From OAO staff Nan Heim, Gina Cole and Liz Anderson
January 2003
Earn CME Credits at 2003 Post Graduate Convention! 
The Oregon Academy of Ophthalmology is now accredited by the Oregon Medical Association to award Category 1 CME for physicians.
Registration brochures for the 2003 Post Graduate Convention were mailed earlier this month, but there is still time to sign up. If you don't have a registration form, call the OAO office at e-mail your request to oregonao@oreyemds.org.
New this year also is our ability to accept your registration fee with a credit card.
So, don't procrastinate. REGISTER NOW! You can view the agenda and educational objectives at www.oreyemds.org/pgc.html.htm.
Annual Meeting . . .
The OAO Annual Meeting will be held on Friday, February 28, 2003, in conjunction with the Convention. In preparation for that agenda, OAO Bylaws Article X, Section 1, requires 30 days notice of proposed changes to the Bylaws. The last revision to the Bylaws was in 1996. Enclosed is a copy of those changes that will be put to a vote at the Annual Meeting. If you have any comments or questions, please call the OAO office.
The OAO is grateful to Kevin McKinney, M.D., Jack Cioffi, M.D., and Tim Gard, M.D., for their hard work in reviewing and amending the Bylaws to meet the concerns and requests of OAO members.
Seniors' Speakers Bureau
The OAO would like to thank members who have volunteered to speak at Oregon senior centers. Since the statewide mailing in September, we have arranged for several "Aging Eye" presentations around the state. Don't give up on us if we haven't called you yet! This outreach project is a year-round effort.
Thanks to our members who have already or are signed up for a talk, including…
Bart Adams, M.D. Merritt Linn, M.D.Michael Fang-Yen, M.D. Steven Mansberger, M.D.
Sandra Hufsmith, M.D.
Budget Issues Loom over the '03 Legislature
On January 13th, a new Governor and a new Legislature were sworn into office in the State Capitol.
The legislators are not all new, of course, and neither are the issues they will debate.
Budget woes will dominate the session, which is expected to last until mid-summer. Even if Ballot Measure 28, the income tax increase, passes in the statewide election January 28th, the state's economic outlook continues to e grim. Balancing the budget in our income-tax dependent state will be the major challenge for the '03 Legislature.
Other issues high on the Legislature's and the Governor's agendas: the Oregon Health Plan, PERS (Public Employee Retirement System) and medical liability insurance.
Rep. Ben Westlund (R-Bend) chairs a new House committee charged with examining the Oregon Health Plan. He has vowed to do what it takes to save the Plan.
What happens if the Oregon Health Plan goes away? Simply put, we return to Medicaid and fewer Oregonians are insured.
Too early to tell what will happen with the liability issue. We will keep you posted.
Sign up for Physician for a Day.
For many years, the Oregon Legislature has had an official "Physician for the Day." The M.D. who volunteers spends the day at the State Capitol and is introduced in the Senate. He or she provides first aid services if need, which is almost never. Mostly it's an opportunity to meet some legislators and observe the process.If you are interested, please call the OAO office at 503-222-3937 and we will get you signed up!
Foresight Ophthalmology PAC
Our last News Briefs congratulated OAO members for their generous contributions to the Foresight PAC, but failed to include some contributions made by our very important and esteemed Life Members. We sincerely apologize to them and want to take this opportunity to commend them, as well as others.
Life Member ContributorsEdward N. McLean, M.D.Kenneth C. Swan, M.D.
Robert C. Watzke, M.D.
Star Foresight Supporter
John A. Topinka, Jr., M.D.Fresh Perspective Supporter
Paul M. Keown, M.D.
Membership Update
Welcome to our newest member, Barbara Smit, M.D., with the Central Interstate Clinic of Kaiser Permanente in Portland.
OAO has received an application for membership from Julie S. Yu, M.D., with Child Eye Care Associates in Lake Oswego. Dr. Yu is a graduate of the University of Missouri School of Medicine. Dr. Yu completed her residency at Rush Presbyterian-St. Luke's Medical Center in Illinois and a fellowship in pediatric ophthalmology at Children's Hospital of Philadelphia. Shawn Goodman, M.D., and Andrea Tongue, M.D., have proposed her membership. Without objection by February 21, Dr. Yu's application will be confirmed.
WINTER 2002
2003 Post Graduate Convention -- Pearls for the Taking
The annual OAO scientific meeting agenda is set. Registrations will be mailed out in early January. If you haven't already, make sure to clear your calendar for February 27 through March 1, 2003.
Guest faculty for the program include:
o David I. Kaufman, D.O., a neuro-ophthalmologist from Michigan State University. Dr. Kaufman was so popular in 2001, we asked him for an encore.
o David A. Maberley, M.D., a retina specialist from the University of British Columbia Eye Care Center.
o Robert L. Stamper, M.D., a glaucoma specialist at the University of California
San Francisco.
o Kenneth W. Wright, M.D., a pediatric ophthalmologist from Los Angeles.
The four subspecialty speakers will share the program with a variety of other interesting topics, including:
o An ethics forum by a panel of experts, including Susan Tolle, M.D., OHSU, Jocelyn White, M.D., Legacy Good Samaritan Hospital, and Rev. John Tuohey, Ph.D., Providence/St. Vincent's Medical Center. Plan to participate in the discussion.
o A coding update by Elizabeth Cottle, C.P.C.. Ask your staff how often Elizabeth helps them through sticky coding questions.
o An update on emerging infectious diseases in Oregon by Robert "Pat" Preston, as well as guidelines from the Center for Disease Control for infection control.
o And two medical mission presentations which will stretch the imagination and make you count your blessings!
The annual business meeting is scheduled for Friday, February 28, at 11:40 a.m. The primary item of business will be the adoption of revised Bylaws, a copy of which will be mailed separately. Please review these changes and be prepared to vote at the meeting. Thanks to Tim Gard, M.D., Jack Cioffi, M.D., and Kevin McKinney, M.D., for their work on the Bylaws Committee.
President's Report
by Rob Bentley, M.D.
Medicare Fee Fix &endash;
A Matter of Patient Access and Fair Reimbursement
We are all anticipating significant cuts in Medicare revenues in2003: a 4.4 percent cut in addition to the 5.4 percent cut physicians experienced in 2002. The 2002 cuts have alreadyresulted in primary care and internists having to limit the number of new Medicare patients, creating a problem for ophthalmologists who want to refer Medicare patients to them.
AAO is asking us to contact our representatives in Congress to convince them of the urgent need for technical corrections to the Medicare physician payment formula without waiting for a solution to the broader Medicare system problems.
Lagos luxury hotelsWith 15% of its citizens enrolled in Medicare, Oregon is slightly above the national average of 14%. The Medicare Rights Center, a patient advocacy group, has identified Oregon as one of the states where Medicare patients are already having difficulty finding physicians who accept new Medicare patients.
Oregon physicians' losses due to the 2003-05 cuts are estimated to total about $74 million, or $9,319 per physician. Many physicians can (and are) opting out of Medicare, which creates an access problem for Medicare patients, and greatly increases their out-of-pocket costs if they choose to continue to see their doctor on a private pay or nonparticipating basis.
Congress is scheduled to return on January 7, 2003. They must make the technical corrections before February 1, 2003, when the 2003 Medicare Fee Schedule will go into effect.
Please send a letter now to your Senators and Representatives asking them to make the technical corrections before February 1 in order to maintain patient access to physicians and the highest quality medical care for America's seniors.
Senator Gordon Smith Senator Ron Wyden 404 Russell Senate Office Bldg 516 Hart Senate Office Bldg Washington, DC 20510-1001 Washington, DC 20510 Phone: 202-224-3753/ Fax: 202-228-3997 Phone: 202-224-5244/Fax: 202-228-2717 Representative Earl Blumenauer Representative Darlene Hooley 1406 Longworth House Office Bldg 1130 Longworth House Office Bldg Washington, DC 20515 Washington, DC 20515 Phone: 202-225-4811/Fax: 202-225-8941 Phone: 202-225-5711/Fax: 202-225-5699 Representative Peter Defazio Representative Greg Walden 2134 Rayburn House Office Bldg 1404 Longworth House Office Bldg Washington, DC 20515 Washington, DC 20515 Phone: 202-225-6416/ Fax: 202-225-0032 Phone: 202-225-6730/Fax: 202-225-5774 Representative David Wu 1023 Longworth House Office Bldg Washington, DC 20515-2701 Phone: 202-225-0855/Fax: 202-225-9497
Legislative Outlook: Budget Woes
The Oregon Legislature convenes on January 13, 2003, for what many predict will be its longest session ever. Their main challenge, of course, will be the overwhelming state budget deficit.
The Legislature met in six special sessions in 2001 to try to fill holes in the budget. Some of the $1.4 billion budget hole -- $310 million -- would be restored if voters approve Ballot Measure 28, the temporary income tax proposal, in the January 28th special election.
So far, predictions are that the measure will go down to defeat. If it does fail, the Legislature pre-approved $310 million in cuts, including $95 from k-12 schools,$41 million from higher education, $90 million from social services, and $45 million from corrections.
The outlook for the 2003-05 biennium is even worse. Revenue is expected to fall short by about $2 billion of paying for state services at current levels.
Can the Legislature raise taxes on its own? Technically, yes. However, if the Legislature enacted a tax without referring it to the voters, petitions would almost certainly be circulated to put it on the ballot.
Governor-elect Kulongoski, a Democrat, says that Oregonians are not ready to support higher taxes without some evidence of greater efficiency in government. He has said that reform of PERS, the public employee retirement system, is one of his top priorities.
So, there are bound to be more spending cuts. For example, the very existence of the Oregon Health Plan is in question.
Republicans will call the shots in the House because they have a strong majority: 35 Republicans to only 25 Democrats. Rep. Karen Minnis (R-Fairview) will be the new House Speaker, and Rep. Tim Knopp (R-Bend), House Republican leader. Rep. Jeff Kruse (R-Roseburg) is expected to chair the House Health Committee for the third session in a row.
The State Senate is evenly split: 15 Democrats, 15 Republicans. Negotiations are underway to split leadership positions and committee chairmanships. But it could be several weeks before these decisions are made.
Membership Update…
Welcome to our newest member Michael Fang-Yen, M.D., with Eye Health Northwest in Oregon City.
OAO has received an application for membership from Barbara Smit, M.D., with the Central Interstate Clinic of Kaiser Permanente in Portland. Dr. Smit is a graduate of the University of Washington School of Medicine where she also went through her residency. Dr. Smit completed a fellowship in glaucoma at Swedish Medical Center in Seattle. Diana Bennett, M.D., and Christina West, M.D., have proposed her application. Without objection by January 13, her membership will be confirmed.
Joslin Award Program Needs Your Nominations!
For the past three years, the Academy has promoted the Joslin Clinic Medal for diabetic patients. The bronze medallion has been presented to fifteen patients in Oregon who have "lived well" with diabetes for 50 or more years. The award recognizes a significant achievement on the part of these individuals. The publicity serves to encourage others that it is possible that they can also live well with diabetes.
The OAO asks each of you to help with this program by calling us at (503)222-3937 with the names of any of your patients who have had insulin dependent diabetes for 50 or more years.
Please keep this program in mind when examining your patients. We have found that just mentioning the existence of such an award is encouraging to most diabetics.
A Banner Year for Foresight Ophthalmology PAC
Thanks to 78 ophthalmologists who contributed generously this election year, OAO's political action committee had one of its best years ever, contributing over $40,000 to legislative candidates and other campaigns.
Among the PAC's contributions . . .
o NO on Ballot Measure 23. The badly flawed "single payer" health care proposal went down to defeat. OAO's PAC contributed $2,000 to the successful campaign.
o Kulongoski for Governor. We met with him, found him responsive and well-informed, several OAO members know him . . . and we felt it was critical this election year to back the winner.
o Forty winning legislative candidates. Our contributions included State Senate candidates Lenn Hannon (R-Ashland), Frank Morse (R-Albany), Peter Courtney (D-Salem), Joan Dukes (D-Astoria), and Richard Devlin (D-Lake Oswego). Senator Kate Brown (D-Portland), daughter of a retired Minnesota ophthalmologist, wasn't running this year, but we supported her fundraising efforts for other candidates. Brown is a front-runner for Senate President next session.
Among House candidates, our contributions included:
Vicki Berger (R-Salem) Mark Hass (D-Beaverton) Jeff Kruse (R-Roseburg) Jeff Barker (D-Aloha) Billy Dalto (R-Salem) Mary Nolan (D-Portland) Lane Shetterly (R-Dallas) Mitch Greenlick (D-Portland) Jerry Krummel (R-Wilsonville) Betsy Johnson (D-Scappoose)
Tim Knopp (R-Bend) Greg Macpherson (D-Lake Oswego) Ben Westlund (R-Bend) Dave Hunt (D-Oregon City),
Gordon Anderson (R-Grants Pass) Jackie Dingfelder (D-Portland) Karen Minnis (R-Fairview) Laurie Monnes Anderson (D-Gresham)
Rep. Minnis is House Republican leader and will be elected Speaker of the House in January.
Foresight Ophthalmology PAC supports candidates from both parties, based on several different criteria. If the candidate is an incumbent, has he or she been supportive on our issues? Is the candidate open to information? Is the candidate interested in health care and likely to be on a health committee?
Most important, we always respond to a recommendation from an OAO member to support a candidate.
JULY/AUGUST 2002
President's Report
by Rob Bentley, M.D."…where is it all going to end?"Tom Stoppard
Last year the Oregon Legislature established the Optometric Formulary Council, charged with recommending a formulary of drugs for optometrists to use and prescribe. The law set July 1, 2002, as the deadline for the Council's recommendations to the Oregon Board of Optometry.
The Council met the deadline, but it may not be the end.
Jack Cioffi and I serve on the Council, repre-senting OHSU and OAO. The Council met three times this year to consider several categories of drugs for optometric use. Jack and I argued on some key issues, such as injectables and dyes, but ended up on the losing side of Council votes on these issues.
Last month the Board of Optometry proposed new rules to implement the formulary. We were able to negotiate some positive changes in the rules, such as prohibitions of intraocular injections and general anesthesia.
The latest development is that last week the Board of Medical Examiners reviewed the proposed optometry rules and formulary. BME members have several concerns which will be conveyed to the Board of Optometry.
Now the question is, how will the optometrists respond?
We will continue to keep you posted on developments. Other than that, only one thing is certain: this is an ongoing process. Where it will end I cannot predict.
Exciting Line-up for '03 Convention
The 2003 Post Graduate Convention is scheduled for February 27, 28, and March 1.This will be our fourth year to return to the scenic World Forestry Center in Portland. John Samples, M.D., Irv Handelman, M.D., Joe Robertson, M.D., and Shawn Goodman, M.D., have been preparing an interesting and varied program, and are pleased to announce some of the guest faculty. They include:
Robert L. Stamper, M.D., a Glaucoma specialist at UC San FranciscoDavid Kaufman, D.O., a Neuro-Ophthalmologist at Michigan State
Kenneth W. Wright, M.D., a Pediatric Ophthalmologist from Los Angeles
Additionally, the program will include a panel discussion on ethics with Fr. John Tuohey of Providence, Jocelyn White, M.D., of Legacy Health Systems, and Susan Tolle, M.D., Director of the Center for Ethics at OHSU, and presentations on medical missions by some of your peers.
Be sure to check out the OAO web site -- www.oreyemds.org. The "Post Graduate Convention" page will include a syllabus of the topics to be covered in 2003 as they become available.
OAO Building New Legislative Network
by Nan Heim and Gina Cole, OAO Lobbyists
The general election is fast approaching with the 2003 legislative session close behind. OAO is launching a new legislative network that is critical to the association's success during the next session. The network is an effort to connect Academy members with their state legislators.
Legislators like to hear from and get to know constituents and their issues. And . . . no one knows the ophthalmology profession better than ophthalmologists.
As Lyndon B. Johnson once said, "The time to make friends is before you need them." It's important to prepare for the 2003 session now by building relationships between Oregon Academy members and legislators. Many OAO members have volunteered to contact legislators and/or candidates in their area &endash;- but we need more!
It's as easy as having a cup of coffee.
And, to assist members, a legislative network handbook is underway. This easy-to-use packet will include talking points on the Oregon Academy's issues and information on how to contact legislators.
If you already have an established relationship with a legislator or are willing to contact your legislator, please contact the OAO office at (503)222-3937.
Membership Update...
Welcome to our newest members:
Paul Finley, M.D., with Hillsboro Eye ClinicFrederick W. Fraunfelder, M.D., with Casey Eye Institute
Scott X. Stevens, M.D., with Bend Ophthalmology
OAO has received an application for membership from
Yujen Wang, M.D., with Retina and Vitreous Center of Southern Oregon, P.C. Dr. Wang is a graduate of Tufts University School of Medicine. He completed his Residency at the Albert Einstein College of Medicine and a Fellowship in Retina-Vitreous at the University of Alabama at Birmingham. William Rodden, M.D., and Rob Bentley, M.D have proposed his application.
Without objection by August 19th, his membership will be confirmed.
MEMBERS IN THE NEWS...
Fireworks Eye Safety Month
Dan Holland, M.D., a pediatric ophthalmologist from Portland, dazzled the media with his message about fireworks safety during the 4th of July holiday celebrations. Every June, the State Fire Marshal calls attention to the potential danger of fireworks. At the press conference, Dr. Holland cited statistics that consumer fireworks cause one-third
of recorded eye injuries each year and that an estimated 10% of children injured by fireworks suffer permanent damage such as loss of an eye, finger or hand. Steve Caldwell, a patient of Dr. Holland, gave a moving testi-monial of how fireworks injured his eye as a young child, and how it changed his life and the way he handles fireworks with his children now.
The Academy issued a press release to communities across the State and offered local ophthalmologists as contacts for interviews and additional information. Rob Mathews, M.D., Bend, and John Polansky, M.D., Eugene, are among Academy members who were interviewed by their local media. The OAO appreciates the extra effort made by these ophthalmologists at protecting the children of Oregon.
New Medical Director for Devers
Steven Mansberger, M.D., a Glaucoma specialist, has been named medical director of Legacy Health Systems' Devers Memorial Eye Clinic. His work at Devers Eye Institute's research center includes a vision screening community outreach program, the largest of its kind in the world, with 10,000 participants.
Do you have anything you would like us to shout from the rooftops? Call the Academy at (503)222-3937 or e-mail the information to oregonao@oreyemds.org.
JOSLIN 'SPOUSE' AWARD
On Tuesday, May 14th, nearly 200 people cheered as Merritt Linn, M.D., presented a plaque to Elmer Wiens, husband of Louise Wiens, a Joslin Medal recipient and patient of John Wood, M.D., of Salem. Mrs. Wiens has lived with diabetes for over 60 years; Mr. Wiens was acknowledged for his 60 years of enhanced diabetic support and care of his wife.
The lunchtime award ceremony recognized six people living successfully with diabetes for over 50 years with a medal from the Joslin Diabetes Center in Boston After lunch, there were breakout sessions, including a panel discussion moderated by Dr. Linn in which the Medal winners shared personal success stories about coping with diabetes and its demands, and answered questions from the audience. REMEMBER that you can nominate your patients. Dr. Linn will be sending out a nomination form this fall.
Call the OAO office if you have any questions.
BCBS Policy Changes
OAO has been successful in working with Regence BlueCross BlueShield on revising several reimbursement policies. Rob Bentley, M.D., Mark Peters, M.D., and Elizabeth Cottle, CPC, and Liz Anderson met with Donald Thieman, M.D., Vice President of Medical Affairs, and members of the reimbursement committee of Regence BCBS to discuss a list of six issues presented by the OAO. The following policies have been revised as described.
Reimbursement policy revision: Fluorescein angiography
Effective for claims processed on or after February 19, 2002, CPT 92235 Fluorescein angiography (includes multiframe imaging) with interpretation and report is eligible for reimbursement consideration as a bilateral procedure without Medical Affairs review. Although records need not be submitted with the claim, your chart notes must clearly document that two separate injections were performed. Please note: CPT 92235 should not be billed with procedure code modifier &endash;50 Bilateral Procedure. To report bilateral fluorescein angiography, please use CPT 92235 either:
- On one claim line with a '2' in the units field, or
- On two separate claim lines using procedure code modifiers &endash;LT Left side and &endash;RT Right side.
Fluorescein angiography will continue to be denied as incidental if performed on the same date of service as either:
- CPT 92240 Indocyanin-green angiography (includes multiframe imaging) with interpretation and report, or
- CPT 92287 Special anterior segment photography with interpretation and report; with specular endothelial microscopy and cell count; with fluorescein angiography.
Ophthalmologists and optometrists were notified of this change in March. This revision applies to all traditional, preferred and managed care lines of business.
Reimbursement policy revision: Fundus photography
Effective for claims processed on or after February 19, 2002, CPT 92250 Fundus photography with interpretation and report is eligible for reimbursement consideration when billed as a stand-alone procedure during a surgical procedure's global period or follow-up days. If performed on the same date of service as any evaluation and management (E&M) or ophthalmology exam for a routine or screening vision diagnosis (e.g., ICD-9 367, V82.7), fundus photography will continue to be denied as incidental. This procedure also remains ineligible for bilateral reimbursement.
This revision applies to all traditional, preferred and managed care lines of business. Ophthalmologists and optometrists were notified of this change in March.
Reimbursement policy revision: Ophthalmic diagnostic imaging
Effective for claims processed on or after February 5, 2002, claims for CPT 92135 Scanning computerized ophthalmic diagnostic imaging (e.g., scanning laser) with interpretation and report, unilateral are eligible for reimbursement consideration without review for medical necessity. Previously, this procedure was considered experimental and investigational, and charges were denied as a patient balance. This procedure is also known as Heidelberg Retinal Topography, and should not be billed using CPT 92499 Unlisted ophthalmological service or procedure.
This policy applies to all traditional, preferred and managed care lines of business.
Reimbursement policy revision: Keratoconus contact lenses and fittings
Effective for claims processed on or after April 2, 2002, the following guidelines will apply when submitting claims for patients with keratoconus who receive contact lenses:
- The primary diagnosis code must be for keratoconus (ICD-9 371.XX).
- All visits for fitting services should be submitted with an E&M code (CPT 99201-99215) and no modifier.
- Charges for the contact lenses should reflect their actual cost and be report with HCPCS V2599.
Please note: Contact lenses and fittings for keratoconus will be considered a medical benefit, not a routine vision benefit. It is important to use HCPCS V2599 only for contact lenses dispensed specifically for keratoconus.
This revision applies to all traditional, preferred and managed care products except the Federal Employee Program (FEP). Ophthalmologists and optometrists were notified of this change in March.
If you have any questions about this particular policy, please call Allied Products at (503)226-8740.
April 2002
OAO Meets with Regence BCBS on Reimbursement Issues
On April 1st, Rob Bentley, M.D., Mark Peters, M.D., and Elizabeth Cottle, CPC, met with Donald Thieman, M.D., Vice President of Medical Affairs, and members of the reimbursement committee of Regence BCBS to discuss a list of six issues presented by the OAO. Here is a heads up on certain coding policy changes in the works at Regence:
o Regence has decided to cover all technologies of HRT Analyzer (CPT 92135) retroactive to February 5, 2002, and will be sending a notice out on May 1 to the provider community.
o A notice to providers was sent March 12 allowing fluorescein angiography (CPT 92235) with interpretation and report as a bilateral procedure retroactive to February 19, 2002. The committee will look into their ICG coverage policy.
o Vitreous floaters (ICD 379.24) will be considered a medical diagnosis when presented with a medical evaluation and management code.
o Fundus photography (CPT 92250) with interpretation and report is eligible for reimbursement consideration when billed as a stand-alone procedure during a surgical procedure's global period or follow-up days retroactive to February 19, 2002.
o The Zeiss IOL Master (CPT 92136) will be covered and notice will be sent to the provider community in coming months.
o Probing of lacrimal canaliculi, with or without irrigation (CPT 68840), will be reviewed by BCBS as a bilateral procedure.
Dr. Thieman asked us to pass along news of a new Regence BCBS of Oregon Provider Information web site specific to the needs of physicians, health care facilities and their staff. The site offers current comprehensive information in an easy to use format. Check out the site and remember to share the web address with your staff &endash; www.or.regence.com/provider/bcbso.
Optometric Nontopical Formulary Council Report
The Optometric Nontopical Formulary Council met for the fourth time Tuesday, April 9th, at Devers Eye Institute in Portland. This meeting came after a diligent effort by OAO members at the public hearing held last month. Merritt Linn, M.D., George Caspar, M.D., and Andrew Harris, M.D., testified to the Council on the proposed formulary, expressing their concerns about insufficient training and pharmaceutical knowledge especially when using injectable anesthetics and dyes.
What had been considered a slam dunk by the optometrists ended with a postponement until the Chair of the Council could confer with the Board of Pharmacy, and further written testimony could be received and reviewed, leaving the door open for further discussion regarding anesthetics, dyes, and time-limited use and subsequent referral on some drugs.
By the April 9th meeting, the Council had received 130 letters, including 53 from OAO members, as well as letters from Thomas Weingeist, Ph.D., M.D., President of the American Academy of Ophthalmology, and from Hugh Stelson, M.D., President of the Oregon Medical Association.
The Council agreed that the letters focused on common themes, including public safety, F/As, anaphylactic shock, injectables, optometric training, misuse and long-term use of some medications. After a lengthy exchange of concerns, the Council:
o Adopted an optometric prescription drug formulary, which will now go to the State Board of Optometry for approval. By law, the Board can adopt it as is or subtract from it, but cannot add to it.
o Adopted language to EXCLUDE the use of Sub-Tenons and retrobulbar injections: "Doctors of Optometry certified for nontopical TPA use may administer subcutaneous and subconjunctival injections. Sub-Tenons and retrobulbar injections are excluded." Rob Bentley and Jack Cioffi persisted strongly to get this restriction on injectables.
o A separate motion to include Category 19, Dyes, passed on a five to two vote, with Rob and Jack arguing against including dyes and voting no.
By law, the proposed formulary will now go to the Oregon Board of Optometry. They can adopt the formulary or a portion of the formulary, as well as the clinical competency criteria for optometric physicians for prescription of pharmaceutical agents, through the administrative rule process. The OBO will then license optometric physicians for the use of pharmaceutical agents listed on the Optometric Nontopical Formulary.
The Academy is grateful to Rob Bentley, M.D., and Jack Cioffi, M.D., for the many hours spent in working through this difficult task.
The Nontopical Optometric Formulary referred by the Council is:
Category 17 &endash; Anesthetics
Category 18 &endash; Analgesics
Category 19 &endash; Dyes
Category 20 - Anti-allergy Agents
Category 21 - Anti-infectives (Antibiotics, Anti-virals, Anti-fungals)
Category 22 - Anti-glaucoma and Ocular hypotensives
Category 23 - Anti-inflammatory Agents (excluding anti-neoplastics)
Category 24 - Any combination of the above agents
Category 25 - Emergency use agents
The Council additionally adopts the following protocols related to the Optometric Nontopical Formulary:
o Doctors of optometry certified for nontopical TPA use may use, administer or prescribe non-topical agents in Categories 17 &endash; 25.
o Doctors of optometry may use or administer pharmaceutical agents in Categories 17 &endash; Anesthetics, as indicated for procedures that are permitted under OAR Chapter 852, Division 20 &endash; Standards of Optometric Practice.
o Doctors of optometry may use or administer pharmaceutical agents in Categories 19 &endash; Dyes, as indicated for procedures that are permitted under OAR Chapter 852, Division 20 &endash; Standards of Optometric Practice.
o Doctors of optometry shall consult with a doctor of medicine or doctor of osteopathy prior to extending treatment with nontopical corticosteriods beyond 7 days.
o Agents classified principally as anti-neoplastic are not included in Category 23.
o Doctors of optometry may use or administer pharmaceutical agents in cases of emergency requiring immediate attention.
o Doctors of optometry certified for nontopical TPA use may administer subcutaneous and subconjunctival injections. Sub-Tenons and retrobulbar injections are excluded.
Children's Health Fair
For the fourth year, members of the OAO participated in the 2002 Children's Health Fair in Southeast Portland. This annual event provides free healthcare services to children from low-income families and is the result of a partnership of agencies and medical groups.
The Academy appreciates the time volunteered by Shawn Goodman, M.D., Ann Stout, M.D., Aazy Aaby, M.D., and Mary DeFrank, M.D. The doctors were assisted by Shawana Young, Dusty Stolz and Juanita Larlee, students in the Portland Community College Ophthalmic Technician Program. Working with translators and multiple languages, fifty-nine children were screened.
Membership Update
OAO has received an application for membership from Frederick W. Fraunfelder, M.D. Dr. Fraunfelder is an Assistant Professor of Ophthalmology at OHSU and sub-specialist at the Casey Eye Institute, where he completed a Fellowship in Cornea/External Disease/Refractive Surgery. His application has been proposed by Larry Rich, M.D., and Joe Robertson, M.D. Without objection by May 20th, his membership will be confirmed.
Oregon Political News
It's an election year, with the primary on May 21 and the general election in November. It looks like Democrat Ted Kulongoski vs. Republican Jack Roberts in the race to succeed Governor Kitzhaber. Several OAO members will meet Kulongoski in the Academy office this month.
Don't look for any change in Oregon's Congressional Delegation.
All five Members of Congress are likely to be re-elected. U.S. Senator Gordon Smith will likely withstand a challenge from Bill Bradbury. Senator Ron Wyden isn't up for re-election this year.
All sixty seats in the Oregon House of Representatives are up for election this year . . . but there won't be many changes.
Since the State Supreme Court threw out term term limits for legislators, 47 of sixty incumbents are running for re-election.
Fifteen of the thirty State Senate seats are up for election this year. Some long-time State Senators are retiring, including Senator Mae Yih (D-Albany), friend to OAO member John Lees, M.D., and a strong ophthalmology supporter.
Several legislative candidates have come by the OAO office to introduce themselves and find out about our issues. More than one has reported receiving an endorsement from the optometry PAC along with a sizable contribution. If you want information about a candidate, call us in the OAO office, (503)222-3937.
2002 Post Graduate Convention
A strong sense of fellowship pervaded this year's CME event. A program of excellent speakers and timely materials wasn't hindered by a flooding bathroom thanks to the especially nice weather and beautiful facility. Among the 92 physicians attending, neuro-ophthalmology and cornea were the hands-down favorites for practicable information. Thrown into the mix for the first time were impressive presentations by Dan Gradin, M.D., John Ng, M.D., and Mark Peters, M.D. , who talked about their medical missions in foreign countries. Special thanks go to John Samples, M.D., Irv Handelman, M.D., and Tom Shults, M.D., for putting this event together.
Concurrently with the doctor's program, the OAO sponsors an ophthalmic technicians and assistants program with CECs offered by JCAHPO. The quality of this education program is gaining recognition, at least on the west coast. A biometry bootcamp, coding seminar, OSHA update, and courses on corneal transplantation, ARMD, pediatric eye exams, refraction, and ptosis gave the 137 technicians attending a challenging menu of new and review information.
Special thanks to Joanne Harris, COT, PCC Ophthalmic Program Director, Eva Lindahl, COMT, Duanna VanCamp, COT, and the PCC ophthalmic students for all their help.
OAO is very appreciative of the extra support from exhibitors Pharmacia, Allergan, Novartis, and Lumenis. They make a big difference in the quality of our event!
January 2002
6 . 5 . 4 . 3 ... The Countdown Is On!
The 2002 Post Graduate Convention is less than five weeks from now--February 28th-- and we are excited about the program and speakers we have to offer you. Call if you haven't received a registration brochure. Highlights include:
David Apple, M.D., is a Professor of Ophthalmology and Pathology at the Storm Eye Institute, Medical University of South Carolina. Dr. Apple will update you on various forms of cataract refractive surgery and identify post-operative complications and their pathogenesis.
Christina Flaxel, M.D., is an Associate Professor at the USC Keck School of Medicine, University of Southern California, and a retinal specialist at Doheny Eye Institute. Dr. Flaxel will review angiographic characteristics of AMD, together with current studies and new treatments, including integrating vitamin therapy, photodynamic and transpupillary thermal therapy.
Barrett Katz, M.D., is a Professor and Chair of the Department of Ophthalmology at The George Washington University School of Medicine in Washington, D.C. Dr. Katz will instruct on gleaning information from an examination of the optic disc and its interaction with the vitreous, and when to pursue further neuro-ophthalmic evaluation. Bring along a troubling case for consultation and teaching.
Thomas D. Lindquist, M.D., Ph.D., is a multi-specialty ophthalmologist affiliated with the Virginia Mason Medical Center in Seattle. Dr. Lindquist will discuss current diagnostic and therapeutic recommendations regarding Acanthamoeba Keratitis and Herpes Simplex virus within the anterior segment, and management of recurrent corneal erosions.
Howard Slavin, Esq., is a trial lawyer from Los Angeles whose practice emphasizes the defense of physicians in medical malpractice matters. Mr. Slavin will offer you practical pointers in identifying risk management issues in your practice and observations on present trends in liability in excimer laser and other refractive techniques.
Jim Swartley, M.D., AAO Associate Secretary of State Governmental Affairs will join us on Saturday morning for Breakfast with Leaders. Come with your questions and comments on the state of affairs in ophthalmology.
Political News
The State's Budget Battle: A High Stakes Chess Game.
Governor. The first move was the Governor's as he announced in early January an "all cuts" budget. The "slash and burn" budget eliminates $830 million in state spending for the the 2001-03 biennium, which ends June 30, 2003.
Kitzhaber said he is adamantly opposed to "quick fixes" for the state's budget crisis -- such as taking money from the tobacco settlement or the Common School Fund. The Common School Fund money invests income from state-owned property, with the interest going to schools.
If you use the "quick fix" money, says Kitzhaber, you'll just make the budget crisis worse for the next Legislature. Even as he announced the "all cuts" budget, the Governor said it is not acceptable. If the Legislature passed this budget, he would veto it.
Legislature. Next move: the Legislature's. On January 17, legislative leaders from both parties proposed $530 million in budget cuts. In direct opposition to the Governor, the Legislature wants to borrow from the Common School Fund. House Speaker Mark Simmons (R-La Grande) says it's a "rainy day fund" and "it would be foolish not to use it."
Muddying the waters even more, the Legislature didn't propose simply putting back in $300 million of the Governor's "all cuts" budget. They come up with their own set of cuts -- some the same, some different.
Governor. On January 22, Kitzhaber announced his "real" budget proposal with $414 million in budget cuts and $425 in revenue. The Governor proposed increasing the state's beer and wine tax, cigarette tax, and motor vehicle registration fee. He also made the long expected announce-ment that he is calling the Legislature into special session on February 8.
What's next? Between now and February 8, legislators will be busy meeting in party caucuses and sending delegations to meet with the Governor trying to agree on a plan. The Governor and the legislators are "only" $112 million apart in cuts -- although the packages of cuts are different. But Kitzhaber and legislators are miles apart on revenue. Legislators are not at all squeamish about using the "quick fix" funds, but taxes? Don't think so.
"But they're just sin taxes . . ."
Oregon's beer and wine tax and cigarette tax are among the absolute lowest in the nation. Why not increase them?
Short answer: it's an election year. Now that term limits have been repealed for legislators, most legislators are running for re-election. And most don't want to vote for ANY new taxes in an election year, even the so-called "sin taxes." Even liberal Democrats are shying away from supporting the Governor's tax proposals. "No way we're going to get tagged as 'tax and spend' liberals," said one Democratic legislative candidate asked about Kitzhaber's package.
Election year outlook: State Senate.
Redistricting is done. Term limits are gone. With Filing Day just a few short weeks away, the picture is getting clearer about who is going to run for the Oregon Legislature this year. We will know for sure on March 12, the deadline for all candidates to file for office this year.
In the State Senate, fifteen of thirty seats are up for election this year. With the redistricting done by Democratic Secretary of State Bill Bradbury, Democrats have a good chance of taking control of the Oregon Senate for the first time in over a decade.
At the same time, ophthalmology has its best outlook in the Senate in many years. Senator Kate Brown (D-Portland) is the likely new Senate President. The daughter of a Minnesota ophthalmologist, Senator Brown actually knows the difference between medical doctors and optometrists.
The term limits decision has good news and bad news for us. Strong ophthalmology supporters such as Senator Lenn Hannon (R-Ashland) and Senator Peter Courtney (D-Salem) had been termed out but will now run again. At the same time, optometry's strong supporter Senator Charles Starr (R-Hillsboro) can also run again. But his district was significantly changed in re-districting; his seat may not be as safe as it used to be.
We'll take a look at the Governor's race and House races in an upcoming News Briefs. In the meantime, what does all this mean for us? We need Foresight Ophthalmology PAC more than ever this critical election year . . . If you haven't contributed already, send your check today!
Foresight Ophthalmology PAC, 833 SW 11th Avenue, Suite 315, Portland, OR 97205
New Glaucoma Screening Codes - A report from Elizabeth Cottle, C.P.C.
A long awaited request by Ophthalmologists has been fulfilled, but it's a good news, bad news situation. Effective January 1st, 2002, Medicare will pay for screening exams for glaucoma. The details are:
Coding . . . Use HCPCS code G0117 for a screening exam by a physician The Portland Medicare allowance is $53.37 for G0117. The only diagnosis code they will pay is V80.1, screening for glaucoma.
Exam . . . The components of the exam should include: visual acuity, IOP, slit lamp exam of anterior chamber, and dilated posterior exam.
Who Qualifies? . . . Medicare beneficiaries with a family history (blood parents or siblings) of glaucoma, or African-Americans over 50 and on Medicare, or those with diabetes qualify. The benefit is available once per year (>365 days).
Issues . . .
oThis exam cannot be combined with any other service (i.e., gonioscopy or visual fields) or you will be denied. Do not bill both an E&M exam or Eye code and these codes either.
oIf you provide this exam and find glaucoma, you should have the patient return for a glaucoma work-up. They would, however, then be established patients within your practice.
oBe sure your staff know how to handle these calls from patients and decide how your office will schedule the appointments.
oAlthough you can provide this screening to established patients, it would not be appropriate if you have addressed their glaucoma risk at an earlier visit.
Membership Update
Welcome to our newest members: Christopher D. Kullas, M.D., with Oregon Eye Specialists in Portland, and Scott E. Stice, M.D., with Eye Care Physicians and Surgeons in Salem.
Two ophthalmologists have applied for membership. Without objection by February 28th, these memberships will be confirmed.
Paul Finley, M.D., with Hillsboro Eye Clinic, P.C., is a graduate of Emory University and completed his Residency at Casey Eye Institute. His application for membership has been proposed by Darell Lumaco, M.D., and Devin Gattey, M.D.
Scott X. Stevens, M.D., with Pilot Butte Medical Center in Bend, is a graduate of Oral Roberts University. Dr. Stevens completed his Residency at the Henry Ford Hospital in Detroit and a Fellowship in Cornea/ External Disease/ Refractive Surgery at the University of South Florida. His application for membership has been proposed by Stanley Shepardson, M.D., and Irv Handelman, M.D.
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