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05/25/2018

OOS Mid-Year Report

President’s Message

Greetings. For those who do not know me, my name is Joseph Coney, MD. I am a retina and vitreous disease specialist at Retina Associates of Cleveland. It is my pleasure to serve as president of the Ohio Ophthalmological Society (OOS). I hope to continue the tremendous leadership provided by my predecessor, Walker Motley, MD.

In this issue of the OOS newsletter, you will learn that the Ohio Department of Health has agreed to continue funding our outstanding sports eye safety program, Play Hard Don’t Blink. We have also created new social media channels for OOS so that you and your colleagues can share information about the tremendous work you are providing your patients and community.

There is important information for you to know as a practitioner. The state pharmacy board continues to weigh changes to compounding rules that affect ophthalmologists. And we are still encouraging Anthem to rescind a set of guidelines related to anesthesia during cataract surgery procedures.

I also want to remind everyone that your support of our PAC is critically important as we approach an election season in Ohio. Your donations help us to support the candidates and issues that support ophthalmology. Lastly, it is never too early to mark your calendars for our next Annual Meeting – Saturday, Feb. 23, 2019.

Regards,

Joe Coney, MD

OOS Third Party Payer and Regulatory News

OOS Advocating to Change Anthem's Cataract Surgery Anesthesia Guidelines 

Anthem’s recent guidelines sharply restricting the use of anesthesia services during cataract surgeries has drawn the ire of ophthalmologist in Ohio and across the country. Anthem has said the stipulations are only guidelines for physicians to follow and not a firm policy. But that very position has caused confusion among ophthalmologists who worry the insurance payer can with little notice shift a guideline to a policy.

The guidelines state monitored anesthesia care is not medically necessary for cataract surgery unless the patient:

  • is younger than 18 years; or
  • is unable to cooperate or communicate
  • is unable to lie flat
  • has failed or has contraindications to topical, local, regional or moderate sedation,
  • is undergoing prolonged or complex surgery.

The American Academy of Ophthalmology (AAO) strongly disagrees saying the ophthalmologist should make the decision on whether an anesthesiologist or nurse anesthetist is needed in the operating room. The AAO has asked Anthem to rescind the guidelines.

In the meantime, the OOS has raised concerns about these guidelines to state regulators and directly to Anthem.

In March, the OOS spoke to Anthem and requested a meeting with some Ohio ophthalmologists so that Anthem can here from doctors on how these guidelines could negatively affect patient care. We are still waiting to learn if Anthem will agree to a meeting. The guidelines – which apply only to commercial plans and do not affect Medicare Advantage patients – have not been implemented in Ohio.

The OOS will continue to reach out to Anthem and urge them to rescind the guidelines.

Ophthalmologists Urge Pharmacy Board to Amend Compounding Rules

The State Pharmacy Board of Ohio has issued amended compounding rules for comment. The pharmacy board is proposing to rescind all existing rules and redraft new rules. Many aspects of the proposed rules mirror the provisions included in the existing rules. 

It is encouraging that the pharmacy board elected to reopen the compounding rules to broaden TDDD license exemptions for some physicians and lessen the requirements for non-sterile compounded drugs, among other changes.

However, many of the concerns previously expressed by the OOS remain. The OOS is working with the Ohio State Medical Association (OSMA) and other specialty societies to articulate these concerns to the Board. The OSMA and OOS met with the pharmacy board and CSI in late May to share directly how these rules can negatively impact physicians who compound in their offices.

Physicians agree that compounding activities must be performed in the safest manner possible. It is important to note that the legislative and regulatory backlash against prescriber compounding began not because of physicians mishandling compounded medications, but rather as the result of the contamination of compounded products made by a compounding pharmacy. Compounding activities in Ohio have been safely performed in physician offices for decades and do not require such stringent regulations.

In a letter sent to the pharmacy board earlier this year outlining the mutual concerns of physicians from different specialties, physicians, including ophthalmologists, noted that several federal regulatory agencies and national-level organizations are currently researching the best approaches to address physician compounding. In fact, the Food and Drug Administration (FDA) recently acknowledged a need to revise draft USP guidance documents related to compounding.

The FDA plans to better define the circumstances under which drugs are being mixed and applied in a manner that creates negligible patient risk, and therefore would not be subject to the same compliance policy under the agency’s risk-based approach to implementing these requirements.

The national regulators have also recognized the need for a balanced approach to regulations. Physicians in Ohio agree that attempts by the Ohio pharmacy board to set new policy prior to publication of these updated guidance documents may create an undue burden on physicians who routinely combine drugs and medicine in a manner that creates negligible patient risk.

Physicians have asked the pharmacy board to rescind all compounding rules until the national discussion has concluded and a consensus has been reached regarding the most appropriate way to regulate in-office compounding. Physicians also suggested the board consider allowing physicians to compound low-risk medications (such as mixing lidocaine with sodium bicarbonate or diluting allergens) without the investment in expensive air filtration equipment.

OOS Legislative Update

Medical Marijuana to Become Law This Fall

Ohio’s long-anticipated medical marijuana law is set to take effect on September 8, though the program may not be fully operational by that date, state regulators warn. Glaucoma is one of the 21 medical conditions under which a patient could be qualified to use the product.

State regulators were given two years to build the program after the law was approved in 2016. Nevertheless, the state has been beset by challenges as to who can grow the plant. That could trigger potential delays in processing the plant into vaping form, oils, lotions and patches (smoking the plant is prohibited by the law) leaving many to wonder whether the actual supply this fall can meet the demand.

Provisional licenses for 24 medical marijuana cultivators was awarded in November 2017 but by the end of April none had begun growing the plant, according to media reports. Licenses for several testing labs, 40 processors, and 57 dispensaries were expected earlier this year. Still, not all have been awarded. The program was delayed by legal challenges over how the state scored applicants who had applied to be cultivators. The Commerce department has admitted to errors and hired a third-party accountant to re-score the applications and restore integrity in the process.

As of late May, 89 Ohio physicians had completed a training course on the law and were approved by the state medical board for a certificate allowing them to recommend – not prescribe – medical marijuana.

The distinction between “recommending” and “prescribing” may seem like a semantic but it is important because, although Ohio allows medical marijuana in limited circumstances, federal law still deems the plant illegal and lists marijuana as a Schedule I drug on par with heroin.

OOS to Continue Sports Eye Safety Program

The Ohio Ophthalmological Society (OOS) sports eye safety program will extend into 2019 thanks to the strong ongoing support of the Ohio Department of Health (ODH). The ODH has awarded the OOS a $550,000 grant to fund the Save Our Sight program through June 2019.

The OOS uses the funds to support the association’s highly successful Play Hard Don’t Blink program, which supplies sports goggles, baseball and softball helmets, fielder’s masks, and prescription goggles free of charge to more than 35,000 Ohio children playing youth sports. The OOS works with parents, schools and youth coaches to distribute the equipment each athletic season to help prevent eye and facial injuries.

The OOS has also received funding from ODH to rebrand Play Hard Don’t Blink and update its website, which promises to bring even more notoriety to the OOS sports eye safety program. That process should be complete later this summer.

Telemedicine Bill Introduced

A telemedicine bill has been introduced at the Ohio Statehouse that would require health benefits plans to provide coverage for telemedicine services on the same basis and to the same extent as in-person services. House Bill 546 would also prohibit a health benefit plan from excluding telemedicine services from coverage solely because they are telemedicine services.

Under the proposal, insurers could not impose any annual or lifetime benefit maximum in relation to telemedicine services, other than such a benefit maximum imposed on all benefits offered. Insurers also would not be able to require cost sharing for telemedicine services in an amount greater than that for comparable in-person services. If enacted, these parameters would apply to all health benefit plans issued, offered, or renewed on or after January 1, 2019.

Young Physicians Represent Ohio at the AAO Mid-Year Forum

Ohio ophthalmologists who attended the American Academy of Ophthalmology’s Mid-Year Forum in Washington, D.C. in April were joined by five ophthalmology residents from programs across the state as part of the Advocacy Ambassador Program.

The Ambassador Program allows members-in-training to attend the national media and gain access to various related events with their registration fee waived. The young physicians are then provided a PowerPoint document of the Forum presentations that can modified and then shared with other residents in their programs here in Ohio.

The OOS provided five scholarships of $750 each this year to the following Ambassadors:

  • Stephan Dixon, University of Cincinnati Medical Center
  • Jaehong Han, Case Western Reserve / University Hospitals
  • John Liu, Case Western Reserve / University Hospitals
  • Payal Shah, Summa Health Systems
  • Yue Zhao, Cleveland Clinic

In addition to the clinical sessions over the four-day meeting, the Ambassadors also included dinner programs, Congressional visits with elected leaders and their staffs, and social events.

Ohio was also represented at the meeting by current OOS president Joe Coney. Other OOS members who attended were John Stechschulte, Carl Minning, Linn Mangano, Bernie Perla, and Jeff Perkins, among others.

Election Preview; OMEPAC Support Needed

Following Ohio’s May 8 primary election, the ballot for major state and federal offices is now set.

For U.S. Senate, incumbent Democrat Sherrod Brown will be challenged by Republican Jim Renacci.

There are no incumbents in the battles for Ohio’s five statewide offices.

In the race for governor, Democrat Richard Cordray and running mate Betty Sutton will face Republican Mike DeWine and running mate Jon Husted. Democrat Steve Dettlebach and Republican Dave Yost will vie for attorney general. Democrat Zack Space will challenge by Republican Keith Faber for auditor. Democrat Kathleen Clyde and Republican Frank LaRose will square off for secretary of state. And Democrat Rob Richardson and Republican Robert Sprague will compete to be treasurer.

There are also races for Ohio congressional seats, state legislature and Ohio Supreme Court. Primary results and candidates for each office can be found at www.vote.ohio.gov.

Election Day is Tuesday, Nov. 6.

As you all know, the Ohio Medical Eye Political Action Committee (OMEPAC) supports candidates and issues that supports ophthalmology. We will evaluate each candidate and offer our assistance where appropriate.

We, of course, cannot do this without your contributions to OMEPAC. To contribute online visit the OOS website, www.ohioeye.org, and click on the yellow donate to OMEPAC button on the lower right side of the front page.

Hold The Date - 2019 Annual Meeting - Saturday, Feb. 23 

The OOS will be holding its 2019 Annual Meeting on Saturday, Feb. 23, 2019 at the Columbus Hilton at Easton. Once again, there will be educational programming for physicians, technicians and nurses. Meeting details and registration will be available in early December. If you know a vendor that would be interested in a sponsorship or exhibit space, please contact the OOS office at oos@ohioeye.org or 614-527-6799.

Follow Us on Social Media!

We have found new ways to share the tremendous work ophthalmologists do in Ohio. The Ohio Ophthalmological Society (OOS) has all-new social media tools. Join the digital age and follow us today:

  • Twitter: @OhioOpSociety
  • Facebook: Ohio Ophthalmological Society
  • YouTube: Ohio Ophthalmological Society

And, don’t forget about our website:

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