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2019 Mid-Year Forum Report

A report from Mid-Year Forum 2019 in Washington, DC

Written by Alexis Warren MD and Caroline Wilson MD

Pictured: Caroline Wilson MD and Alexis Warren MD, PGY-2s University of Iowa

Every year, the Iowa Academy of Ophthalmology and University of Iowa sponsor at least one ophthalmology resident from the University of Iowa to attend the American Academy of Ophthalmology's (AAO) Mid-Year Forum in Washington, D.C. This year we were lucky enough to be selected as the "Advocacy Ambassadors" from Iowa, with the goal of learning more about advocating for our patients and for the field of medicine as a whole. We are excited to share our experience at Mid-Year Forum this year, with updates on the issues at hand in Washington currently affecting our patients. 

Day 1 - Congressional Advocacy Day

Mid-Year Forum Group

Iowa ophthalmologists at Loebsack’s office

Pictured: (left to right) Alexis Warren MD, Katie Murray (aide to Loebsack), Caroline Wilson MD, Anne Langguth MD, Elizabeth Gauger MD, and Keith Carter MD

On April 11, more than 400 ophthalmologists went to Capitol Hill to meet with members of Congress. Our Iowa team met with Senators Grassley and Ernst, as well as Representative Loebsack's staff. We discussed four main topics with our Senators, including drug shortages and drug prices, pre-authorization requirements, "step therapy", and research funding for the NIH/NEI and Department of Defense. There were four main issues highlighted which are listed below. 

  1. Drug prices and shortages. Unexpected price increases in both brand name and generic medications, as well as drug shortages, have greatly affected our ability to effectively treat our patients. The Food and Drug Administration has already attempted to address this issue by building a Drug Shortage Task Force, an organization with the role of analyzing the root causes of these drug shortages. As ambassadors, we also urged Congress to support a new bill, the CREATES  (Creating and Restoring Equal access to Equivalent Samples) Act (S. 340/H.R . 965). This bill is aimed at eliminating barriers for generic drug developers to enter the marketplace and thereby provide timely amplified production of commonly used drugs. Multiple bills have been introduced in Congress to address drug prices this year, including S.99/H.R.448 (Medicare Drug Price Negotiation Act), H.R447 (Affordable and Safe Prescription Drug Importation Act), and S.102 (Prescription Drug Price Relief Act of 2019). These bills propose to reduce drug prices by increasing competition amongst drug companies and allowing for negotiated drug prices. Additionally, Congress is questioning the role that Pharmacy Benefit Managers (PBMs) play in drug delivery. PBMs, such as Express Scripts and CVS Health, were created to negotiate drug prices between drug manufacturers and insurance companies/consumers with the intention to lower drug prices overall. However, there are concerns that these PBMs have been central in the escalation of drug prices. For more on drug pricing and PBM’s click the following link to watch this being discussed at a recent Senate hearing. https://www.cnbc.com/2019/04/09/watch-pharmacy-middlemen-testify-at-senate-drug-price-hearing.html
  2. Pre-authorization policy. We are all familiar with the daily headache of pre-authorization paperwork that is more often than not approved. These administrative tasks cause unnecessary burden to physician practices and can ultimately delay necessary patient care. Our goal was to advocate for our patients and colleagues with efforts to eliminate some of these redundant and potentially dangerous barriers to appropriate and efficient healthcare. There is no specific bill proposed at this time to address this issue but our objective was to educate our Congress about the negative effects of this policy with the hopes to garner their support in building legislation to protect us in the future.
  3. Next Step Therapy. In 2018, the Centers for Medicare & Medicaid Services (CMS) issued new guidance allowing “step therapy” in Medicare Advantage (MA) for physician-administered drugs. Step therapy requires a patient to fail a cheaper medication before a more expensive one is approved for coverage, usually through prior authorization. For our patients in Ophthalmology, "failing" often equates to permanent worsening in vision or even blindness. Although there was no specific legislation proposed on this issue, we each shared personal stories that detailed how policies like this can negate our clinical judgment as physicians and could ultimately result in permanent vision loss to our patients due to untimely and inefficient treatment. The hope is with the support of our local Congress, we can encourage CMS to reverse this decision in the near future. 
  4. Research funding. As physicians, it’s not only our job to take care of our patients through clinical and surgical duties, but to also continue our efforts in research and scientific ideas that will lead to curing blindness and vision-related disease. This would not be possible without the funding needed to sustain these projects. This year we were asking for an increase in NIH funding to $41.6 billion and an increase in the National Eye Institute funding to $850 million. These increases would help to sustain the most up-to-date and pertinent research ideas working to prevent vision loss. We also discussed the importance of continued funding of research related to those injuries sustained by our veterans. As residents, we are fortunate enough to serve the military community so this was one issue that was near and dear to our hearts.

For more information about these topics: https://bit.ly/2J4Rxug 

Iowa Team part II

Iowa Team part II

Pictured: Jeffrianne Young, MD (private practice comprehensive ophthalmologist), Caroline Wilson, MD, Alexis Warren, MD, and Justin Bloomberg, DO (Des Moines VA)

Day 2- LEAP (Leadership, Engagement, Advocacy, and Practice Management) program and Council Meetings

After a long first day in Washington, we were exhausted but ready to battle another day. Friday morning started with a new and innovative program called L.E.A.P, which stands for leadership, engagement, advocacy and practice management. The L.E.A.P program serves as an introduction to life after training for young ophthalmologists. During this time, we were able to interact with several ophthalmologists through panels and one-on-one discussions about practical issues we may face in our careers and how to better equip ourselves to become future leaders in this field. We met ophthalmologists at various points in their careers who shared their personal stories and experiences as physicians, engaged citizens, and leaders in their own communities.

Also during Day 2, the AAO regional, state and subspecialty council meetings were held. The Council is the Academy’s policy advisory body to the Board of Trustees. These meetings are particularly important because they are our opportunity to bring issues to the attention of the Academy’s Board through the Council Advisory Recommendation process. 

The Surgical Scope and OphthPAC are two funds through the AAO  that were also highlighted throughout Mid-Year Forum and are extremely important for us to support for continued quality in patient care. These are just two small ways we can stay engaged in our ophthalmologic community. Any participation, no matter how small, can make a difference. You can find more information about these funds and how to contribute on the American Academy of Ophthalmology’s website here.

Caroline Wilson, George Williams, Alexis Warren

Us and our new friend, George Williams MD, current President of AAO

We want to thank the Iowa Academy of Ophthalmology and University of Iowa Department of Ophthalmology and Visual Sciences for sponsoring us to attend Mid-Year Forum this year. The experience was formative and essential to our growth as future Ophthalmologists.

Monday, May 6, 2019