American Academy of Ophthalmology Web Site: www.aao.org
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November/December 2009

 
Academy Notebook
 
 

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What's Happening 

Changing Demographics: 2009 Survey Results

Who is the member of the American Academy of Ophthalmology?

Every two years, the Academy sends a questionnaire to a random sample of its U.S. members to assess demographics and practice trends, and to identify important issues.1 The 2009 data confirms that the demographics of  our ophthalmic community is changing.

“Our young ophthalmologists, who have been in practice five years or less, are demographically quite different from our general membership,” said Academy secretary for Membership Ruth D. Williams, MD.

While 81 percent of U.S. members and fellows are Caucasian and 81 percent are male, young ophthalmologists are more diverse. Forty-one percent of young ophthalmologists are female and nearly 40 percent identify themselves as non-Caucasian. More specifically, over 25 percent of young ophthalmologists are of Asian and/or Indian descent, as compared with 11 percent of the general membership.

Ophthalmologists who are newer to practice are also more likely to subspecialize and to practice in a group setting. Twenty-eight percent of U.S. members are in solo practice, whereas only 4 percent of young ophthalmologists are in solo practice. Also, over half of the younger members are subspecialized  compared with 43 percent of U.S. ophthalmologists overall.

“As expected, young ophthalmologists use the Internet for continuing medical education and for obtaining clinical information more than their older counterparts. What is more interesting, though, is that those ophthalmologists in their first years of practice still rely heavily on meetings, seminars and journal reading,” said Dr. Williams.

Half of young ophthalmologists use the Internet for obtaining continuing medical education, as compared with just over 40 percent of U.S. ophthalmologists in general. Ninety-three percent of young ophthalmologists go to meetings to further their clinical education and 83 percent rely on journals for learning.
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1 This survey was sent to  7,000 U.S. practicing members, 915 of whom responded. The sampling error is ± 3.2 percent. Separate surveys were sent to U.S. members- in-training and international members.

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FYI 

Board Approves Policy Revisions

The Academy board of trustees has voted to approve revisions to two policy statements—Glossary of Terms and Laser Surgery.

To read these policies and others, visit www.aao.org/about and click “Policy Statements.”

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Ask the Ethicist: The Itinerant Surgeon

Q: An optometrist refers patients to a “cataract specialist” from a neighboring state who flies into the community one day each month to perform a large number of prearranged surgeries. Is this ethical?

A: In order for this arrangement to be ethical, the surgeon must be performing appropriate preoperative assessment and postoperative care or must appropriately delegate portions of that care. Surgical and subspecialty associations (including the Academy) regard perioperative care as an integral part of surgical management. Although some aspects of perioperative care may be appropriately delegated, this scenario raises several significant concerns.

Appropriate surgical management begins with adequate preoperative assessment and a discussion that results in informed consent. A surgeon who delegates this function and does not make an independent assessment of each patient does not meet these standards. These aspects of surgical management may be considered within the exclusive competence of the surgeon and should not be routinely and/or completely delegated to nonsurgeons. Furthermore, a surgical candidate must make an autonomous decision to proceed; if the surgeon’s assessment and consent discussion occur at the operating room door, the circumstances may be considered coercive.

Postoperative care is also the surgeon’s responsibility, though with provisions for permissible delegation. Postoperative care arrangements must be discussed before surgery and consent obtained for the arrangement. Also, “routine” comanagement that primarily serves the physician’s economic interest, rather than the patient’s needs, raises both ethical and legal/regulatory concerns. While care that does not require the unique competence of an ophthalmologist may be delegated, responsibility should not—delegated services must be adequately supervised. This recommendation includes coverage for unanticipated problems requiring an ophthalmologist’s expertise. Appropriate coverage should be prearranged—not handled by referral to an uninvolved ophthalmologist or a local emergency department. Clearly, there will be circumstances in which ideal perioperative management must be modified, but these should be exceptions rather than routine practice.

Last, the itinerant surgeon risks being perceived as merely a surgical technician rather than a physician, which may compromise an adequate physician/patient relationship. If something goes wrong, the risk of legal claims against a relatively anonymous surgeon should not be underestimated.

For more information, visit www.aao.org/about and click “Ethics.” To submit a question for this column, e-mail it to ethics@aao.org.

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Academy Store 

Download Latest Patient Education Products

Two Academy patient education tools are now available as online subscriptions.

Digital-Eyes Ophthalmic Animations for Patients, 2nd Edition (#050123V) is a collection of more than 65 animations of eye anatomy, common eye conditions and treatment options (available in English and Spanish). This subscription is $280/year for members and $387/year for nonmembers.

The Downloadable Eye Fact Sheet Subscription (#057158V) is a collection of more than 40 fact sheets in English and four in Spanish relating to specific eye conditions and treatment options. This subscription is $99/year for members and $134/year for nonmembers.

You may download the files as often as you wish or save them to your computer. With purchase of your annual subscription, you have access to new titles and updated versions.  

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New AAOE Financial Management Guide Now Available

In response to demand for an ophthalmology-specific financial management guide, the AAOE has developed The Profitable Practice Series (#012196).

The seven concise modules cover such topics as billing, collections, understanding financial statements and structuring physician compensation arrangements. These modules help practices increase profitability and learn financial best practices.

Each module is $45 for members and $60 for nonmembers. Purchase the entire collection of seven modules for $284 for members and $378 for nonmembers.

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Check Out the Revised Medical Assisting DVD

Enhance your allied health staff’s patient care skills with the Fundamentals of Ophthalmic Medical Assisting DVD (#0252422).

The second edition of this training DVD provides step-by-step instructions for important procedures and demonstrates how to use equipment and execute many of the diagnostic tests described in Ophthalmic Medical Assisting: An Independent Study Course. Topics include history taking, visual acuity testing, confrontation visual fields, pupil evaluation, slit-lamp assessment, applanation tonometry, clinical optics and ocular motility.

The DVD is $85 for members and $115 for nonmembers. The Ophthalmic Medical Assisting Starter Kit (#0242412) includes the Fundamentals of Ophthalmic Medical Assisting DVD and Ophthalmic Medical Assisting: An Independent Study Course. It is $212 for members and $247 for non-members.

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Academy Store

To order products from the Academy Store, visit www.aao.org/store or phone the Academy Service Center at 866-561-8558 (toll-free in the United States) or 415- 561-8540.

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Meeting Matters 

Claim Your 2009 San Francisco CME Credits by Jan. 20

Beginning Dec. 16, the CME credits that you earned at the 2009 Joint Meeting and/or Subspecialty Day can be reported online. Credits must be reported by Jan. 20.

As a service to members only, the Academy maintains a transcript of Academy- sponsored CME credits earned, provided the member reports those credits to the Academy. Members may also report credits earned through other CME providers, so that a record of all CME credits earned is available on a single transcript.

To report your CME, go to www.aao.org/cme.

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Mark Your Calendar for Chicago 2010

Join us in Chicago for the 2010 Joint Meeting with the Middle East African Council of Ophthalmology (MEACO).

The meeting will take place Oct. 16 to 19 at McCormick Place. It will be preceded by Subspecialty Day on Oct. 15 and 16, which will feature meetings in refractive surgery, retina, cornea, glaucoma, oculoplastics and uveitis.

For Joint Meeting updates, visit www.aao.org/2010.

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Submit Abstracts for Papers, Posters and Videos

If you are interested in being a presenter at next year’s Joint Meeting, abstracts must be submitted online:

  • For Instruction Courses and Skills Transfer Courses, the online submitter opens on Dec. 9 and closes on Jan. 12.
     
  • For papers, posters and videos, the online submitter opens on March 17 and closes on April 13.
     
  • If you are making plans to submit a video abstract, the deadline to submit the actual video is April 23.

Be sure to review the abstract guidelines before making your submission.

For information on submitting an abstract, go to www.aao.org/2010, choose “Scientific Program” and “Presenter Central.” For more information, send an e-mail to meetings@aao.org.

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Members At Large 

Two Brothers Making a Difference for Ophthalmology

“Healthy competition between brothers has proven to be beneficial for the Academy. The Academy works so closely with our partner state ophthalmology societies on so many efforts, and it is critical to have Eye M.D.s at the local level willing to step up to the plate and lead those societies. We couldn’t ask for greater dedication than we get from the two Goel brothers, Ravi and Sanjay,” said Daniel J. Briceland, MD, Academy secretary for State Affairs. Dr. Briceland is referring to the president of the Maryland Society of Eye Physicians and Surgeons (MSEPS), Sanjay D. Goel, MD, and the president of the New Jersey Academy of Ophthalmology (NJAO), Ravi D. Goel, MD.

Both are graduates of the Academy’s Leadership Development Program and have committed immeasurable time to their respective state ophthalmology societies and to the American Medical Association. Both also understand that ophthalmology at the national level is only as strong as its weakest link within the state ophthalmology societies.

To date, Dr. Ravi Goel has orchestrated a complete overhaul of the membership process—with the result being a complete profile of every NJAO member and  prospective member. He has proactively lobbied every NJAO member to  contribute to the NJAO political action committee and  has  significantly increased the visibility of the profession and the Academy.   He is the Academy’s official liaison to the AMA’s Young Physician’s Section and, earlier this year, he won election as the chairman-elect of that section’s governing council. He is also a past member of the Academy’s Young Ophthalmologist committee and was a participant on the Academy’s Revitalization committee whose goals were to ensure that the Academy was focusing on key priorities for the future.

As MSEPS president, Dr. Sanjay Goel has earned a reputation for his ability to think outside the box. He has introduced many initiatives, all of which serve as a shot in the arm for Maryland’s membership recruitment and retention efforts—including new member benefit programs with OMIC. In addition to leading MSEPS, he serves as a member of the Academy’s secretariat for State Affairs, where he acts as an Academy liaison on state governmental affairs and organizational development issues to many state ophthalmology societies.

“These brothers have given so much not only at the local level, but also within the Academy and the American Medical Association,” Dr. Briceland said.

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People

The New York Academy of Medicine has awarded Oscar A. Candia, MD, with the 2009 Lewis Rudin Glaucoma Prize for his article describing a new animal model for the study of the effects of corticosteroids on IOP. The prize recognizes the most significant scholarly article on glaucoma published in a peer-reviewed journal.

The National Advisory Eye Council for the National Eye Institute has announced the appointment of the following Academy members: James Chodosh, MD, MPH, and Donald A. Gagliano, MD. The council’s 12 appointed members advise the NEI about conducting and supporting research, training, health information dissemination and other programs that address blinding eye diseases, visual function mechanisms and sight preservation.

William L. Rich III, MD, the Academy’s director of Medical Health Policy, has been elected chairman of the National Quality Forum’s Health Professionals Council. The mission of the NQF is to improve the quality of American health care. The council provides input on priority setting, education/ outreach initiatives and the endorsement of measures and quality initiatives.

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Washington Report

Academy Fights for Medicare Payment Increase

CMS has begun its annual process of proposing changes to the Medicare physician payment program.   The proposed 2010 Medicare Physician Fee Schedule rule released July 13 includes a number of important changes to physician reimbursement, including a significant increase in the practice expense payments for ophthalmologists as well as other physician specialties and nonphysician health care providers. The increase is based on new data from a survey conducted by the AMA and other medical organizations, with input from 52 medical and other health care professions. While 70 percent of specialties included in the survey will see an increase in their payments, others face decreased payments. Changes are made in a budget-neutral manner, meaning savings or gains must be offset by each other among all Medicare Part B providers. Groups that lose in the equation—cardiology, radiology and oncology—have attacked the survey process (one that they helped develop) and have opposed CMS’ adoption of the proposed rule.

In response, the Academy formed a coalition with 20 other groups to support the rule and counter attempts to stop its implementation. The coalition has met with CMS, the U.S. Office of Management and Budget and the Medicare Payment Advisory Commission (MedPAC), in addition to sending letters to Capitol Hill stressing that the new data correct long-standing distortions that previously favored cardiology, radiology and oncology.

The coalition has pointed out that data for some groups, including ophthalmology, is more than 10 years old. Neutral policy bodies such as MedPAC have advocated for a unified survey of physician data because mixing different data sets for specialties has caused inequities.

Other specific reimbursement changes that CMS proposed in the rule include:

  • retroactively removing the cost of drugs and lab services from the sustainable growth rate;
     
  • updating its competitive acquisition program;
     
  • eliminating consult codes and increasing payments for existing E&M service codes; and
     
  • initiating a value-based purchasing program with resource-use reports that use proprietary episode/treatment grouping software to target “high-cost” providers (the Academy provided in-depth analysis of how specific ophthalmic conditions are poorly categorized in the software).

A final decision on practice expenses and other issues is forthcoming in the Final 2010 Medicare Physician Fee Schedule rule, expected this month.

Neutral policy bodies have advocated for a unified survey of physician data because mixing different data sets for specialties has caused inequities.

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