Eyeworld

EW NEWS & OPINION 16 November 2017 Chief medical editor's corner of the world by Eric Donnenfeld, MD, EyeWorld chief medical editor Why we need to be at the table T here is a proverb in our na- tion's capital about political negotiations: If you're not at the table, you're proba- bly on the menu. In simpler terms, if you are not involved in the discussion, you are probably going to be on the losing side of any nego- tiation that is about to be made. Ophthalmologists are on the menu right now in many ways, and we need to be more involved in de- cisions that affect the future of our specialty, from issues of reimburse- ment to patient care. One thing that I have learned with absolute certainty is the importance of being involved. Today, as physicians—and specifically as ophthalmologists—it is imperative to give voice to real solutions backed by evidence. Other- wise, these decisions will be made for us by people who often, even in the best of circumstances, are not well informed or, under a worse sce- nario, have ulterior motives that are not in our patients' best interests. Ophthalmology has been se- questered from the rest of medicine in many ways. In a previous generation, most cataract surgery was performed in the main operating room in a general hospital, and patients were admitted for several days. We inter- acted with other specialties in the operating room, while rounding on patients and when making visits to the emergency room and performing ers. This coming summer, consider attending the event to be held from July 16–18, 2018, and/or contribute to eyePAC to help change the future of ophthalmology. ASCRS has a seat at the table, and we would like you to join us. EW Contact information Donnenfeld: ericdonnenfeld@gmail.com consults. Today, I may go quite some time without seeing another type of physician in the workplace, and in many cases our interactions have almost ceased to exist. We have left mainstream medicine. At the same time, in an effort to move away from fee for service and into alter- native payment models, hospitals and insurance companies have been active in acquiring internal medicine practices (as well as other specialties and ambulatory surgery centers) and creating patient care models such as Medicare Advantage plans (HMOs and PPOs), accountable care organizations, and medical homes. Not a week goes by that I don't have to speak to a physician (who is not an ophthalmologist) about why I should be performing a procedure that is medically necessary for the patient and they have no knowledge of the subject. Hospital networks and insurance companies are mak- ing decisions about eyecare without our involvement. Clearly, we need to be at the table for these discussions. I would suggest that ophthalmologists care- fully assess the market in their re- gions and consider joining networks or creating larger practices that provide additional clout at these negotiations. On the national scale the stakes are even higher. It seems every week Congress is considering a new national healthcare proposal. The future of healthcare in Washington, D.C. is impossible to predict, but one thing is certain: Unless we are at the bargaining table, we will again be on the menu. There is a pay-to- play mentality with our legislators that often requires campaign contri- butions to gain access for a conver- sation. Our Advocacy/Governmen- tal Relations Committee with the assistance of eyePAC, the ASCRS political action fund, continues to work closely and pragmatically with Congress to effect real change on behalf of our membership. ASCRS is working diligently to support the politicians and policies that follow the basic principles of decreasing the regulatory burden placed upon phy- sicians, preserving "fee for service" and the free market, supporting a patient's right to choose the doc- tor of his or her choice, preserving the sanctity of the doctor-patient relationship and medical liability reform. This past summer ASCRS led the annual Legislative Fly-In to Washington, D.C., and we brought 50 ASCRS•ASOA members, includ- ing many from the Young Eye Sur- geons (YES) Clinical Committee, to meet and educate our political lead- What's for lunch? Does imaging have a role in glaucoma management? Francesco Oddone, MD, says that progression detected by imaging alone should not guide glaucoma therapy Eric Donnenfeld, MD Save the date Legislative Fly-In July 16–18, 2018 Washington, D.C.

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