highest – only less than heart disease, cancer, emotional disorders & pulmonary conditions
SUPPORT: $39.3 Billion for NIH Funding in FY 2019 ($37.1B in FY 2018)
SUPPORT: $800 Million for NEI Funding in FY 2019 ($772M in FY 2018)

19. 4. Simplify Merit-based Incentive Payment System (MIPS): Expand Credit for Participation in Qualified Clinical Data Registries (QCDR)
MIPS falls short of Congressional intent due to complexity & lack of timely feedback
Congress envisioned clinical registries to be a meaningful solution
Registries drive health care improvements by providing feedback on quality & appropriate use metrics
SUPPORT: The AAO’s efforts to expand the credit that physicians receive for participating in a QCDR (such as the AAO’s IRIS Registry) under MIPS
The idea is to move away from fee-for-service and focus on quality of care
Before MIPS there was MACRA (which was apparently worse)
QCDR = Qualified Clinical Data Registry
The benefit is that by having your EMR feed into the IRIS system directly, it cuts out the additional step that is currently required to report that quality. The IRIS registry essentially records that data in real-time and gives you feedback on where to improve without any additional paperwork. That’s what we commonly refer to as a “win-win.”
MIPS has four main components, but using the IRIS (Intelligent Research in Sight) registry currently does not count towards the Advancing Care Information portion, now renamed “promoting interoperability” although it does count towards Improvement Activities.

20. 5. Regulatory Relief from Burdensome Prior Authorization Requirements
AMA survey results of 1000 physicians shows significant burden being placed on physicians due to prior authorization (PA) requirements
AMA survey of 1000 practicing physicians about prior authorizations
– 29 Prior Authorizations requests per physician each week
-34 percent of physicians employ staff who work exclusively on PA
-79 percent of their PA requests are eventually approved
-92 percent reported delays in care for patients who need prior authorizations

21. 5. Regulatory Relief from Burdensome Prior Authorization Requirements
SURVEY DATA:
2 hours administrative work per 1 hour patient care
Average 29 PA requests/physician per week
34% doctors employ full-time staff members exclusively for PAs
annual time-cost of PA is at least $23 billion

22. 5. Regulatory Relief from Burdensome Prior Authorization Requirements
SURVEY DATA cont:
79% of PAs are eventually approved
79% doctors had to repeat PAs for patients stabilized on treatment for chronic condition
92% doctors reported delays in care for those patients whose treatment requires PA
Not a big deal to sign a pt up for cataract surgery and get PA while the patient awaits surgery.
But like we all know, it takes up a lot of time for patients and their family members to take time off of work to come back to get that injection that 80% or more get approved

23. 5. Regulatory Relief from Burdensome Prior Authorization Requirements
New subsets of Medicare (such as Medicare Advantage) are now requiring PAs beyond traditional Medicare plans (illegal)
Academy is requesting that CMS:
Supports our regulatory relief initiative on Medicare Advantage (MA) prior authorization
Provide oversight to the PA requirements established by the MA plans & standardize processes including times & appeals processes
SUPPORT: The Standardizing Electronic Prior Authorization for Safe Prescribing Act (H.R. 4841)
Bipartisan bill sponsored by representatives in AZ, CA, OH, NM

24. Technology-based Eye Care Services in Department of Veterans Affairs
Ophthalmologists at Atlanta VA Medical Center have developed innovative tele-eye program, Technology-based Eye Care Services (TECS)
TECS Program: Expands access to basic eye care services for veterans, especially in rural areas
At the beginning, 20% of participants had not seen an eye care provider in 5+ years
That number has dropped to 5%

25. Technology-based Eye Care Services in Department of Veterans Affairs
Eye exams are not comprehensive:
Screen for most common eye conditions (cataracts, glaucoma, AMD, diabetic retinopathy) among others
Refer these patients for f/u within 30 days (98%)
Provide glasses prescriptions through a trained interactive technician
The program is facing opposition from the American Optometric Association
SUPPORT: TECS Program as a proven vision saving service

26. Lessons Learned
Our elected officials want to make informed decisions. If we are not there to inform them of our position, they will only hear others’ perspectives.
Advocacy is easier than you think; it just takes a conscious effort and appreciation of its impact.
Our elected officials truly enjoy hearing the physicians’ perspective and they respect the work that we do