Eyeworld

EW NEWS & OPINION 14 September 2014 Repeal of the sustainable growth rate Sandra W. Yeh, MD Springfi eld, Ill. As we all know, we have been living for more than a decade with the threat of cuts from the deeply fl awed sustainable growth rate (SGR). Since 2002, Congress has had to enact 17 short-term fi xes to the SGR to pre- vent drastic cuts to Medicare physi- cian payments. What should have been done many years ago was a full repeal and the implementation of a new system that refl ects the realities of present day practice costs. But instead, Congress has spent more than a decade enacting short-term fi xes and "kicking the can down the road." In 2013, the cost to fi x the SGR would have been less than ever at $116.5 billion, and Congress should have recognized this as a golden opportunity to fi nally fi x their "Frankenstein's monster." Yet again, they missed the opportunity, and we are still living under a short-term "fi x" to the SGR until April 1, 2015. The good news is that both the House and Senate, both Republicans and Democrats, have acknowledged that a fi x is needed and that this is an ideal year to accomplish this. H.R. 4015/S. 2000 is bipartisan/ bicameral legislation to repeal and replace the SGR, supported by ASCRS•ASOA and the medical community. However, there is deep disagreement as to how to pay for this. The House passed a fi x paid for by delaying the individual mandate—which is unacceptable to the Democratic Senate—and Senate sponsors have proposed using OCO funds (Overseas Contingency Operation, where they saved funds from foreign wars), which is equally unacceptable to House Republicans. The Fly-In was invaluable to us as we were able to have personal face-to-face communication with both Senate and House leaders. Sen. Rand Paul, MD (R-KY), spoke to us and emphasized his full support of repealing the SGR and fi xing it once and for all. He is in full agreement that this madness of short-term fi xes is ultimately more costly than a fi nal permanent repeal. We were also able to meet with the aide of Sen. Dick Durbin (D-IL), who stated the Senator is very supportive and truly wants this fi xed soon. Both parties are tired of this issue. We may have accomplished a great deal by not only putting forth our position, but by getting both parties to start talking again. Before I was part of the Fly-In, I would sit in my pajamas at home and read about these issues on my computer. The government seems so high up and so far away. In fact, this is not true. There is still a moment of great pride when I walk into the cool, pristine, white marble halls of the Senate and the House. I have come to realize that this is our Senate, our House, and our govern- ment. It is a humbling moment to sit just a foot away from Rand Paul who is "one of us"; he looks us in the eye and says, "I understand your problems, and we will work to fi x them." It is also a great moment when we are able to speak to both Democratic and Republican leaders and realize that they are ready to fi x the problem. Our input could have brought both sides closer. There is a real chance that in the upcoming lame duck session, SGR will be re- pealed and a permanent law will be enacted. We CAN make a difference, we CAN change history; we just have to be willing to do it. The Alliance of Specialty Medicine Legislative Fly-In: Importance of advocacy in ophthalmology S ince you are probably like most ophthalmologists—busy practicing clinical medicine or being involved with research or administrative responsibilities—advocacy for our profession may not be at the top of your list of priorities. Abdicating your advocacy responsibilities to others is risky, since everyday policy decisions that affect you and your patients are made in Washington, D.C., by policymakers and regulators who may be unin- formed and certainly don't have your experience and clinical know-how. If you'd like to make a difference, consider attending a Legislative Fly-In in Washington, D.C., like the Government Relations Committee members profi led in this issue. The ASCRS Government Relations Committee (GRC) is a group of dedicated warriors who are involved in advocacy for our profession. The Committee is under my leadership and ASCRS lobbyist and director of government relations, Nancey McCann. Each year the majority of the GRC members, the ASCRS leadership, as well as other advocacy-minded ophthalmologists attend the Alliance of Specialty Medicine Legislative Fly-In to advocate for specialty medicine in general and ophthalmology in particular. The Alliance is a group of 13 specialty societies that represent more than 100,000 physicians. This year the Legislative Fly-In took place July 7–9 and was attended by 18 ASCRS ophthalmologists and 7 ASOA administrators; it was the fi rst year for full ASOA participation. An additional 14 ophthalmologists (most of whom are ASCRS members) and 7 administrators from the Society for Excellence in Eyecare also participated, making this year's Fly-In the best ever in ophthalmologist/administrator attendance. During the Fly-In, interactive sessions were held with various senators, congressmen, and administrators from regulatory agencies. Capitol Hill visits were arranged so that each participating ophthalmologist or administrator was able to meet with his/her respective senators and congressman or their legislative assistants. The ASCRS contingent concentrated on several legislative priorities during our interactions: ensuring access to specialty care, physician payment reform, and reducing regulatory burdens. Four of our illustrious GRC members have written about the specifi cs of these issues: Sandra W. Yeh, MD, Larry E. Patterson, MD, Vonda Syler, COE, and Frank Price, MD. I want to thank all ophthalmologists and administrators who participate in advocacy efforts for our profession through ASCRS. It's a job in which we all need to be continually engaged. If we don't present our legislative priorities and ideas to Congress and regulatory agencies, then policies and regulations get made and modifi ed without our input, frequently to our detriment. I would like to invite all ASCRS members to participate in a Legislative Fly-In or at the very least be a Grassroots eyeContact and eyePAC contributor. Our ASCRS contingent at this year's Fly-In represented 21 states, but our message could penetrate the ranks of Congress better if we could represent all 50 states. For the sake of our profession, I encourage your participation in the Fly-In next year in July. Please contact Allison Dickert Madson (amadson@ascrs.org) to register. Also, feel free to visit the ASCRS website to learn more about our advocacy efforts and how to get involved. –Brock K. Bakewell, MD, chair of the ASCRS Government Relations Committee continued on page 18

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