Service ~ Education ~ Advocacy

February 2009

EDITORIAL As a perfect example of “just when you think you’ve heard it all,” I read an article in Ocular Surgery News (OSN) this past month titled “Relationships between MDs and ODs Changing as Integrated Eye Care Gains in Popularity.” Let me preface this by saying that most of us have personal or professional relationships with optometrists whether at the office, as referrals or in co-management circumstance. I am certain that, for the most part, these relationships are friendly, (good and/or mutually beneficial). It is not the purpose of this editorial to bash optometry but rather to promote ophthalmology. When I initially read this article I was taken aback by what seemed to be unidirectional optometric endorsement. I was surprised to be reading it in OSN. I did not believe it promoted ophthalmology, or patient care, but promoted optometry. The premise of the “article” is that the integrated model will address the impending physician shortage that is anticipated as a result of the aging population, specifically the predicted shortage of ophthalmologists. There may very well be a physician shortage in the not-too-distant future but I would submit that having non-physicians doing our job, the work of a physician, is not (or probably is not) the answer. Integrated eye care refers to a delivery model in which ophthalmologists and optometrists work together in the same practice or institution, often including the

delegation of patient care. This is in contrast to the co-management models in which ophthalmologists and optometrists practice independently in a referral relationship.

Arezo Amirikia, MD President

Several aspects of the article are objectionable and should concern you. First, Doctor Nordlund, a fellow ophthalmologist states, “the benefit of this model is that you can care for a larger group of people with the same number of surgeons as long as you have the help of primary care eye specialists – the optometrists.” What does this statement mean for the general ophthalmologist? This statement implies that the optometrist is an ophthalmologist that doesn’t perform surgery. This comment disregards, devalues and discounts the years of medical education and formal training that is required of ophthalmologists to learn about the eye and body as a whole in preparation to care for patients. How many physicians spend the entire week in the operating room? Many of our ophthalmology colleagues do not perform surgery. Are we willing to give up everything except surgery? Next, Mr. Reider states that optometrists in many states are seeking a wider scope of practice with the EDITORIAL, continued on p 3

INSIDE THIS EDITION 2 Calendar of Events

4-5 Strategic Planning Report

4 New Member Benefit

7 Save Your Sight Month

CALENDAR OF EVENTS 2009

March

Coding Update – dates and locations TBD

18 Wednesday

MSEPS Board of Directors Meeting Time and location TBD

April

Michigan Blindness Prevention and Services Month

15 Wednesday

MSEPS Board of Directors Meeting via teleconference

22-25 Wednesday – Saturday

AAO MidYear Forum Washington, DC

24 – 26 Friday - Sunday

is a publication of the Michigan Society of Eye Physicians and Surgeons President Arezo Amirikia, MD President-elect A. Luisa Di Lorenzo, MD Treasurer Lance C. Lemon, MD Secretary Evan H. Black, MD Immediate Past President W. Scott Wilkinson, MD Region I Director Daniel D. Thuente, MD

May

20 Wednesday

MSEPS Board of Directors Meeting Time and Location TBD

30 Saturday

A Night for Sight International Wine Auction Ritz Carlton Dearborn

June 6 Saturday

32nd Annual Opthalmology Alumni Day Meeting For information, call 313-916-8254

17 Wednesday

MSEPS Board of Directors Meeting via teleconference

21 Sunday

EyesOn Design car show, Edsel & Eleanor Ford House For information, contact the DIO at 313-824-4710

August 13 Thursday

MSEPS Board Directors Meeting Grand Hotel, Mackinac Island, 2:00 p.m.

14 Friday

MSEPS Annual Business Meeting Grand Hotel, Mackinac Island

Region II Director Ralph P. Crew, MD

13-15 Thursday - Saturday

Region III Director David D. Krebs, MD

September

Region IV Director Stuart Landay, MD Region V Director Timothy P. Page, MD Region VI Director Paul A. Edwards, MD Region VII Director Robert DellAngelo, MD Senior AAO Councilor A. Luisa Di Lorenzo, MD Junior AAO Councilor Robert J. Granadier, MD Executive Director Penny Englerth Michigan Society of Eye Physicians and Surgeons 120 West Saginaw East Lansing, MI 48823 Phone: 517-333-6739 Fax: 517-336-5797 Email: [email protected] Web address: www.miseps.org Page 2 • February 2009

MSMS House of Delegates Amway Grand Hotel, Grand Rapids

16 Wednesday 16-18 Wednesday – Friday

41st Annual Conference Grand Hotel, Mackinac Island MSEPS Board of Directors Meeting via teleconference

The Eye and The Auto World Congress on Driving and Vision, General Motors Research Laboratory, GM Tech Center, Warren Michigan

25 Friday

Western Michigan CME Meeting

October 1 Thursday

Northern Michigan CME Meeting

2 Friday

U.P. CME Meeting

13 Tuesday

SE Michigan CME Meeting

21 Wednesday

MSEPS Board of Directors Meeting Time and Location TBD

24-27 Saturday – Tuesday

AAO Annual Meeting, San Francisco

November 18 Wednesday

August

4-7 Thursday - Saturday

MSEPS Board of Directors Meeting via teleconference

2010

42nd Annual Conference Grand Hotel, Mackinac Island

If your organization has an event you would like listed, please contact the MSEPS office at 517-333-6739 or [email protected].

EDITORIAL, continued from cover

The potential advantages as I see them are expanded services for the patients, increased face time with patients, decreased wait times, and the ability to see more patients. intention of performing surgical procedures not requiring general anesthesia and administering eye injections. Several paragraphs later, Doctor Hovanesian (a former Michigan Ophthalmologist) suggests that those who wish to integrate eye care with optometrists should “train them, trust them and let them shine.” I guess if we take Doctor Hovanesian’s advice, then we can help optometry shine by expanding their scope of practice. Lastly, despite input from multiple physicians and others, there is no balance in this article. Even in the point and counterpoint section of the article, both comments were pros for integrated eye care. There is no model that does not have a con or disadvantage. I am willing to concede that I have learned from this article and agree that there are potential benefits to the integrated eye care model and that I prefer this model to that of the co-management model. The potential advantages as I see them are expanded services for patients, increased face time with patients, decreased wait times, and the ability to see more patients. In addition, if implemented properly, there could be a significant financial benefit. The American Academy of Ophthalmology 2007 member survey confirms that there is an increasing trend toward employing optometrists in ophthalmology practices (an estimated 47% of U.S. ophthalmologists employ optometrists in their practices). Two issues come to mind in any discussion

regarding optometry: scope of practice and co-management. These are very important issues but even more important is the issue of the ethical use of optometrists in our practices. We must be transparent with patients with respect to who is providing the care. We must ask ourselves how much of the patient’s care can be delegated safely and appropriately to optometrists and other members of the staff and if an ophthalmologist chooses to delegate, he/she still must bear ultimate responsibility. In conclusion, I agree that we need to have working relationships with optometrists and other allied health care professionals. However, there are parameters and boundaries within each profession that must be respected. There has been and there will continue to be debate over these boundaries. Moreover, there will always be third parties that have and will continue to come up with innovative ways to financially benefit from our hard work. In the end I would hope that fellow ophthalmologists be true to themselves and to our great profession. I can understand why others want to do what we do because at the end of the day we have taken care of one of the most precious gifts or sense: sight. We must always keep at the forefront of our minds that we are first and foremost physicians. With this comes the responsibility of maintaining the integrity of our profession with lifelong learning and compassion for the wellbeing of our patients.

Julie L. Novak has been named Executive Director of Michigan State Medical Society (MSMS) by the MSMS Board of Directors. Novak, 46, who served the past year as MSMS Acting Executive Director, succeeds Kevin A. Kelly who passed away in December after a year‑long illness. “Julie Novak was unanimously selected by the Board from a field of excellent local and national candidates. The Board has complete confidence that she will continue the tradition of excellence in leadership that our organization has enjoyed for many, many years,” said Gregory J. Forzley, MD, chair of the 44‑member MSMS Board. Novak joined MSMS in 1990 and has served in a variety of positions relating to health care delivery and medical economics. Since 2007, she also served as Director of Operations. Novak holds a Master of Health Services Administration degree from the University of Michigan School of Public Health as well as a bachelor’s degree in International Relations from the James Madison College at Michigan State University.

February 2009 • Page 3

M S E P S Unveils New Memb er Benefit A new member benefit is now available to MSEPS members – the Dynamic Diagnostics, Inc. (DDI) Buying Group. DDI offers a ten percent discount on their ophthalmic products catalogue of diagnostic, therapeutic, and surgical supplies. DDI is a Michigan company based in Livonia. Most orders can be shipped the same day and, because they’re local, shipping charges are minimal. To qualify for the savings, all physicians in the practice must be MSEPS members. To see what products are available, go to the DDI web site at www.dynamicdiagnostics.com or call 800-7174677 for a catalogue. You can get a MSEPS buying group enrollment form at the MSEPS web site at www.miseps.org or call the MSEPS office at 517-333-6739.

MSEPS Board Strategic Planning Session Yields Results

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s part of our drive for continual improvement, MSEPS recently held a strategic planning session with members of its board of directors. Its purpose was to determine the goals and objectives MSEPS should

Page 4 • February 2009

focus on in order to be a thriving organization with an expanded membership in 2013. During the session, an array of opinions was offered on a variety of topics that included how to better serve MSEPS members and raise public awareness about ophthalmology. Board participants concluded that the focus of the organization over the next five years should center on three specific areas: • Membership • Education • Advocacy Each of these areas presents a number of opportunities for action. For example, with membership alone we’ll look at redoubling efforts to attract non-

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Red Flags Compliance is Preventive Medicine

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s a medical practitioner, you often advise patients that prevention is the best medicine. Healthy habits reduce the probability of illness. Regular checkups ensure that any irregularities are detected and treated early on before there is permanent damage. When it comes to identity theft prevention and the law, it is time that we take our own advice.

What are Red Flags Rules? On May 1, 2009, both financial institutions and creditors (non-financial institutions) will have to comply with the new Red Flags Rules under the Fair and Accurate Transactions Act of 2003. This new legislation requires that any entity that allows deferred payment on credit, a property, or service must have a written Identity Theft Prevention Program. The program must address transactions involving “covered accounts” under either of the two following definitions:

participating ophthalmologists to our organization and examine new ways to both increase communication with our members and present more opportunities for them to get together as colleagues. In the area of education, we’ll continue to focus on offering CME opportunities for members and also look at creative ways to get the word out to the general public—as well as other physicians—about the profession of ophthalmology and the vital ways in which ophthalmologists serve people. Finally, a focus on advocacy means that we’ll be intensifying our efforts to look out for ophthalmology’s best interests — whether it’s with legislators or third party payers.

Is your practice compliant? By Frank R. Mitchell, CITRMS

An account that a financial institution or creditor offers or maintains, primarily for personal, family, or household purposes, which involves or is designated to permit multiple payments or transactions. Examples include a credit card account, mortgage loan, automobile loan, margin account, cell phone account, utility account, checking account, or savings account. Any other account that the financial institution or creditor offers or maintains for which there is a reasonably foreseeable risk to customers or to the safety and soundness of the financial institution or creditor from identity theft, including financial, operational, compliance, reputation or mitigation risks. Health care providers that allow patients to defer payments are essentially extending credit, thus making them creditors. “So in the

healthcare context, even where a consumer offers insurance (that would normally cover the bill), if the patient is still ultimately responsible for medical fees not covered by insurance, then that hospital or doctor’s office would be considered a creditor,” says Tiffany George, attorney in FTC’s Division of Privacy and Identity Protection.

The Red Flags Identity Theft Prevention Program There are several requirements to consider when creating your Red Flags compliant Identity Theft Prevention Program. Element One: Identify Red Flags Each financial institution or creditor that is subject to the regulation must identify patterns, practices, or specific activities that indicate the possible risk of identity theft. These items are known as “red flags.” In doing continued on pg. 7

Overall, the session attendees determined that MSEPS needs to better promote the ‘brand’ of ophthalmology to specific target audiences. To do that, we’ll create solid messages about who we are and what our organization stands for, finalize those messages, and then determine what promotional steps our organization will take to expand public awareness about ophthalmology. If you have any feedback, specific ideas on promoting MSEPS and ophthalmology, or want to get more involved, please contact Penny Englerth at penglerth@ msms.org or 517-333-6739.

December 2008 • Page 5

Advocacy Issues IN WASHINGTON ICD-10 Because of unified opposition, HHS announced that it would allow a longer, staggered phase-in of both the new ICD-10 diagnosis codes and the 5010 electronic transactions. Under the final rule, physicians must comply with Version 5010 for some health-care transactions) and Version D.0 (for pharmacy transactions) by January 1, 2012. The ICD-10 code sets rule establishes October 1, 2013 as the compliance date.

MedPAC Recommends Payment Increases in 2010 On January 8, the Medicare Advisory Commission (MedPAC) adopted a recommendation that calls for a 1.1 percent increase in physician payment rates in 2010. MedPAC also reissued its call for Congress to increase payments for primary care services, but did not specify what that increase should be.

SCHIP Legislation Being Considered Reauthorization of the Children’s Health Insurance Program (SCHIP) has been passed through the U.S. House of Representatives and must now go to the Senate. Approved was $35 billion over four years that would cover an additional four million children. The program would be financed mainly by a 61-cent-per-pack cigarette tax increase. States can use SCHIP money for vision screening, but are not required to.

around the nation Children’s Eye Care Bills Florida, Hawaii, Illinois, Missouri, and Oregon all have bills pending that would require comprehensive eye exams for children of various ages.

False Advertising A bill has been introduced in New York that would restrict the use of the title “doctor” in advertising to medical doctors, chiropractors, veterinarians, podiatrists, and optometrists. In Oklahoma, SB 964 would require optometrists to identify themselves with the letters O.D. or the words “optometrist” or “doctor of optometry.”

Prescriptive Rights In Florida, a bill has been introduced to allow optometrists to prescribe oral medications and in Mississippi and Virginia, Page 6 • February 2009

pending legislation would allow optometrists to prescribe contact lenses and “ophthalmic devices” that contain medication.

Surgery A bill introduced in Nebraska would allow optometrists to remove superficial eyelid, conjunctival, and corneal foreign bodies. A bill pending in South Carolina seeks to revise the health code to allow optometrists to “perform surgical procedures including the treatment of the lacrimal drainage system, removal of foreign bodies from the eye and adjacent structures, excision and drainage of lesions of the lid and adjacent structures, and other procedures of the eye and adjacent structures,” which are not specifically prohibited in another section of the health code.

Other Legislation of Interest The Oregon Senate has a bill pending that would allow minors 15 years or older to consent to diagnosis or treatment by an optometrist without consent of a parent or guardian. A bill before the Washington legislature allows a nurse to perform for compensation certain activities delegated by “licensed physicians and surgeons, dentists, osteopathic physicians and surgeons, naturopathic physician, optometric physicians, podiatric physicians and surgeons, physician assistants, osteopathic physician assistants, or advanced registered nurse practitioners.”

BCBSM UPDATE 0191T Insertion of anterior segment aqueous drainage device, without extraocular reservoir; internal approach - Considered experimental and not payable for any group. 0192T Insertion of anterior segment aqueous drainage device, without extraocular reservoir; external approach - Considered experimental and not payable for any group. 92499 Placement of intraocular radiation source applicator - Intraocular placement of a radiation source for the treatment of choroidal neovascularization is considered experimental and, therefore, not payable for any group.

transactions, and verifying the validity of change of address requests in existing covered accounts.

continued from pg.5

so, the organization must consider which of its accounts are subject to the risk of identity theft; the methods it provides to open its accounts; the methods it provides to access its accounts; its size, location, and customer base; and its previous experiences with identity theft. Examples are provided in section 114, subpart J, Appendix A of FACTA. Element Two: Detect Red Flags The regulation states that the Identity Theft Prevention Program should address the detection of Red Flags in connection with the following: •

The opening of new covered accounts by obtaining identifying information and verifying the identity of the person opening the account.

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Using the policies and procedures set forth in the CIP rules of section 326 of the US Patriot Act.

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Authenticating customers, monitoring

Element Three: Responding to Red Flags The Identity Theft Prevention Program must address the risk of identity theft to the customer, and the financial institution or creditor commensurate with the degree of risk posed. The regulation provides an illustrative list of appropriate measures, which includes: •

Monitoring an account for evidence of identity theft;

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Contacting the customer;

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Changing any passwords, security codes, or other security devices that permit access to a customer’s account;

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Reopening an account with a new account number;

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Not opening a new account;

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Closing an existing account;

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Notifying law enforcement;

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Implementing any requirements regarding limitations on credit extensions;

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Implementing any requirements for furnishing of information to consumer reporting agencies;

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Determining that no response is warranted under the circumstances.

Element Four: Updating the Program The financial institution or creditor should periodically update its Identity Theft Prevention Program considering its own experiences with identity theft; changes in the methods of identity theft; changes in methods to detect, prevent, and mitigate identity theft; changes in accounts that it offers and maintains; and changes in its business arrangements.

Watch for Part 2: “What Do I Do Now?” in March edition

M onthly O bservance

Save Your Sight The American Academy of Ophthalmology’s monthly observance for February is “Save Your Sight.” Save Your Sight month entails encouraging patients to have regular checkups to promote early detection of disease, such as glaucoma, AMD, and diabetic retinopathy and to protect their eyes in the following ways: •

Sunglasses for adults and children

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Protective eyewear during sports activities

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Avoidance of fireworks

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Protective eyewear around the house, garage, and yard

Exclusively Endorsed by the Michigan Society of Eye Physicians & Surgeons

Quality professional liability insurance backed by excellent customer service and support. To find out how you can benefit, call 800-968-4929.

A patient handout is available at

http://www.aao.org/aaoesite/eyemd/upload/ February.pdf. It can be downloaded and printed for distribution to patients in your office. February 2009 • Page 7

MICHIGAN SOCIETY OF EYE PHYSICIANS AND SURGEONS

quality patient care

ethics

technological advances

integrity 20 09 AUGUST 13-15

Michigan Society of Eye Physicians and Surgeons Mission Statement It is the mission of the Michigan Society of Eye Physicians and Surgeons to encourage and promote high quality medical care for patients; to enhance the image of the practice of ophthalmology; to promote professional growth of Michigan ophthalmologists through continuing education; and to provide public policy leadership that ensures continuing high standards of medical eye care in Michigan.

Michigan Society of Eye Physicians and Surgeons 120 W. Saginaw East Lansing, MI 48823

compassion

41st Annual Conference GRAND HOTEL MACKINAC ISLAND