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EW NEWS & OPINION 18 September 2015 Experiences from this year's ASCRS Legislative Fly-In Bonnie An Henderson, MD, Boston, ASCRS treasurer Dr. Bakewell: This was your first time attending the Fly-In. Can you tell us what your expectations were leading up to the Fly-In and how they compared to your experience? Dr. Henderson: I didn't really know what to expect. I had heard Dr. Bakewell's and Nancey McCann's presentations and have tried to keep up on the legislative issues but didn't feel as if I had a good han- dle on the type of interactions that occur between ASCRS and Capitol Hill. The governmental issues that impact ophthalmologists are so con- stant that I have often felt powerless over the decision-making process. However, after the Fly-In, I have a completely different outlook. First, I was impressed with how organized ASCRS was on educating the partic- ipants on the current issues at hand and how to present a unified front to push on several key issues. Sec- ond, my interactions with my state's elected officials were surprisingly enjoyable. Their legislative aides were knowledgeable, open-minded, and sincere. I felt that the meetings, albeit brief, were successful in pre- senting our concerns, and I walked away believing that our voices were heard. The Fly-In restored my faith that it is possible to have significant input in our specialty's future. W hat if you had the ability to travel to Washington, D.C. to learn firsthand how our democratic process works and to make a positive impact for our profession and our patients? ASCRS•ASOA members who attended the annual Alliance of Specialty Medicine Legislative Fly-In this July had just that opportunity. The 17 ASCRS members and 10 ASOA members representing 19 states and 24 different congressional districts gathered on Capitol Hill with members of the 13 other specialty medical societies in the Alliance to learn about current policy issues affecting specialty medicine, and then met directly with their representatives and senators to lobby for our issues. I want to give you a taste of what it is like to participate in the Fly-In and have asked some of my fellow attendees to share their experiences here to help encourage you to "get in the game" and join us next year. While ASCRS•ASOA maintains a constant presence in Washington to monitor policy developments and advocate on behalf of our mem- bers, the most powerful influence comes directly from the people our legislators represent—you, me, and our patients. Members of Congress want and need to hear from their constituents about how federal policies are affecting their states and districts. Our annual Fly-In allows us as physicians and administrators to demonstrate how laws and regulations are impacting our practices and, most importantly, our patients. This year, we specifically focused our advocacy efforts on delaying Stage 3 of Meaningful Use. Fly-In participants were able to speak directly to their legislators to say that while physicians and practices are committed to improving healthcare quality and delivery and imple- menting EHR systems, the Centers for Medicare and Medicaid Services (CMS) Stage 3 proposed rule would be nearly impossible for most physicians to achieve. Following advocacy from ASCRS and others in the medical community demonstrating the difficulty physicians were hav- ing achieving Stage 2 requirements, CMS issued a proposed rule providing much-needed flexibility including lowering the patient electronic access measure requirement from 5% to one patient and changing the secure electronic access measure from 5% to having a fully functional electronic messaging system. Despite realizing the need for flexibility with those measures, CMS proposes to increase the thresholds further in Stage 3. Therefore, we need Congress' intervention to prevent CMS from finalizing the Stage 3 proposed rule. During the Fly-In, our members were able to demonstrate successfully that the measure thresholds in Stage 3 would be too high to meet, and I'm happy to report our message was heard. Legislation to delay Stage 3, H.R. 3309, was introduced in the House of Representa- tives by Rep. Renee Ellmers (R-NC) on July 29. In addition, Senate Health, Education, Labor and Pensions (HELP) Committee Chairman Lamar Alexander (R-TN) has publicly stated he supports delaying Stage 3. Senate legislation will be introduced soon. This is a direct consequence of our advocacy during the Fly-In. You may be thinking that while all this advocacy is worthwhile, you personally do not have the required skills and legislative knowledge to participate. Many of these issues may seem complicated and lobbying on them could be daunting. However, at the Fly-In, we make sure to provide all participants with plenty of background reading and issue training before they head to the Hill. Most importantly, the entire group is able to hear from a series of speakers, prior to meeting with their own legislators, who are key healthcare policy leaders in Congress, the administration, and other organizations. This year, we heard from Sen. Sherrod Brown (D-OH); Rep. Andy Harris, MD (R-MD); Sen. Bill Cassidy, MD (R-LA); Sen. Ben Sasse (R-NE); Rep. Michael Burgess, MD (R-TX); Rep. Phil Roe, MD (R-TN); Rep. Raul Ruiz, MD (D-CA); and several representatives from CMS speaking on all 3 of the current quality reporting programs. Several of the speakers echoed the Alliance's concerns regarding Meaningful Use Stage 3. From listening to these speakers, and from my experiences at the Fly-In over the last several years, I've realized that while the training and in-depth discussions we have prior to meeting with lawmakers are helpful, the most pow- erful message is the one we can bring as experts in ophthalmology treating real patients in our districts and states. I was particularly struck this year by the bipartisan calls for physician advocacy. Both Reps. Harris and Ruiz, who are themselves physicians, challenged the participants to become advocates not only for their profession, but for their patients. According to Rep. Ruiz, physicians must "get off the sidelines" and let legislators know how their policies affect patient care. Only we physicians can tell the story. To help tell the story, I've asked a few of the participants to share some of their impressions and experiences from the Fly-In. After reading about your fellow members who attended and the impact they've made, I'm challenging you to "get in the game" and join us next year. If you do not want to wait until next year to start advocating for our issues, you can participate a little closer to home and set up a meeting with your legislators in your district or state. If you are interested in attending next year's Fly-In or would like to set up a meeting at home, please contact Allison Madson, manager of PAC and grassroots, at amadson@ascrs.org. Full details on being a grassroots advocate and our key policy issues are available at www.ascrsgrassroots.org. Brock K. Bakewell, MD Chairman, ASCRS Government Relations Committee

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