In an effort to lobby for better access to care, discuss important issues with lawmakers and increase education, more than 400 ophthalmologists traveled to Washington recently for the American Academy of Ophthalmology’s annual Capitol Hill visit.
Michael X. Repka, MD, the AAO’s medical director for governmental affairs, called the meeting an important experience for both attendees and legislators.
Michael X. Repka
“It’s important for us to be there to keep our issues on the forefront,” he told Ocular Surgery News. “Sometimes our issues are congruent with other parts of medicine, but sometimes they’re not.”
During the visit’s congressional advocacy day, AAO members met with members of Congress and their staffs to discuss issues important to patient care, specifically addressing prior authorization, step therapy, drug shortages and vision research funding.
The organization believes that requiring prior authorization for Medicare Advantage plans can be disadvantageous to both patients and medical providers because it unnecessarily delays service and becomes an extra cost to staff time and patient time.
“What we’re finding in many parts of ophthalmic practice, the prior authorization requests are approved 95% to 99% of the time,” Repka said. “Use it where it makes sense. Just don’t use it to delay care — that hurts the patient.”
Ophthalmologists also advocated against allowing Medicare Advantage requirements for step therapy, in which a patient must try and fail on less expensive therapies before moving on to potentially more beneficial treatment plans.
Medicare Advantage programs have begun instituting these plans in multiple specialties, but for ophthalmology patients, it has mostly been for age-related macular degeneration and diabetic retinopathy cases.
“We believe this is illegal because Medicare Advantage participants should have the access to all of the treatments a patient in traditional Medicare would have,” Repka said. “It puts vision at risk because if you have to fail at a therapy by losing three lines of vision, there’s no guarantee you’ll get your vision back when you switch to the more expensive second or third step.”
In addition to these two important areas, advocates discussed how to address drug shortage issues, which affect all specialties, and funding important vision care groups such as the National Eye Institute.
According to Repka, the visit was successful for both the education received by the physicians and the legislative staff as well as the experience. “The experience of going to the Hill is one that actively engaged citizens, including ophthalmologists, should experience from time to time,” he said. “In terms of patient care, it’s really about protecting the public eye health.” – by Rebecca L. Forand
Disclosure: Repka reports he is the AAO’s medical director for governmental affairs.