Viewpoint

Fending for Ourselves

Larry E. Patterson, MD

Ophthalmology practice is my principal occupation. My “side business” is government relations — and, well, business is booming these days. Serving on the OOSS board for six years, as OOSS President for two years and presently serving on the Government Relations Committees of ASCRS and OOSS, I've come to think of public policy as worthy of the significant time and energy I devote to trying to enable the ophthalmology and ASC communities to impact public policy. But I realize I can become so accustomed to doing the work and so impassioned with its goals and objectives that I can lack the perspective to ask myself whether, really, this work should ever have to be done in the first place.

This epiphany came to me compliments of Charles Krauthammer, MD, who presented the keynote address to our members at OOSS's annual conference in Chicago. Krauthammer's comments were, as expected, conservative and brilliant, from his analysis of the healthcare reform debate and his assessment of the upcoming Presidential race to his take on foreign policy.

But what inspired this column are informal remarks he made at a luncheon of the OOSS President's Council. I had briefed him beforehand regarding our efforts to repeal CMS's asinine regulation that, since 2009, has prevented ophthalmic surgeons from performing a YAG on the same day that we examine the patient and refer him to the ASC. He was truly stunned. He made the astute — and absolutely accurate — statement that OOSS, like myriad other medical organizations, must devote substantial precious resources to “fending off,” and then reversing, regulations and policies developed by bureaucrats and legislators who know nothing about the clinical or economic impact of their actions.

It is indisputable that providing surgery in ophthalmic facilities saves the government and the patient substantial money every time an ASC is selected. Our outcomes are superlative, infection rates infinitesimal.

I wish that the silly prohibition on same-day surgery — ultimately repealed after two years of lobbying — had been the only time our resources needed to be dedicated to fending off clearly arbitrary, costly and unnecessary regulations. Not so, my friends: For over two decades, OOSS and the ASC industry have had to beat back efforts by the feds, states and the hospital industry to limit physician ownership of ASCs. In 2009, CMS issued a policy that banned reuse of single-use IV vials, notwithstanding the absence of evidence of transmission of blood-borne pathogens during healthcare procedures when vials are reused with appropriately sterile procedures. Now we are facing critical shortages of IV anesthetics partially because of the waste necessitated by this policy.

Back to Krauthammer's comments: he posited that it would make so much more sense if we could devote OOSS's revenues — your hard-earned, generous contributions and dues — to programs that will educate our members and staff about better clinical and business practices. It's reassuring that Mike Romansky, OOSS's Washington counsel, and his colleagues in AAO and ASCRS helped our organizations reach places of prominence in the nation's capitol, but I'm certain that they'd rather be advancing proactive policies that benefit our patients rather than devoting so much of their time “fending off ” legislation, regulations, transmittals, instructions and pronouncements that simply don't make sense.