All eyes on Capitol Hill

Washington, DC-A record number of ophthalmologists hit the hallways on Capitol Hill last month to urge their legislators to protect Americans' access to eye care and boost funding for eye research.

More than 350 ophthalmologists-including about 130 ophthalmology residents-attended the annual American Academy of Ophthalmology (AAO) Advocacy Day on April 26.

For Ravi D. Goel, MD, a cataract and refractive surgeon in Cherry Hill, NJ, the visit with his congressional representatives was a natural extension of his practice as a physician and an opportunity to build on his relationship their staffs. It was Dr. Goel's 10th year to participate in the annual legislative effort.

With an estimated 32% cut in Medicare physician fees scheduled for Jan. 1, physicians implored their representatives to find an equitable payment plan to replace the faulty sustainable growth rate (SGR) formula. In February, Congress voted to avoid what then was a 27.4% cut by freezing rates while legislator scramble to find an alternate formula. However, the SGR-mandated cut grows in the meantime.

Cathy G. Cohen, the academy's vice president, governmental relations, said members of Congress are considering a plan by Rep. Allyson Y. Schwartz (D-PA) that would penalize physicians with a 14% cut if they don't transition to an accountable care organization (ACO). Such a penalty, Cohen said, is drastic and "a huge disservice to put that on the table."

With input from the academy and other medical groups, Schwartz has amended her plan somewhat to allow physicians to escape the cuts if they're participating in all of the federal programs aimed at improving quality, including the Physician Quality Reporting System, electronic health records, e-prescribing, and value-based purchasing, Cohen said. But with a health system designed to transition to ACOs, many questions remain about how specialists fit into a model that favors primary care.

In addition to the physician-payment issue, ophthalmologists encouraged their representatives to allocate $32 billion for federal fiscal year 2013 funding for the National Institutes of Health, including $730 million for the National Eye Institute.

Dr. Goel said he sees his lobbying effort to secure that funding as his role in assisting colleagues doing basic-science research.

"The NEI produces great research that helps my patients," he said. "My role in their research is to make sure they have the funding they need to help my patients."

Jeff S. Maltzman, MD, a glaucoma specialist in Phoenix and president of the Arizona Ophthalmological Society (AOS), said he understands how intimidating it can be for physicians to talk with legislators, but it's critical for their understanding of how medicine operates.

"We don't learn this in medical school and residency," Dr. Maltzman said. "It became very clear to me very early on that a lot of what happens at the state and federal level affects very much how we practice and how we provide care to our patients."

To encourage more physicians to become comfortable talking with their representatives and senators, the AAO began encouraging state societies to sponsor residents' participation in the Advocacy Day. This year, a record 130 residents attended at the expense of state societies and eye programs. Dr. Maltzman said the AOS sponsored two third-year residents at the University of Arizona: Joan Kim, MD, and Ijeoma Asota, MD.