Eyeworld

EW NEWS & OPINION 22 September 2016 MD (director of CMS' Center for Standards and Quality), present- ing to us along with staff from the committees that drafted MACRA. All of the presenters were interested in taking questions and listening to our thoughts. The meetings with elected officials and their staff were as I expected. Some were more interest- ed in our issues and engaged with us well. With others, it was evident that our issues were not high prior- ities, but they were willing to meet with someone who votes in their state/district. The value of attend- ing the Fly-In was in learning more about issues that are important to our practices, being able to build re- lationships with our elected officials that, hopefully, will grow over time, and spending time with peers. The Fly-In taught me that it is important to participate in the process. With legislators and their aides, they referenced what they had heard from other constituents. It was evident that they listen to con- stituents. They may not agree with everything, but they were all willing to listen. One of the biggest intangible benefits was spending time with other practice administrators. We talked about legislative issues but also other practice issues. I live in rural Colorado, and finding the time to spend with peers is not easy—and is invaluable. Doyle Stulting, MD Atlanta I have been to the Fly-In multiple times, and I think it is beneficial for several reasons. First of all, it is edu- cational, so attendees gain a much better understanding of the issues that affect our lives and our profes- sion. Second, it gives us an oppor- tunity to educate our legislators and their staff members about unintend- ed consequences of pending and existing legislation. Third, it allows development of personal relation- ships with our government represen- tatives—not only to influence their decisions on current issues but also to become resources that they can use to shape their legislative actions in the future. Finally, it gives us an opportunity to thank friendly legis- lators for their support. I have seen my suggestions become part of the 21st Century Cures initiative and have provided background infor- mation to legislative staff on many occasions and, I think, have helped form decisions on several topics over the years. My experiences at the Fly-In have helped me understand that our legislators may not really under- stand the impact of the policies they implement. What seem to be good ideas may have an impact that is different than what was intended. We can help our legislators under- stand this and the impact of compli- ance on the quality of medical care that we deliver. Personal stories and real-life experiences can have a sig- nificant impact on formation of the laws that govern our profession. During this year's meetings with legislators, I discussed the burden of compliance with MACRA in the cur- rent time frame and how it would detract from my ability to provide good care to my patients. I also talked about how many of my expe- rienced colleagues and I have seen a decline in the profession over the years—to the point that many of us are trying to figure out how to retire, rather than enjoying the opportuni- ty to help our patients. "How to get out" has replaced enjoyment of the best profession in the world. Residents attend ASCRS•ASOA/ Alliance of Specialty Medicine Legislative Fly-In on inaugural YES Scholarship The 2016 ASCRS•ASOA Fly-In group included five ASCRS residents and fellows who attended with support from the inaugural ASCRS Young Eye Surgeons (YES) Legislative Fly-In Scholarship Program. The program is designed to enhance younger mem- bers' understanding of public policy issues affecting ophthalmology and provide networking opportunities with established ASCRS members, including leadership. We asked the YES attendees to share their thoughts on the experience. Courtney Bovee, MD Boston This was my first time attending the Fly-In, but not my first time in the nation's capital to discuss issues crit- ical to medicine with legislators. I started coming to Washington, D.C. as a first-year medical student and have participated in many meet- ings with local, state, and national elected officials since the start of my medical education. One of my favorite parts of the Fly-In was the briefings on the morning of the congressional visits. Hearing legislators discuss their views on health policy from both sides of the aisle was incredibly eye opening. As a physician about to enter practice, it was helpful to learn specific details about the MACRA program and how my practice will need to adapt to ensure we meet all of the specific requirements. As a young eye surgeon, I am amazed by the increasing complex- ity of payment models. During the Hill meetings, we urged legislators to carefully evaluate the MACRA ruling and to remember that any further changes need to be designed to preserve the patient/physician relationship and protect those patients receiving care in a small or solo practice setting. Several of the legislators and their aides had no idea what challenges the MACRA implementation timeline would have on practices and the extent of coordination it would require among physicians, EHR vendors, and support staff. I especially enjoyed the oppor- tunity to meet with other subspe- cialists, including urologists and neurosurgeons. Hearing their areas of strengths and weaknesses in their respective practices allowed me to view my practice more critically. The Fly-In also gave me the opportunity to interact with other like-minded young eye surgeons who have a strong desire to advance the field of ophthalmology through advocacy. This experience taught me that I do have a voice. On a daily basis, I instruct doctors and technicians on what they need to do to follow the endless legislative rules without feeling like I have a say in any of it. This experience has taught me that we need to be involved in organi- zations like ASCRS and the Alliance of Specialty Medicine and voice our concerns whenever possible. I was fortunate to meet with Congressman Chris Collins (my local congressman) and explained that the MACRA implementation timeline is too short. Practices will need more time to prepare for par- ticipation in the new program. Since this is a transition year, I asked that he urge CMS to push back the first performance period so that practices have time to transition from the current programs into the new pro- grams. He was very engaged in the conversation, asked many questions, and seemed willing to help us. After the Fly-In, I returned to my practice, shared this experience with my physicians, and encouraged them to think about going next year. I enjoyed meeting physicians and administrators from other specialties as well. It brings to light that we are all in this together; no matter what specialty or type of practice (large or small), we are all dealing with the same legislative issues. It was a wonderful experience, and I now recognize that we all need to speak up if we want change. Joe Theine, MBA Durango, Colorado My expectations of the Fly-In were (1) to receive some education on the issues, (2) to be presented to by elected officials and staff—but not have much interaction, and (3) to meet with elected officials' staff from our state/district. Overall, my expectations were exceeded. I was surprised to have Kate Goodrich, Reflections continued from page 21 continued on page 24

• Cover