A Washington Post

By Jonathan Prenner, MD, and Richard Kaiser, MD

We are so obsessed with our ORs and clinics that it is easy to tune out societal noise unrelated to retina. Have you seen La La Land yet? Don’t have time. Are you at least excited for the new season of Game of Thrones? Haven’t watched it. How about that Patriots comeback in Super Bowl LI? Went to bed at halftime because surgery was scheduled for the next morning.

But there are some events with decibel levels so high that even those dedicated entirely to their craft cannot ignore them. One such event was the 2016 US election. News about the election—before, during, and after the casting of ballots—wove its way into even nonpolitical discourse. In retina, nary a conversation about regulatory issues ignored the consequences the election could force on the industry: either sustained Obama-era health care policy in the event of a Hillary Clinton victory, or an upending of order in a Donald Trump victory.

Donald Trump won, in case you haven’t heard. And although the dust has not settled from the election, the inauguration has occurred, the cabinet is filling out, and the policies the president touted during the campaign are morphing from rhetoric to rule.

Can you, a busy retina specialist, digest all these changes and determine what they mean to you and your practice? No, no: That way madness lies. Good thing NRMD is here to help.

Keeping track of who won and lost in the election is hard enough; keeping track of who will play which role is even harder. Jeffrey J. Kimbell and Kenneth L. Hodge, two Washington veterans with knowledge of how the cogs in the legislative machine are greased, break down how recently confirmed Health and Human Services Secretary Tom Price and new Senate Minority Leader Charles Schumer (D-N.Y.) could work together to craft meaningful changes to the Affordable Care Act (ACA) in the coming years (New Faces, New Dynamics: The Health Care Reform Debate). With an understanding of the roles of the various players, readers’ concepts of how health care policy is actually crafted may come into focus.

For all the ACA did to divide doctors on questions of access and ethics, the Medicare Access and CHIP Reauthorization Act (MACRA) did much to unite them. Nearly everyone agreed that flaws in the sustainable growth rate formula were bad for patients and doctors, and we are hard pressed to find a reader who thinks that passage of MACRA was a step in a wrong direction. Still, after any change in policy that may affect practice patterns, doctors seek guidance on how to adjust to new regulations. Dixon Davis, MBA, of BSM Consulting, a medical consulting firm with a special interest in retina practices, reviews how recent rule changes could mean that retina practices may see significant boosts in reimbursement in 2019 and beyond—or reductions in reimbursement if they don’t follow the rules (Bonuses and Penalties).

Those of you interested in how retina plays a role in helping move the chess pieces in Washington will find an article by George A. Williams, MD, helpful (How the AAO Helped Stop a Washington Disaster). Dr. Williams tells how the American Academy of Ophthalmology (AAO) worked closely with members of Congress to quash a potential regulatory disaster in Washington that had the US Food and Drug Administration and the Centers for Medicare and Medicaid Services proposing conflicting policies. Without the AAO’s input, the policies would have encouraged the use of compounded biologics while restricting access to such medications—a Washingtonian paradox more common than one might hope, Dr. Williams observes.

The current generation of retina leaders who advocate for the profession are senior physicians whose passion for navigating byzantine Washington backwaters leads to successes for retina specifically and ophthalmology in general. However, the bench is not deep, and retina needs more junior physicians to participate. Mohsin H. Ali, MD, and Siya Huo, MD, two ophthalmology residents working with Jennifer I. Lim, MD, at the Illinois Eye and Ear Infirmary, share their experiences from the AAO Mid-Year Forum and from Congressional Advocacy Day (Ophthalmology on the Hill). Perhaps with a greater understanding of what advocacy for our profession looks like, more young physicians will be interested in working with our ophthalmic colleagues in other subspecialties to help keep ophthalmology’s voice on Capitol Hill strong.

The cherry blossoms are blooming near the Tidal Basin. Let’s hope this issue inspires a blossoming retina specialist to take up profession- and patient-centered advocacy.

Co-Chief Medical Editor Jonathan Prenner, MD
• associate clinical professor, department of ophthalmology, Rutgers Robert Wood Johnson Medical School, New Brunswick, N.J.
@jlprenner; jonathanprenner@gmail.com

Co-Chief Medical Editor Richard Kaiser, MD
• professor of ophthalmology, Jefferson Medical College; co-director, retina fellowship, Wills Eye Hospital; both in Philadelphia
@Retinadoc44; richardskaisermd@gmail.com


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About New Retina MD

New Retina MD delivers cutting-edge content to retina specialists in their first 15 years of practice. Each issue provides fresh insight from younger physicians plus established mentors on clinical and nonclinical issues affecting ophthalmologists in the earlier stages of their careers. NRMD features surgical pearls, clinical research endeavors, practice management, medical reimbursement and policy, continuing educational requirements, financial planning, innovations, and more.