Report from Mid-Year Forum 2024 in Washington, DC

Written by Samuel Tadros and Patrick Donegan, PGY-2s University of Iowa

Every year, the Iowa Academy of Ophthalmology and University of Iowa generously sponsor ophthalmology residents from the University of Iowa to attend the American Academy of Ophthalmology's (AAO) Mid-Year Forum in Washington, D.C. We were selected this year as the "Advocacy Ambassadors" from Iowa and traveled to D.C. from April 17 to 20, 2024 with the goal of learning more about advocacy within ophthalmology and medicine more broadly. We are excited to share our experience at Mid-Year Forum this year and how the priorities discussed are currently affecting our patients.

Part 1 – Congressional Advocacy Day

The conference opened with a dinner reception hosted by many of the leaders of AAO and their associated congressional lobbying organizations. The purpose of this reception was to outline the policy priorities that we were going to be advocating for on the hill. But the highlight of this session was that our very own Dr. Aaron Dotson was recognized as the prestigious Copeland Advocacy Education Fund recipient. It was awesome to see him acknowledged for the amazing work that he has done promoting diversity and inclusion in our field.  Well done, Aaron!

The next morning, we headed to Capitol Hill. We were able to meet with the staffers for Senators Chuck Grassley and Joni Ernest, as well as the legislative aid for Representative Ashley Hinson. It was also our incredible privilege to meet in-person with Representative Dr. Mariannette Miller-Meeks. We are so fortunate that the representative from Iowa’s first district is herself an ophthalmologist and graduate of our residency program. It did not take much effort to introduce our policy priorities as she already knew them inside and out. These were the specific asks that we made to the Congress.

1. Medicare Physician Payment –Stability and Fairness. Physicians caring for Medicare beneficiaries continue to grapple with a stationary freeze in annual Medicare physician payments until 2026, when updates resume indefinitely at a rate of only 0.25 percent a year, well below the rate of medical or consumer price index inflation. Furthermore, payment schedules for physicians have tracked far below hospital reimbursements when compared with inflation. We urged Congress to pass the Strengthening Medicare for Patients and Providers Act which provides a critical framework for stabilizing the Medicare physician payment system. 
2. Maintaining High Quality Eye Care Services for American Veterans. As residents we have a particular sense for the role of the VA in our education. The Academy is concerned that language in recent updates of the VA’s standard of practice would undermine surgical eye care standards. Specifically, it removed language that “only ophthalmologists can perform invasive procedures, including injections, lasers, and eye surgery.” We raised concerns that this would jeopardize the safety of our veterans and interfere with the scope of practice legislation that is already being debated at the state level. 
3. Prior Authorization and Step Therapy Requirements. Every physician is aware of the burdensome nature of prior authorizations and how they delay proper care for our patients. The bill Improving Seniors’ Timely Access to Care Act is to be reintroduced during the next legislative session, and we urged Congress to pass this bill as it addresses the overuse of prior authorization. We also urged the Congress to pass the Safe Step Act which removes unnecessary step therapy burdens for physicians. From our discussions, there is a lot of optimism that both laws will be passed in the near future. 
4. Improving Access to Pediatric Eye Care. Physician shortages in pediatric ophthalmology have been noted for some time. In an effort to remedy this, we asked Congress to increase funding of the Pediatric Subspecialty Loan Repayment Program to 30 million dollars to encourage more trainees to pursue pediatric ophthalmology as a career choice. We also urged support for the Early Detection of Vision Impairments in Children’s Act once introduced. 
5. Increasing Federal Vision Research Funding. We are fortunate to be a part of a department that has research at the center of its mission and pushed the field of ophthalmology forward in so many ways. We were able to share some of these advanced with our elected leaders. We asked the Congress to support funding the National Institute of Health and National Eye Institute in the next fiscal year to reflect biomedical inflation and growth. We also asked for funding from the Department of Defense Vision Research Program to help our veterans who have sustained ocular trauma or traumatic brain injuries in the line of duty. 

Part 2 – LEAP Program and Spring Counsel Meetings

After our journey on Capitol Hill was done, we got the chance to take part in the LEAP program. This program, centered on the pillars of Leadership, Engagement, Advocacy, and Practice Management, was a fun and innovative session targeted towards trainees and young ophthalmologists. We were able to meet other Advocacy Ambassadors from across the country and exchange ideas. The focus of the sessions was very practical and challenged us to think about the future leaders we could be. Our very own Chief Resident, Dr. Mahsaw Mansoor, sat on one of the panel discussions about advocacy, and she was able to share some of her awesome work in reducing medical waste with a broader audience. 

Then, the meeting shifted to the Spring Council meetings that were separated by region. We heard from representatives from state-level academies from Midwestern states about the challenges and successes that they have had over the last year. Some common themes discussed included strategies for scope of practice battles and increasing funding for state-level academies. These topics were again brought up at the general meeting the following morning with a lot of productive and vigorous debate among the different stakeholders from across the country.

This experience was incredibly formative for both of us. We gained an appreciation for the role of advocacy at a national level, but also how we can get involved at a state and local level to protect our field and our patients. The Surgical Scope Fund and OphthoPAC are two of the funds that were repeatedly highlighted at Mid-Year Forum. Contributing to these funds is just a small way to stay engaged and can make a big difference.  

We would like to earnestly thank the Iowa Academy of Ophthalmology and the University of Iowa Department and Visual Sciences for sponsoring us to attend Mid-Year Forum this year!