As a practicing ophthalmologist, I cannot stress enough the absolute necessity of making our voices heard. If we don’t speak up, no one else will advocate for our patients and profession. As the saying goes, if you are not at the table, you are on the menu.
For many Americans, Washington, D.C. feels like a distant place with little relevance to their everyday lives. However, the laws passed by Congress and the regulations crafted by federal agencies considerably and financially influence our practices, affect the methods we use to treat our patients and add to physician burdens and burnout.
While an outside view of Congress can make it seem chaotic, ineffective and not worth the time, this could not be further from the truth. Each year, in one way or another, members of Congress and their staff develop policies that impact our practices and our patients. This is where you come in, because most policymakers lack a health-care background. Among the 535 members of the 118th Congress, only 26 members in both chambers combined (19 physicians, five dentists and two nurses) have any understanding of what we do and how their policies impact our practices and our patients. This further underscores the critical need for ophthalmologists to be involved in educating members of Congress and their staff.
Why I Advocate
Advocacy allows me to have a greater impact on patient care and physician issues on a larger scale. I can improve patients’ and physicians’ lives, not just one-on-one, but by the thousands. It is so rewarding to see an idea become an actual piece of legislation — it is actually School House Rock brought to life.
Monique Barbour, MD, an ophthalmology colleague, is a councilor. Regarding what it takes to advocate, she asserts: “To be an advocate is to have courage, independence and passion for the things that matter. My opportunity to serve as councilor opened doors for me to dictate, face to face, not only to legislators on Capitol Hill, but also to state and local decision-makers regarding eye-care issues critical to the practice of ophthalmology nationwide. Without the voice of those who possess both expertise and experience in ophthalmology, legislation, regulations and other policy decisions may not reflect what is best for our profession and our patients. No voice is too soft when the voice speaks for others. I’ve learned that the wisest thing I can do is to be in my own corner, and be an advocate for patients, myself and others like me.”
On a state level, our advocacy has resulted in securing Funding for Medicaid E&M payments at 100% of Medicare and expand Insurance coverage for breast and lung cancer screening, hearing aids and prostheses. I am especially excited that the idea that I championed with Maryland colleagues established a home for unmatched medical school graduates with the Bridge to Medical Residency Act. The legislators listened and then acted!
How I Got Started
I have established relationships with both state and federal legislators after visiting with a Federal legislator at the Mid-Year Forum (MYF) and attending events in his district. This year, while attending a meeting at MYF, we were told to meet with this legislator’s aide. The legislator happened to be walking into his office at the time. When he saw me, he motioned to the aide to bring our group right in. What was supposed to be a 10-minute meeting turned into an hour. He took the time to listen to each resident, took notes and commented on our issues.
I owe my introduction to advocacy to our Maryland colleague, Basil Morgan, MD. He has learned over the years that “politicians have a hand in every aspect of our work. They regulate everything we do. Therefore, it’s crucial to actively engage in their business.” Furthermore, he states that, “There are no permanent enemies, only permanent interests. So don’t let it get to you if a politician doesn’t support one piece of legislation. Because later, your interests may coincide, and they can become your staunchest advocate.” Dr. Morgan’s guidance has been invaluable in shaping my approach to advocacy.
An Example of Advocacy
One recent example of advocacy involves prior authorization (PA) requirements, which delay care for patients and place a tremendous burden on physician practices. On a federal level, our strong advocacy resulted in the successful reintroduction of the Improving Seniors’ Timely Access to Care Act with newly updated legislative text. Advocacy efforts included working with the AAO and visiting and writing legislators and attending their events. All of this was a team effort under the guidance of AAO Washington, D.C. office of Governmental Affairs and OphthPAC.
Through collaboration with the bill sponsors, we helped shape the new legislation, and it has a much greater chance of being successfully signed into law this Congress. If passed, this legislation would establish e-PA for Medicare Advantage (MA) plans’, including standardization of transactions and clinical attachments, increase transparency around MA PA requirements and their use, and clarify CMS’ authority to establish timeframes for e-PA requests, including expedited determinations, real-time decisions for routinely approved items and services and any other PA request. Once again, through these relationships, we have been able to help generate change.
How You Can Advocate
Advocacy involves highlighting important issues and influencing policymakers’ actions to support these issues. Therefore, we must be active participants in communicating with our policymakers. We must write letters, send emails, Tweet at (try and keep it positive!), make phone calls, and meet with lawmakers face-to-face to explain legislation and concerns impacting our practices.
With that said, of all these methods, building a strong personal relationship with your member of Congress can generate the most change. Being there as a resource when Members and their staff are making medical policy decisions can truly move the needle in the right direction.
That is why I cannot stress enough the importance of coming to Capitol Hill and meeting your lawmakers as often as possible. Each year, as part of the MYF, the AAO hosts a Congressional Advocacy Day, during which they set up Congressional meetings for you. This is not only a fantastic way to begin building your relationship with your members of Congress and their staff but also offers you valuable interaction with your colleagues.
Get involved with Academy advocacy and become an advocate by visiting www.aao.org/advocacy/action/overview). To stay up to date, follow the work we are doing in our weekly Washington Report Express that is published every Thursday evening. It shares the latest legislative and policy developments at the state and federal levels of government impacting our patients and profession.
Make your voice heard by taking a couple minutes to send letters to our elected officials when they can be most impactful on legislation. Those alerts can be found on the Academy’s website (www.aao.org/advocacy/action/vv).
Conclusion
It is truly up to us to make our voices heard to help shape the future of medicine now and for physicians to come. This will not only help the field of ophthalmology but can also improve care for the countless thousands of patients we collectively see and treat on a yearly basis.
We must work together with one voice to implement the positive change we want to see. But it is only together that we can make our voices heard. Please join me in the fight to protect patients’ access to the highest quality ophthalmic care, in perpetuity.
Do your part to advocate for our patients and the future of
ophthalmology. OM
