Eyeworld

SPRING 2024 | EYEWORLD | 105 G Contact Herndon: leon.herndon@duke.edu Parekh: parag2020@gmail.com Radcliffe: drradcliffe@gmail.com Relevant disclosures Herndon: None Parekh: None Radcliffe: None 10–20 years, Dr. Parekh said this most recent sit- uation with MIGS might be the wakeup call for ophthalmologists. To be involved effectively, Dr. Parekh said physicians need to be informed. Read the Wash- ington Watch Weekly, which highlights some of the key issues, Dr. Parekh said. Donate to the eyePAC, which is the ASCRS political action committee, he added. "We elect our friends to Congress," Dr. Parekh said. "Two of our greatest friends are Mariannette Miller-Meeks, MD, and Rand Paul, MD, in the House and Senate. This is not about being conservative or liberal…it is about who helps us and our patients. If we can have more friends like that in Congress, then those types of elected officials can put pressure on CMS, on the FDA, and hold hearings and write letters of inquiry." Another important part, Dr. Parekh said, is to get to know your local senator or congress- man both on the national and state level. "As doctors and small business owners, we are pil- lars of the community. We are a source of good jobs, and we help the community see better and live better, and if something bad is happening to doctors, it affects the whole district. If we don't speak up, they'll think everything is fine. You have to speak up to let them know." "We know now, at least for today, those LCDs have been retired by the MACs," Dr. Rad- cliffe said. "Looking back on the experience and having been a part of the team that was writ- ing letters and compiling data and preparing presentations to fight these LCDs, we've learned a few things." The first lesson, in Dr. Radcliffe's opinion, is that, when it comes to payers, procedures are only as good as the high-quality data shows. "When it comes to the MIGS procedures, we literally have perhaps 1,000 published arti- cles that support their use and also show very consistent outcomes with good pressure reduc- tion and good medication reduction," he said. "Medicare is more fixated on the IOP reduc- tion, whereas clinicians are very happy with the medication reduction because we can tell our patients are happier to be on fewer meds, and that's something that's lost a little on the payers." Fortunately, he said, in advocating to the MACs, ASCRS, AAO, and AGS were able to use high-quality data that had been produced to demonstrate the validity of the procedures, in particular goniotomy. There was a prospective, multicenter, randomized study that demonstrat- ed that goniotomy was at least equivalent to the placement of a trabecular bypass stent, Dr. Rad- cliffe said, and this is the type of data that goes a long way in terms of persuading Medicare and other payers to support the use of a procedure. "Surgeons who are able to participate in these high-quality prospective randomized clin- ical studies should do so and should recognize that they're helping their field, they're helping patients, and ultimately advancing the quality of glaucoma care in a very meaningful way." The second lesson he took from this expe- rience was that advocacy matters, and com- placency and fatalism/cynicism are harmful. "When I sat in on a feedback session that was held by the WPS MAC, there were perhaps 10 different LCD policies that had been proposed in different fields of medicine, and it was very notable to me that, for most of the LCD pro- posed changes, there were no clinicians there to speak up against the changes, and presumably those went through," Dr. Radcliffe said. "But when it came to the MIGS proposed changes, there were many, many clinicians from private practice, from academic centers, and even those who had worked with industry who were able to speak on the positive outcomes. I also know that many clinicians wrote letters to politicians, as well as to the Medicare MAC directors, and I think the volume of these letters had a very big impact." The engagement and advocacy of doctors, the societies, and their patients was incredibly valuable, he said. Dr. Radcliffe noted the tireless work of ASCRS, AAO, and AGS, particularly highlighting the dedication of Dr. Parekh, Mark Cribben (AS- CRS director of government relations), Michael Repka, MD, David Glasser, MD, Dr. Herndon, and Geoffrey Emerick, MD. "This is a story about the value a society, such as ASCRS, brings back to its members, and ultimately back to the patients."

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