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March 2012

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No Call for Celebration

I just finished reading “Innovation +” (President’s Statement, January) by Academy President Ruth D. Williams, MD. It demonstrates to me how very out of touch the Academy is with its members. I refer specifically to her reference to Medicare reimbursement for cataract surgery being $1,640 in 1987. She goes on to celebrate the fact that today cataract surgery is far better and costs less. The fact that skilled medical professionals now get reimbursed one-third of what they did a quarter-century ago—for what is admittedly a far superior procedure—is most certainly nothing to celebrate, particularly by the organization that ostensibly has its members’ interests at heart.

I graduated from medical school in 1980, and my tuition was $5,000 a year. I just paid my last tuition payment for my daughter who graduates from college in May, and her college education cost me $50,000 a year. Plus, my son is striving to go to medical school. If he is blessed enough to get in, the tuition at my alma mater is currently $45,000 a year, not including room and board.

The point here is that everything has become more expensive, yet physicians continue to get reimbursed substantially and dramatically less.

Gary F. Spitz, MD   
Little Neck, N.Y.   


The following is a response from Academy President Ruth D. Williams, MD.

You and I—and our ophthalmologist colleagues— can share the pride of developing superior surgery at lower cost. Together, we can embrace higher quality, increased safety and terrific patient satisfaction. I make a distinction here between “cost” and “payment.” I celebrate reduced cost, not reduced payment.

This January, ophthalmologists experienced a 1 percent increase in reimbursement, even while there is great pressure to reduce payments to all physicians. Ophthalmology receives this $500 million more per year because of the Academy’s leadership on practice expense: The Academy initiated a medicine-wide review on practice expense, and it helped finance the study that provided the data. All ophthalmologists benefit directly from this increase in the practice-expense portion of our reimbursement.

Every year, Academy staff and physician-volunteers spend hundreds of hours working through the AMA’s Relative Update Committee, as well as Medicare and commercial carrier relations committees, to advocate for appropriate physician payment for ophthalmology. In addition, our efforts to establish an Academy PQRS registry created a mechanism to report via registry, which has a higher rate of success in reimbursement than claims-based reporting.

Over the past decade, Medicare payments to ophthalmology have risen by 32 percent. Most of this is explained by increases in productivity. It is unfortunate that the writer considers the Academy out of touch on this issue. Every Academy member—including its volunteer leaders—feels the reimbursement pain.

Ruth D. Williams, MD   
2012 Academy President   


Meet Your Legislator

The Iowa caucus and primary battles have been the focus of much media coverage. The United States has a temperamental fascination with politics. Every four years, a frenzy of speech and opinion captures the nation’s attention, only to slip into hibernation until the next presidential election—much like the hoopla surrounding the World Cup or the Olympics. Although advocating for the welfare of our patients and our careers is no mere sport, it requires knowing the playing field and having the right team members to back you up. The Academy’s Congressional Advocacy Day is valuable in both of these arenas.

As you read this, legislation is being debated and shaped—legislation that will impact ophthalmology greatly. Medicare payments are again on the congressional budget chopping block due to the detrimental ramifications of its flawed sustainable growth rate formula. Issues of scope of practice and patient safety are being battled state by state. Intrusion into the doctor-patient relationship is being mandated without abatement in sight.

These are a few of the reasons why it is so critical that ophthalmologists engage in these issues and fight for the profession. I have been fortunate enough to attend Congressional Advocacy Day in the past and have discovered that communicating face-to-face with legislators is one of the most direct ways to effect change at the highest level. This year’s Congressional Advocacy Day remains a rare and effective opportunity to let policy makers know that thoughtful, compassionate physicians need to be allowed to do what they do best—without huge pay cuts, without worrying about the dangers that scope of practice incursions pose for our patients, and without bureaucratic intrusion.

When you register for Advocacy Day, the Academy will schedule visits with your local senators and representatives. Take this opportunity to present the concerns of the profession to your legislators and foster relationships with them. They are people you want on your side when the stakes are high—and they are.

Joseph T. Nezgoda, MD   
Member, Academy Young Ophthalmologist Advocacy Subcommittee,   
and Representative, AMA Resident and Fellow Section   


Congressional Advocacy Day is held April 25 and 26 in conjunction with the Mid-Year Forum. For more information about either event and to register, visit and click “2012 Mid-Year Forum.”


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“Very educative case. I didn’t know about vitreous cysts before today. Now I’ll always have it in mind as a differential diagnosis.”

—Nnenna Henrietta Onyechi, MD

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“Fantastic image but quite sad that in our day and age people still go blind from this age-old disease.”

—Alaji G. Gashau, MBBS

Diagnosis and Treatment of Giant Cell Arteritis

“A very compact and informative résumé of this interesting subject. Very useful to general ophthalmologists.”

—Omar N. Al-Yaqubi, MBChB

Patients With Fuchs and Cataract: Staged or Combined Procedures?

“Excellent article on a problem I must address weekly. Regarding guttae and MIOLs, what criteria do you use when deciding if an MIOL is appropriate? Do you avoid them if you see any guttae?”

—Randal K. Hughes, MD

The comments above are published with permission from their respective contributors.


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