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    Midway through 2024, the Academy, our political action committee, OPHTHPAC®, and our Surgical Scope Fund have been working to address the critical issues facing ophthalmologists and their patients.

    That’s included hosting our Congressional Advocacy Day in April, when ophthalmologists from all over the country came to Washington, D.C., to talk with lawmakers about issues like protecting veterans' access to high quality surgical eye care, physician payment reform, and increased investment in vision research.

    In our 2024 Advocacy Mid-Year Report, we highlight the Academy’s top 10 issues and explain the actions we have already taken during the first six months of the year.


    Addressing Physician Payment Challenges

    Ensuring the financial stability of ophthalmology practices nationwide is a top advocacy priority for the Academy. Following an unprecedented cyberattack on Change Healthcare, which left practices without cash flow, the Academy took an all-hands approach to help them stay afloat.

    We sent letters to Change Healthcare leadership, outlining how they could assist practices in managing the fallout. These efforts led to an urgent meeting between Academy CEO Stephen D. McLeod and UnitedHealth Group’s chief medical officer, where we advocated for increased financial assistance and a pause to step therapy requirements. We also urged CMS and other payers to offer more support to small practices.

    Meanwhile, we engaged Congress on reforms for long-term stability in the Medicare payment system. Congressional hearings on Medicare payment reform have been influenced by our ongoing efforts. Our OPHTHPAC® speaker series events have further raised awareness among lawmakers, highlighting the need for payment reform. Your advocacy is crucial for turning this conversation into action.


    Prior Authorizations and Step Therapy

    The Academy continues to insist on reforms to how insurers use prior authorization and step therapy requirements. This year has brought a lot of progress.

    As a result of Academy advocacy with a coalition of physician groups, CMS finalized a prior authorization rule implementing some reforms in the Improving Seniors’ Timely Access to Care Act, which will make the legislation easier to enact into law by lowering its expected costs. Finalizing this rule smoothed the path for our congressional champions to reintroduce the bill in this Congress.

    Pressure from the Academy and our coalition partners at the end of last year led Humana and Aetna to end prior authorizations for cataract surgeries for Medicare Advantage beneficiaries in Georgia. Despite calls for data and a meeting, Aetna continues to require them for Medicare Advantage patients in Florida.

    Meanwhile, prior authorization “gold card” bills — first introduced in Texas — gained traction at both the state and federal level.


    Pediatric Eye Care Access

    The Academy worked with a coalition of pediatric ophthalmologists to secure the introduction of a bill to create the first federally funded program to address children’s vision and eye health.

    Our members discussed this legislation with lawmakers during Congressional Advocacy Day, and in May the Early Detection of Vision Impairments in Children’s Act was introduced by our congressional champions. 

    We have also worked to address the increased financial strain on pediatric ophthalmologists. We have prioritized several efforts to help pediatric ophthalmologists provide the vital care their patients need. First, we continue to ask Congress to fund the Pediatric Specialty Loan Repayment Program — and to increase those funds. We also urged the American Medical Association to prioritize Medicaid payment reform, since so many states undercut Medicare reimbursement rates.


    Protecting MIGS Coverage

    The Academy has been working hard to ensure patients have access to minimally invasive glaucoma surgery (MIGS).

    In June 2023, a Medicare administrative contractor proposed major changes to MIGS coverage. Soon after, four other contractors proposed nearly identical changes which would make it difficult for many ophthalmologists to use their preferred surgical treatment option for glaucoma patients.

    The Academy and several coalition partners fought back against this interference with the physician-patient relationship. Yet by November, all five contractors released final policies with many of their proposed restrictions, despite our recommendations.

    We escalated our concerns and urged members of Congress and CMS to intervene. In response, the five contractors first delayed the effective date for these new policies, later canceling them altogether.

    After further discussions with our coalition, the Medicare contractors released more reasonable proposals for MIGS coverage in June 2024. This was a major win for you and your patients, and we expect these policies to be finalized later this year following a public input process.


    VA National Standards Initiative

    A U.S. Department of Veterans Affairs (VA) initiative to develop national standards of practice for more than 50 health care professions could affect patients far beyond our nation’s veterans.

    That’s the message the Academy has sought to convey to Congress as we continue to engage the VA during its less-than-transparent process.

    Thanks to our relationships and representation in Congress, Academy CEO Stephen D. McLeod, MD, testified before the House Veterans’ Affairs Subcommittee on Health. Ophthalmologist and U.S. Rep. Mariannette Miller-Meeks, R-Iowa, chairs the subcommittee.

    Our work with Congress has generated several letters to the VA on the issue. Ophthalmologists reiterated our concerns in April meetings with legislators and their staff during Congressional Advocacy Day.

    We also continue to work with organized medicine to press the VA for more transparency and physician involvement in the project.


    Scope of Practice

    The Academy continues to evolve our efforts to protect patients’ access to safe eye surgery amid growing concerns about national scope-of-practice changes alongside optometrists’ efforts to lowering patient safety standards by changing state laws.

    Although optometrists have tried to gain surgical authority in 14 states so far this year, we’ve successfully advocated to uphold high surgical safety standards in nine states so far: Idaho, Kansas, Minnesota, Missouri, Nebraska, New Hampshire, Utah, Vermont and West Virginia.

    Despite tremendous efforts by the Academy and South Dakota Academy of Ophthalmology, lawmakers opted to put patient safety at risk and enacted a dangerous optometric scope bill in the state. We continue to defend safe surgical standards in three states whose legislatures are still in session: Massachusetts, New Jersey, and Ohio. You can support our work with a confidential donation to the Surgical Scope Fund.


    Advocacy Fundraising

    Protecting patients’ access to quality care at the state and

    OPHTHPAC is your profession’s political action committee fighting for policies that help your practice, and more importantly, your patients. In addition to ensuring veterans receive the highest quality surgical eye care, these policies include fighting to increase Medicare reimbursement and enhance patient access to treatment and care by reducing the burdens of prior authorization and step therapy. Support OPHTHPAC to ensure ophthalmology’s voice is heard on Capitol Hill.

    The Surgical Scope Fund helps derail dangerous optometric surgery initiatives at the state level that jeopardize patient safety. Your support enables the Academy to partner with state ophthalmological societies to educate lawmakers and the public on the importance of high-quality surgical eye care standards.

    Champion patient safety and ophthalmology by donating to both funds today.


    IRIS Registry and MIPS Bonuses

    The Academy’s IRIS® Registry (Intelligent Research in Sight) continues to help ophthalmologists succeed in the Merit-Based Incentive Payment System (MIPS). For 2022, the most recent year for which public data exists, ophthalmology had the among the highest average score on quality of any physician specialty.

    Thanks to the registry — and strong Academy advocacy after cost issues — most ophthalmologists avoided 2024 penalties for 2022 MIPS performance. CMS stopped counting cost performance during the pandemic but resumed weighting that category for 2022.

    Due to an error, CMS initially applied a diabetes cost measure to some ophthalmologists it shouldn’t have. Another problem affected cataract cost scores (CMS automatically pulls data from Medicare claims to evaluate your cost performance).

    Both times, the Academy and its partner societies worked with CMS to resolve the issues. We also got CMS to adjust part of its methodology for the 2023 performance year and pushed for other long-term changes.


    Vision Research Funding

    The Academy continues our longtime commitment to advocate for strong vision research funding in the U.S. government. For fiscal year 2024, Congress funded the National Institutes of Health (NIH) at $47 billion and the National Eye Institute (NEI) at $896 million, and the Department of Defense Vision Research Program (VRP) at $20 million.

    During Congressional Advocacy Day 2024, ophthalmologists urged Congress to increase funding for NIH, NEI, and the VRP. Our funding requests were:

    • FY 2025 NIH funding of at least $51.3 billion
    • FY 2025 NEI funding of at least $1 billion
    • FY 2025 VRP funding of at least $30 million

    Engaging the Next Generation

    It’s more important than ever for all ophthalmologists to get involved in advocacy. That’s why the Early exposure encourages career-long engagement in advocacy. One of our most strategic efforts, the Advocacy Ambassador Program, aims to motivate and inspire members in training — residents and those in fellowship training — to participate in Mid-Year Forum and Congressional Advocacy Day so they return home as active and engaged advocates. Including online, where we've launched our official X account dedicated to advocacy updates, @eyeadvocacy.

    Over the past two decades, thousands of young ophthalmologists have joined the program. Alumni have gone on to testify in state scope-of-practice battles, help implement patient-friendly laws, and serve in various state and national leadership roles.

    This year set a new record: 220 advocacy ambassadors participated in meetings with members of Congress and their staff. Whatever your stage in training or practice, we need your voice.