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LEGISL ATIVE UPDATE Volume 14 • No. 2 August 2016

Pennsylvania Ophthalmology News

Legislative Message

By Kenneth P. Cheng, MD, PAO Secretary of Legislation and Representation

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As the 2015-2016 legislative session draws to a close, we should reflect on where we have been, where we are going, and what it will take to get to where we want to be.

The real take-home message is to keep in mind our primary objective – quality eye care and patient safety. For years we have been working on having a Definition of Ophthalmic Surgery placed into Pennsylvania law to remove any ambiguity about lasers, injections, or other surgical procedures performed on or around the eye being thought of as “procedures” rather than “surgery” and the practice of medicine.

Our effort to get SB 795, A Definition of Ophthalmic Surgery passed has continued.

While it has not yet become law, it has thoroughly and completely accomplished what it was intended to do. It has been a widely discussed piece of legislation, vigorously opposed by the optometrists, and the legislature is now well versed on what the difference is between an ophthalmologist and an optometrist. While the optometrists have put forth legislation to expand their scope of practice, SB 1012, that bill has not moved because of the presence of our bill and the recognition that eye surgery should only be performed by real surgeons who have the appropriate education and training. The optometric grassroots effort this year has been

intense and there is tremendous pressure to compromise patient safety, but we have so far prevailed. SB 1012 has been stopped in the Senate professional licensure committee. So, while SB 795 has not officially passed into law, because it stopped in the same committee, it has accomplished its purpose – the protection of patients by preventing scope of practice expansion into surgery by inadequately trained practitioners. The legislative session does not end until November, so the work continues.

Where we want to be is where we have been, and where we are right now – with quality standards for eye surgery in place protecting patients and with surgery being performed only by surgeons. We will continue to work to have SB 795, A Definition of Ophthalmic Surgery, passed by the legislature. After this legislative session ends the bill will have to be reintroduced. It will take on a new number, but in concept it will be the same as it was when it was HB 1188, HB 838, and now SB 795. It will take more involvement from you to remain a successful strategy for patient safety.

Without your continued support of the PAO as members, there would be no voice of an organization representing ophthalmologists across Pennsylvania. There would be no infrastructure of expert and fantastic administrative assistance to facilitate and coordinate all of these efforts. There would be no respected lobbyists to represent ophthalmologists to the legislature day in and day out, ensuring that patient safety is not

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LEGISL ATIVE UPDATE Legislative Message

What is this Grassroots stuff?

forgone for political expediency and that our voices are not forgotten.

By Milliron & Goodman Government Relations

As the elections approach, your participation in our PAC is absolutely vital to keep our legislative friends in office and to support candidates that oppose our foes. The optometric PAC has far more money than ours does due to the participation of their membership. To continue to have a voice, we must have more participation in our PAC. It’s the reality of the world we live in. You can contribute online at www.PAEyeMDs.org.

While I understand this is a legislative article that is supposed to outline legislative issues, I think the most important topic I can cover with you is grassroots. Looking at the notable scholarly website Wikipedia, grassroots is defined like this:

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We need you to take just a little time to let your legislators know that you are a constituent and that you care about patient safety and quality eye care. I know it’s asking a lot, but meeting your legislator really isn’t difficult and really doesn’t take much time at all. Call for an appointment and take the time for a brief meeting to introduce yourself as an ophthalmologist who lives in their district.

I can tell you that it absolutely does have a tremendous impact. Relationships matter – big time. At the very least, pay attention to the PAO’s emails and requests for help. Make the phone calls or send messages when we need you.

What happens across the US as organized optometry tries to expand its scope of practice into surgery affects the entire country.

State societies, like the PAO, work tirelessly to defend patient safety and to prevent optometry’s expansion into surgery. They can only do this, as does the PAO, with support from the AAO’s Surgical Scope Fund. It’s critical and the fight can’t continue without it. Each state that falls to a compromise on surgical standards makes it that much harder to defend patient safety in the next. Make a contribution to the Surgical Scope Fund, as we’re all in this together.

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Lastly, thank you for taking the time to read this message. If you’ve been engaged in the effort though participation with the PAC, the Surgical Scope Fund or grassroots activity, a second thank you. Our success couldn’t have come without you. If you haven’t been involved in the past, please give it strong consideration now. Our continued success depends upon you.

In addition to his role in the PAO, Dr. Cheng also serves as the Metro East Representative on the AAO’s State Affairs Secretariat and as Chair of the AAO Surgical Scope Fund.

www.paeyemds.org

It is lobbying with the intention of reaching the legislature and making a difference in the decisionmaking process. Grassroots lobbying is an approach that separates itself from direct lobbying through the act of asking the general public to contact legislators and government officials concerning the issue at hand, as opposed to conveying the message to the legislators directly.

I know physicians are busy. However, for your patients’ sake, spend an hour a year getting to know your State Representative and State Senator. What I mean by “getting to know” is meet with them. Face to face. There doesn’t have to be an issue that day or month. There doesn’t have to be an issue that year. Nonetheless, there will be an issue with optometric scope of practice, surgical privileges or another issue effecting medicine. Whatever the issue is, your Representative and Senator will trust your advice since they know you first. It is not difficult to “get to know” your local Senator and Representative. The most difficult part seems to be picking up the phone, making an appointment, and showing up.

Since 2005, the General Assembly (House and Senate) has had an 89% turnover. Since 2010, there’s been a 52% turnover. After 2016, there will be at least 18 new members in the House and Senate combined. Have you taken the time to adjust to the voters’ changes? Get engaged, let the Academy know. It is how we will be successful in protecting your patients.

Definition of Ophthalmic Surgery legislation – SB 795 You may not know it, but there was more discussion in the Senate on our definition of surgery legislation in 2015-16 than ever before. Senators David Argall and Rich Alloway introduced the legislation in early 2015. The Pennsylvania Optometric Association opposed the legislation. Their Association has stated that the legislation is not necessary and a potential threat to their present and future scope of practice. We disagree. There were no less than 10 to 15 meetings in the Senate on SB 795. A final agreement between the Optometric Association and our Academy could not be reached. Therefore the discussions ended in early 2016. Nonetheless, we are pressing on with the legislation. While this has been a very long endeavor, persistence is critical to an overall win.

What does the Optometric Association want now?

I choose my words above carefully. I write Optometric Association, because it is very evident that the Association is very different in its thinking than every day optometrists. The support, by the Association, for the entirety of Senate Bill 1012 is outrageous. The bill would allow optometrists to do all of the following if passed as introduced: 1. Optometrists to call themselves “optometric physicians” 2. Allow the Board of Optometry to approve drugs for optometrists instead of the Department of Health 3. Allow optometrists to prescribe Schedule II opioids – codeine, hydrocodone and combinations 4. Allows injections by optometrists 5. Allows optometrists to perform laser surgery 6. Allows optometrists to drain cysts 7. Allows optometrists to remove embedded foreign objects from the eye 8. Allows optometrists to diagnose and treat “all” conditions of the human visual system 9. Allows optometrists to order and review MRIs and CT scans

LEGISL ATIVE UPDATE 10. Optometrists try to define surgery as an “insurance procedure” that they cannot be prohibited from entering 11. Removes any and all restrictions on the treatment of glaucoma 12. All students, not just year 4 optometric students, to learn and perform all procedures taught in optometric school 13. Allows optometrists to treat (inject) for anaphylaxis Also, their Association asked that “the supply and preparation of eyeglasses” be included in their practice act to help ensure their members were exclusively eye glass providers in Pennsylvania. This is a real threat. The Senate is taking their requests seriously and so should you. In the future, please explain to your Senator why this bill is full of bad ideas. It is very difficult to believe that even 1/3 of Pennsylvania optometrists want what the Optometric Association is going for in SB 1012. It is evident from our discussions in 2015 that the Optometric Association’s strategy is a “spaghetti strategy” – throw a plate of spaghetti against the wall and see how much can stick. So far the wall hasn’t let any stick.

Get engaged today.

White Hat Issue One thing is for certain, patients have a difficult time getting prescribed drops into their eye.

When patients apply the drops, they can go all sorts of places other than the eye. The Academy has seen bills around the country to help resolve the issue. The hope would be to allow patients to be prescribed drops with a higher volume of medicine, with insurance companies reimbursing properly. The Academy is researching the issue and looking at ways to help patients.

PA Politics, Legislative tracking and Schedule The Pennsylvania House of Representatives and Senate work on a two year cycle. It starts January 1st of the odd year (2015 or 2017) and ends November 30th of the even year (2016 or 2018). This year, along with Hillary Clinton and Donald Trump, all 203 House members and 25 of the 50 Senators are running in the November 8th General Election. At this point, I do not foresee major shifts in Pennsylvania politics. It is likely that the Republicans will maintain control of the House of Representatives and Senate. Governor Tom Wolf has two more years of his original four year term left. Our issues are not partisan.

They never have been. We have many good

friends working with us in the House, Senate and Administration. We must continue to build upon those relationships. During the 2015-16 legislative session, there will be nearly 3000 bills introduced in the House of Representatives. In the Senate another 2000 bills. On top of that 4000 resolutions. Of the 5000 bills introduced, it is likely that about 4% will actually become law, maybe a bit lower this legislative session. The process is meant to be frustrating, long and difficult. Think about the outcomes if it wasn’t. Finally, the schedule for this fall: the House and Senate have not announced their voting schedule, but I expect the General Assembly to have limited voting in September and October. After the General Election, it is go-time for 2017-18.

Over this summer and fall, please contribute your thoughts on where the Academy should be legislatively. What’s your priority? What are your patients telling you? Get engaged.

Contact us: If you have any questions regarding the current legislative landscape, please feel free to contact Milliron and Goodman by phone at (717) 232-5322 or email at andy@millirongoodman.com.

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