• July 12, 2023 8:55 AM | Becca Liebers

    WAO Action Alert - Contact NGS Today and Tell them Not to Restrict Access to Sight-Saving Glaucoma Surgeries

    Action Requested by August 5

    Recently, National Government Services (NGS) published a proposed local coverage determination policy on micro-invasive glaucoma surgery (MIGS) that considers some procedures, including adult goniotomy and canaloplasty, to be “investigational.” Medicare typically does not pay for investigational or experimental treatments.

    The Wisconsin Academy of Ophthalmology is concerned that NGS’ proposed policy states that the MIGS procedures below are considered investigational in patients over age 18 for glaucoma management:

    • Goniotomy or ab interno trabecular bypass surgery
    • Viscocanaloplasty
    • Canaloplasty in combination with trabeculotomy ab interno
    • Gonioscopy-assisted transluminal trabeculotomy
    • Ab Interno Canaloplasty
    • Cyclophotocoagulation

    WAO is submitting comments to NGS, and also invites members to submit personal comments directly to NGS. Comments should  be sent to NGSDraftLCDComments@anthem.com by August 5, 2023. Be sure to include “Public Comment for Proposed LCD - Micro-Invasive Glaucoma Surgery (MIGS) (DL37244)” in the subject line.  Please note, that due to online security requirements, NGS is unable to accept encrypted emails, compressed attachments, and links. Comment letters are accepted as MS Word and/or Adobe PDF attachments.           

     Key points that you may choose to include are:

    • There is extensive published data and clinical experience over more than 10 years using MIGS, including goniotomy and canaloplasty to treat glaucoma.
    • Patients with glaucoma, which disproportionately affects Black and Hispanic patients, need access to a range of surgical procedures.
    • Trabecular meshwork stents have an important role in treating patients with glaucoma and coverage for standalone trabecular stents under CPT code 0671T is appreciated.
    • There are some patients for whom treatment with medications is inadequate and their glaucoma is not at a stage requiring more invasive procedures such as trabeculectomy and tube shunts. For these patients, MIGS help preserve quality of life and reduce total costs to the healthcare system.
    • Cyclophotocoagulation can be vision-saving in patients with no other options and decades of literature evidence support its efficacy, thus it should not be considered investigational.
    • To ensure that Medicare beneficiaries with glaucoma have meaningful access to these transformative procedures, the draft LCD should be revised to include coverage for:
    • Goniotomy or ab interno trabecular bypass surgery
    • Viscocanaloplasty
    • Canaloplasty in combination with trabeculotomy ab interno
    • Gonioscopy-assisted transluminal trabeculotomy
    • Ab Interno Canaloplasty
    • Cyclophotocoagulation

    WAO Letter

  • June 28, 2023 3:01 PM | Becca Liebers

    Consistent and focused advocacy is critical to the long-term viability of ophthalmology and the delivery of quality medical eye care in Wisconsin. And the WAO is an active force in the State Capitol working on health care issues that impact the practice of ophthalmology. Our comprehensive advocacy program aims to:

    1. Strengthen the image of the practice of ophthalmology and educate policymakers on the importance of medical eye care; and
    2. Provide public policy leadership to enhance the practice of ophthalmology and ensure high standards for medical eye care are maintained in Wisconsin.

    Of course, our most effective advocacy efforts actively engage WAO members in their strategy and execution – aiming to capitalize on the expertise of our physician members. Member participation in WAO’s advocacy programs is increasingly important, as we are facing two highly concerning policy challenges in the 2023-24 legislative session: 1.) The APRN bill currently is under consideration by lawmakers that would authorize broad independent nursing practices in Wisconsin; and 2.) Efforts by optometrists to expand their permissible scope of services to include laser surgeries.

    Thankfully, WAO is well-positioned to act on these issues. In addition to our direct lobbying efforts through our professional lobbying firm (HZW), we have several grassroots advocacy programs in place to influence public policy at the state level. If are not already involved, WAO encourages you to participate in the following two key programs to strengthen our influence in the Wisconsin Legislature and ultimately help us meet our legislative/regulatory goals:

    •  Participate in the WAO Capitol Connection Program

    In WAO’s ongoing effort to raise the profile of ophthalmology and our organization in the State Capitol, we have established our Capitol Connection program to encourage WAO members to invite their local legislators to visit their clinics and facilities.

    The program is designed to help WAO members build and strengthen working relationships with legislators and offers a unique face-to-face opportunity to educate them about the importance of ophthalmology and medical eye care. Through the Capitol Connection program, lawmakers can learn firsthand what is important to the ophthalmology community. In many cases, just a single meeting or contact can have a significant impact on a legislator's view or position on a legislative issue.

    To date, we have held multiple successful legislative tours and have several more being planned for the near future. Hosting a legislator at your site is easy, enjoyable, and can make a significant advocacy impact, so we would encourage all WAO members to participate in this highly effective advocacy program.

    If you would like to host a legislative tour at your site, please contact the WAO office at wao@badgerbay.co. We will work with you and your legislators to coordinate the meetings and will provide participating members with full support, including legislator bios, advocacy tips, issue briefings, and supporting documents. 

    • Contribute to the WAO Political Action Committee

    One of the most effective advocacy tools the WAO has as its disposal is the Ophthalmologists for Better Government Political Action Committee (PAC). The PAC allows WAO to collect contributions from members into a single account to support candidates for state legislative office who understand and support issues important to ophthalmologists, the practice of ophthalmology, and Wisconsin’s House of Medicine.

    As mentioned above, the WAO PAC is funded through contributions from ophthalmologists across the state and is only effective as a political tool if members participate in the program. With that in mind, please take a few moments and contribute online TODAY to the Ophthalmologists for Better Government PAC. Every dollar helps, as the risk of non-involvement in the political process is getting too high to ignore.

  • June 28, 2023 3:00 PM | Becca Liebers

    Health Care in the News

    Assembly Speaker Robin Vos: Medicaid expansion will never happen, but medical marijuana might

    Wisconsin Public Radio - By Anya van Wagtendonk

    Medicaid expansion will never happen under the leadership of Wisconsin Assembly Speaker Robin Vos, but a Republican proposal on medical marijuana could be unveiled later this summer, the lawmaker pledged on Tuesday.

    Vos, R-Rochester, made the remarks at a luncheon hosted by Wisconsin Health News at the Madison Club. He spoke about his health care priorities, including his overarching philosophy that American health care is accessible and high-quality — and therefore costs more.

    "That is the challenge that I think we have, because it can't simply be a role of state government to subsidize the system. But I think it can make sure that we have access for those who are the most poor in partnership with the federal government," he said.

    Read more…
  • June 28, 2023 2:59 PM | Becca Liebers

    Earlier this month, the Wisconsin Legislature passed legislation (Assembly Bill 245), which was subsequently signed by Gov. Tony Evers, to eliminate the state’s personal property tax. Elimination of the personal property tax was a top legislative priority for the business community –  including those in the health care sector – as the antiquated tax was an unnecessary financial and administrative burden for businesses across Wisconsin.

    The personal property tax was initially implemented in the 1830’s, before Wisconsin was a state, to fund the territorial government. At the time, Wisconsin did not have an income or sales tax. Lawmakers have been chipping away at the personal property tax for decades, and the passage of AB 245 – a sweeping bipartisan bill that also provides an increase in state funding to local governments – finally completes the job in abolishing the tax.

    Senator Dan Knodl (R-Germantown), who spearheaded efforts to eliminate the tax, said, “With this legislation signed into law, the personal property tax has been finally eliminated. I have been working towards this moment throughout my time in the legislature and it is such a relief knowing this tax will no longer burden our small business owners.”

    Previously, when a business purchased an item (i.e., personal property), not only did they have to pay sales tax on it, but they also had to pay personal property taxes on the item for as long as they owned it. Under the new law, Wisconsin businesses will receive long-overdue tax relief.

  • June 28, 2023 2:58 PM | Becca Liebers

    As was reported in the May edition of the WAO Advocacy Newsletter, on May 24, the Wisconsin Senate Health Committee held a public hearing on two critical bills being lobbied on by the Wisconsin Academy of Ophthalmology (WAO): Senate Bill 145, the Advanced Practice Registered Nurse (APRN) bill, and Senate Bill 143, the physician Truth-In-Advertising bill.

    The APRN bill, which the WAO and other physician groups oppose in its current form, would implement extensive independent nursing powers for APRNs, including the authority to prescribe medications and the ability to practice independently without physician collaboration. The Truth-In-Advertising bill, which the WAO supports, would provide practical patent safety measures by restricting non-physicians from using certain words, terms, letters, or abbreviations that would characterize them as a physician.

    Since the May public hearing, no official action – in either the Senate or Assembly – has been taken on the bills. However, negotiations continue behind the scenes between the physician community and nursing interest groups. The Wisconsin “House of Medicine” continues to believe there is a path to a compromise on the APRN bill with nursing stakeholders, but remains steadfast that any agreement must include the following provisions:

    • Require four years of real-world, team-based care experience before an APRN can advance to practice independently. Current law does not allow for independent practice.
    • Include “Truth in Advertising” title protection language in the bill to help ensure patients better understand who is providing the care they need.
    • Ensure that a physician specializing in pain medicine collaborates with independent APRN clinics (those not directly connected to a hospital or health care system) so that complex pain medicine for patients can be provided more safely.

    The WAO will continue to provide members with updates on the status of both bills as the legislative process unfolds.

  • June 28, 2023 2:57 PM | Becca Liebers

    The Wisconsin Legislature’s budget-writing committee – the Joint Finance Committee (JFC) – recently concluded its work on the 2023-25 state budget bill, essentially rewriting Gov. Tony Evers’ $104 billion two-year spending plan for the state. The committee has sent the budget to the full Legislature, which will take-up and ultimately pass (with no significant changes) the bill this week.

    The budget bill includes numerous health care-related provisions that may be of interest to WAO members. Please find below the budget items approved by JFC related to the Wisconsin Department of Health Services:

    • Funds Medicaid cost to continue.
    • Increases hospital reimbursement rates.
    • Increases primary care provider reimbursement rates for certain codes to 70 percent of Medicare rates.
    • Increases the maximum allocation for Disproportionate Share Hospital payments to $71.6 million.
    • Requires DHS to establish new reporting requirements for long-term care Managed Care Organizations.
    • Prohibits Medicaid payments for puberty-blocking drugs or gender reassignment surgery.

    Once approved by lawmakers, the budget will be sent to Evers for veto review and approval. The next edition of the WAO Advocacy Newsletter will provide a full recap of the budget bill.

  • June 20, 2023 11:46 AM | Becca Liebers

    Thank you to Roxana Godiwalla, MD and Steven Seto, MD for attending the AAO Mid-Year Forum and representing Wisconsin as Resident Ambassadors. We asked them both to provide a brief summary of their experience attending the event, see below:

    Dr. Godiwalla: Excellent! Felt so humbled to have the opportunity to speak with government officials, and so proud of our Ophthalmologists across the country! Looking forward to being part of advocacy again!

    Dr. Seto: Overall an excellent and important experience that brought light onto the legislative side of medicine and ophthalmology. I think this experience was not only worth attending but was important enough that I would suggest all residents be required to attend it at least once in their training. I would personally be interested in attending future MYFs from my experience this year, both as a resident and in my future practice.

    Review a full overview of the Mid-Year Forum from AAO here.

  • May 25, 2023 10:36 AM | Becca Liebers

    Make plans to join your fellow Wisconsin physicians for the 2023 Wisconsin Doctor Day, which will be held on Thursday, June 15th at Monona Terrace in Madison, WI. Learn first-hand how you can make a difference in the legislative process! CLICK HERE to view the agenda or CLICK HERE to learn more and to register.

    Doctor Day is an annual, multi-specialty event bringing together Physicians and Medical Students from nearly 20 different physician organizations. The event features networking, educational sessions, and legislative meetings.

  • May 25, 2023 10:36 AM | Becca Liebers

    Earlier this month, a group of state legislators introduced a youth tanning bed safety bill (AB 241 / SB 261) that aims to help parents better protect their teenagers from the long-term health risks associated with indoor tanning, including skin cancers and serious eye damage. The bill would require parental or guardian consent for teenagers to use tanning beds.

    From skin cancer to immune system impairment and severe damage to the external and internal structures of the eye and eyelids, the health hazards from UV radiation overexposure are clear. UV radiation is a proven human carcinogen, and the risk of future skin cancer increases significantly when adolescents intentionally expose themselves to artificial sources of UV rays. In fact, according to a recent per reviewed study, indoor tanning can increase user risk of developing squamous cell carcinoma by 58% and basal cell carcinoma by 24%. In addition, using tanning beds before age 20 can increase the chances of developing melanoma by 47%, and the risk increases with extensive use.

    The legislation, which is supported by the Wisconsin Medical Society, Wisconsin Dermatological Society, Children’s Hospital of Wisconsin, and the Wisconsin Public Health Association, includes the following two main provisions:

    • Requires 16- and 17-year-olds to provide written authorization from a parent or guardian before using indoor tanning equipment (current law prohibits adolescents under 16 from using tanning beds); and
    • Prohibits tanning bed operators from advertising or promoting indoor tanning as free from risk or that it offers medical or health benefits.
    On May 18, Assembly Bill 241 received a public hearing before the Assembly Consumer protection Committee.
  • May 25, 2023 10:34 AM | Becca Liebers

    On May 24, the Wisconsin Senate Health Committee held a public hearing on two critical bills being lobbied on by the Wisconsin Academy of Ophthalmology (WAO): Senate Bill 145, the Advanced Practice Registered Nurse (APRN) bill, and Senate Bill 143, the physician Truth-In-Advertising bill.

    Of course, the Wisconsin “House of Medicine” – through the Wisconsin Medical Society – had a strong presence at the public hearing and articulately voiced our opposition to the APRN bill in its current form. The bill would implement extensive independent nursing powers for APRNs, including the authority to prescribe medications and the ability to practice independently without physician collaboration.

    During the testimony on AB 145, the physician community made it clear that there is a path to a compromise on the bill with nursing stakeholders, but any agreement must include the following provisions:

    • Require four years of real-world, team-based care experience before an APRN can advance to practice independently. Current law does not allow for independent practice.
    • Include “Truth in Advertising” title protection language in the bill to help ensure patients better understand who is providing the care they need.
    • Ensure that a physician specializing in pain medicine collaborates with independent APRN clinics (those not directly connected to a hospital or health care system) so that complex pain medicine for patients can be provided more safely.

    As expected, the nursing community came out in full force to testify in favor of the bill. Their messaging was also predictable, as they spoke about their training, ability to fill gaps in the health care workforce, and the capacity of advanced practice nurses to practice independently. They said Wisconsin needs to catch-up with the 27 states that allow advanced practice nurses to practice without physician collaboration.

    Throughout the hearing, which became heated at times as lawmakers peppered the physician community with hard-hitting questions, the “House of Medicine” remained composed, stressing the important role nurses play in a physician-led health care environment, but also insisting on the need to include critical patient safety guardrails in the legislation.

    Although the hearing on the Truth-In-Advertising bill (SB 143) was a bit shorter, it was not necessarily less contentious. Thie bill, which would provide practical patent safety measures by restricting non-physicians from using certain words, terms, letters, or abbreviations that would characterize them as a physician, is “supported” by Wisconsin Nurses Association as part of a broader compromise on the APRN bill. However, testimony in opposition to the bill was offered by nurse anesthetists, chiropractors, and optometrists.

    According to their comments, they believe the bill restricts them from communicating their health care experience, expertise, and services to patients. In fact, a chiropractor testifying alongside a representative from the Wisconsin Optometric Association, said optometrist are primary care providers – who routinely perform surgeries – and the legislation would not recognize their training, experience, and role in the health care system.

    On the flip side, despite skepticism by several lawmakers on the committee over the need for the bill, the physician coalition provided strong comments, expressing the importance of the proposal for patients, who are often confused about the qualifications of different health care professionals. The legislation will allow them to better understand when they are receiving care from a physician or from a non-physician provider.

    CLICK HERE to review the  written testimony the physician community – including the WMS, the WAO, and several other specialty physician groups – submitted to the committee.

    Future editions of the WAO Advocacy Newsletter will provide members with on update on the status of both bills in the legislative process, as well as the results of ongoing negotiations with other stakeholders, lawmakers, and the Governor’s office.

Contact Us

Wisconsin Academy of Ophthalmology

563 Carter Court, Suite B
Kimberly, WI 54136
Ph: 920-560-5645 • WAO@badgerbay.co

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