Eyeworld

104 | EYEWORLD | SPRING 2024 G UCOMA Leon Herndon Jr., MD, president of AGS and the former chair of the ASCRS Glaucoma Clinical Committee, was involved. He noted the collaboration between ASCRS, AGS, AAO, and Outpatient Ophthalmic Surgery Society to look at what was in these proposed LCDs and to refute the proposed changes. "It was a long process," he said, which involved numerous meetings and calls to try to clarify the LCDs and educate the MACs. "It was an all-hands-on-deck exercise, and I think if we had not had these collaborative efforts, then we probably would not have been successful." ASCRS Government Relations Committee Chair Parag Parekh, MD, said that being in- volved in these issues should be something that every doctor does. "We went into this field to treat patients and not get our hands dirty with politics, but sadly, it's followed us. We have a choice to make. Either you stand up and fight for your patients and yourself or just give up and let insurance and the government do what they want," he said. "We're surgeons; we're people of action; and to me, it should be in our character to want to fight back and take some action and have some kind of measurable im- provement in our situation." Dr. Herndon said reimbursement changes come up frequently, and it's common for pro- cedures to be cut. In this case, they would not have been covered. But he said this really boils down to patient care issues. "You're taking val- ued procedures from the surgeons' hands that they think are best to keep the patients from going blind," he said. Dr. Herndon said that, despite these LCDs being retired, it's important to be vigilant going forward. "Advocacy is so important," he said. "It really boils down to having a patient-centric approach." Also key, he said, is to have better research available in the future. He noted long- term efforts to form a consortium of researchers to put together studies so there will be data to back up these procedures in the future. "In the short term, I've gotten a better education about the process and opportunity to educate colleagues about the process," he said. "The key driver is research and an evidence-based approach." Dr. Parekh said that the focus on the MIGS codes and reimbursements started a few years ago. And because of these innovative, effective techniques, doctors did more and more MIGS, like goniotomy and canaloplasty and even some of the new variations on cyclophotocoagulation. This rapid adoption of surgeons to the MIGS procedures has led to large growth in uti- lization of these procedures, which caught the attention of the MACs, said Nathan Radcliffe, MD. These are amazingly important procedures, Dr. Parekh said. "The best work in the field of glaucoma in the last 10 years, in my opinion, has been MIGS," he said. "The reason, to me, that the volume has gone up so much is because doctors are realizing how effective these proce- dures are, and how topical treatments, like eye drops, shouldn't be the go-to first line." This is more of an interventional mindset, which Dr. Parekh sees as a good thing. "I think that's a much better way to look at the disease, and it's a much better way to treat the disease." Dr. Parekh said he believes patients would also rather have their disease treated with- out the need for drops. He described cost and compliance issues (the need to remember to take the medication daily or even several times per day). "There are also so many side effects to these eye drop medications. It's much better to have it treated so precisely and effectively with surgical intervention," he said. Because of these advancements, Dr. Parekh said this has spurred a new way of looking at the disease and treatment options, and the carriers are still looking at it in an old way. If you look at the LCDs, they basically implied that drops are fantastic and the gold standard, Dr. Parekh said. The LCDs also perhaps saw drops as a less expensive option and way to control costs. Many of the procedures that were in ques- tion with the LCDs for MIGS, Dr. Parekh said, are procedures that have been done in the past but now there's a new device. When the device gets approved, it's a different FDA approval, he said, so all those devices went through proper FDA channel to get approved, but those require- ments did not include a randomized controlled trial. "There's plenty of other data, but the MACs are fixated on that fact, which was not a requirement for approval." If there haven't been enough wakeup calls in the past with cataract surgery cuts and all the Medicare cuts that happened over the past continued from page 103

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