In 2019, I attended my first American Academy of Ophthalmology Mid-Year Forum (MYF) in Washington, D.C. It was an eye-opening experience with the combined energy of hundreds of ophthalmologists advocating for their patients in different states, fueling a communal agenda to protect sight and empower lives.
I was fortunate enough to again be selected as an Advocacy Ambassador through the Ohio Ophthalmological Society (OOS) to attend Mid-Year Forum 2020. However, the COVID-19 global pandemic forced its cancellation.
It is a testament to the Academy’s dedication to patient advocacy that the first-ever Virtual Advocacy Day was hosted on May 12. As part of the Ohio contingency, I was proud to represent our state along with John Stechschulte, MD, a member and past president of the OOS, as we engaged in virtual meetings with our congressional representatives, including the staffs of Sen. Sherrod Brown, D-Ohio, and Rep. Steve Chabot, R-Ohio, throughout the day.
2020: The Issues
The two big issues we discussed were that prior authorization and step therapy requirements are delaying medically necessary care, and that physician practices need additional assistance to remain viable to care for patients during and after the COVID-19 pandemic. The issue of prior authorization and “fail first” (or step therapy) is not new and was discussed last year at MYF.
As the majority of ophthalmic practices scaled back staff and clinic hours during the pandemic, there were fewer resources than ever to tackle the onerous administrative burden of filling out the necessary prior authorization requests for approval, and the process overall has slowed down.
Ophthalmologists, regardless of subspecialty, understand that step therapy ultimately delays patients receiving their appropriate therapy. One of our requests this year was to halt step therapy requirements or at least to consider transiently suspending prior authorization during this global crisis so that patients can get medications they need to protect and preserve their vision.
The lack of staff and resources is a direct result of a reduction in patient and surgical volume, with most ophthalmic practices having to furlough or lay off staff. Ophthalmology along with other specialties like otolaryngology and dermatology has been particularly affected by COVID-19. In fact, recent surveys indicate that ophthalmology has suffered the greatest decline in terms of outpatient visits and surgeries.
Although the Medicare Accelerated and Advanced Payment Program was used to provide funds to practices during this pandemic, CMS recently decided to suspend the program. One point of discussion on additional assistance to care for patients during this crisis was the need to reinstate the program and for Congress to consider additional funding for the Paycheck Protection Program in the CARES Act.
Advocacy Pearls: More Than One Way to Get Involved
I was fortunate to learn about MYF as a third-year medical student, and I have always had an interest in patient advocacy. What I have found throughout residency is that most people are interested in fighting for their patients and our profession. They just don’t know how or haven’t been given the opportunity to do so yet. So here are my top three recommendations on how to get involved:
- Turn to your local and state societies. Every state has an ophthalmology society, and many large cities do as well. Although the members may consist mostly of practicing ophthalmologists, this is a great way to meet and network with people who have been involved with advocacy for a while or simply want to stay in touch with policymakers to ensure that they have a say in how our profession and delivery of care is affected by legislation.
There will almost certainly be a large annual meeting that you can attend, and for first time attendees, this is a great way to get involved and meet like-minded colleagues. Our OOS annual meeting highlights two graduating residents from Ohio that present their research or a grand rounds presentation, and this year we had six medical students, residents, and fellows give poster presentations!
The OOS sponsors several residents every year to attend the MYF through the Academy’s Advocacy Ambassador program, and every year there is a resident board member position that rotates between the residency programs in Ohio to provide the opportunity to get involved with advocacy at the state level. Attending the Academy’s annual meeting and getting to know members of the state society can also be a great venue to learn about fellowship or job opportunities!
- Attend the Mid-Year Forum. Getting involved with advocacy at local and state levels is arguably the most impactful way to represent your community and patients, but everyone should attend the MYF at least once. Mid-Year Forum provides the setting to collaborate with ophthalmologists from across your state over a period of several days as you work together to meet with your state’s congressional representatives over coffee, open forum, or small meetings with their staff.
Attending MYF allows the opportunity to directly speak to our policymakers at the highest level, and every year, our efforts make a difference in shaping the opinions of our lawmakers who represent us and ultimately impact healthcare decisions. Being on Capitol Hill in Washington, D.C., is an experience of its own — I don’t know a single resident, fellow, or colleague in practice who ever regretted attending MYF or had anything negative to say about it. In fact, the positive energy and drive to advocate is so infectious that most people leave brimming with enthusiasm and ready to make a difference in their local communities. The challenge is keeping that feeling alive all year!
- Visit the Academy’s Young Ophthalmologists (YO) section online. Under “Engage with the Academy” on the Academy’s YO section, there is information on volunteering opportunities, a list of state societies, MYF, the YO committee, the Surgical Scope Fund, EyeCare America and the Leadership Development Program. If you go through the website and look at each section, you’ll see how easy and accessible advocacy is! Find out how to become an effective leader and volunteer.
We are in the midst of a global pandemic and all ophthalmology and society meetings have been canceled or rescheduled. Still, technology has made it easy to stay in touch with colleagues, and I greatly value and enjoy the friendships and connections I have made. Join your state society today, and I have no doubt that it will enrich your training, perspective, and experience as an ophthalmologist, just as it has for me.
About the author: Arjan S. Hura, MD, is an ophthalmology resident at the University of Cincinnati.