From the Desk of WAO President David Nash, MD
For patients who need eye care, they quickly find out there are several different types of specials who work together to provide eye care, most notably ophthalmologists and optometrists. As you know, the difference between ophthalmology and optometry is a common source of patient confusion. That same confusion is also common among policymakers. A key reason for their confusion stems from the fact that optometrists are often referred to as eye doctors although they do not have medical degrees.
While we know ophthalmologists and optometrists frequently work together to effectively manage the long-term eye health and vision of patients, it is important for the public to recognize the difference in education and training between these eye care specialists. Education of both patients and policymakers is more important than ever as optometrists in Wisconsin and across the country continue efforts to expand their scope of practice to include laser eye surgery.
When it comes to tissues in the eye, we are talking about micrometers from one important tissue to the next. Ophthalmologists understand the room for error is small, and surgery on the eye is a specialized field of ophthalmology that requires years of advanced medical training and specialized equipment to perform. We also need policymakers in Madison to understand the concept of allowing an unqualified provider to shoot a laser in the eye is extremely troubling.
While optometrists are well-educated and critical to the collaborative eye care team, they are not trained to perform delicate surgical procedures, including laser surgeries. Optometrists can work alongside ophthalmologists to provide comprehensive eye care, including pre- and post-operative care for patients undergoing laser surgery, but they should not perform the procedure themselves.
As we watch other states across the country expand their optometric scope of practice laws to specifically include certain office-based laser procedures for glaucoma and post-cataract care, I am thankful the WAO has a robust government affairs program committed to securing policies at the state level that preserve patient safety and encourage the delivery of high-quality medical care.
The optometrist “scope creep” challenge we currently face is not likely to go away anytime soon, but the WAO is highly focused on the issue, and we will keep members update on any new developments.
Ophthalmologists are board certified medical doctors and surgeons who provide the highest quality of medical and surgical eye care for military veterans, and who are committed to maintaining the highest possible safety standards.
The U.S. Department of Veterans Affairs is considering policies that would reverse those surgical standards by subjecting our veterans to eye surgery performed by someone without proper medical education and surgical training. That’s right - a person who did not go to medical school or complete a surgical residency training program could perform surgery using a blade or laser on the eyes of our brave veterans.
We cannot let this happen. If you care about protecting the health and safety of those who sacrificed for our country, donate today so we can educate policymakers and the public about the dangers facing our veterans. The Wisconsin Academy of Ophthalmology is proud to sponsor a “Team Wisconsin” as part of the national initiative to protect veterans eyesight. Donating has never been easier. Simply log onto WAO’s very own team fundraising page and help us reach our goal of raising $5,000+ to support the campaign.
As ophthalmologists, we are dedicated to protecting sight and empowering lives. If the VA makes these changes, it will lower surgical eye standards and place veterans’ eyesight and quality of life at risk. They deserve better. They’ve earned it. Together, AAO and WAO serve as advocates for patients and the public, leading ophthalmic education and advancing the profession of ophthalmology.
The Wisconsin Chapter of the Foundation for Fighting Blindness is holding the annual VisionWalk on May 21. The event is located at Veteran’s Park at the Lagoon. Registration opens at 9am and the walk begins at 10:30am. Since its inception in the Spring of 2006, Vision Walk has raised over $63 million to fund sight-saving research. Join the Wisconsin VisionWalk community; together we step closer to fighting blinding diseases. Visit the event page for more information.
WAO is looking for experts in their fields to submit presentations to educate and inspire our attendees. Presentations will be accepted until Saturday, April 8. We estimate that all applicants will be notified of the status of their applications before the end of April.
Proposal selection is based on the following criteria:
Learning Objectives:
Each abstract will need to include two to three concise and complete learning objectives that describe what the learner will be able to do at the conclusion of the session.
Please send questions to WAO@badgerbay.co.
SUBMIT HERE
With Wisconsin ophthalmologists facing a potential scope battle during the 2023-24 legislative session – as optometrists appear committed to expand their scope of services to include laser surgery – the WAO Government Affairs Team is keeping a close eye on Ophthalmology vs Optometry scope battles playing out in other states.
There are numerous states that have already expanded their optometric scope of practice laws to specifically include certain office-based laser procedures for glaucoma and post-cataract care. In addition, there are efforts currently underway in other states to pass similar optometric “scope creep” laws. Please find below a brief snapshot of what is happening with this growing threat to medical eye care across the country:
In the closely watched Feb. 21 primary for the Wisconsin Supreme Court – which centered on the issue of abortion after the U.S. Supreme Court overturned Roe v. Wade in 2022 – liberal-leaning Milwaukee County Judge Janet Protasiewicz and conservative former Supreme Court Justice Daniel Kelly captured the most votes in the four-way race and will face-off in the April 4 general election. Protasiewicz took 46% of total votes cast, with Kelly coming in a distant second, capturing 24% of the votes. The winner of the general election will decide the ideological direction of the 7-seat high court, which is currently controlled 4-3 by conservative-leaning justices.
The other high-profile primary race saw Republican state Rep. Dan Knodl (R-Germantown) defeat fellow state Rep. Janel Brandtjen in the GOP primary for the 8th WI Senate District. Knodl will face Democrat Jodi Habush Sinykin in the April 4 spring election for the chance to replace former Republican Sen. Alberta Darling, who left office in Dec. 2022 after holding the senate seat for three decades. If Knodl ultimately wins the seat, Republicans will hold a veto-proof majority in the senate.
Earlier this month, Gov. Tony Evers announced his appointment of Kirsten Johnson as the next secretary of the Wisconsin Department of Health Services (DHS). Johnson, who begins her new role on Feb. 27, will replace former Secretary Karen Timberlake’s who left the state agency at the end of 2022. According to a press release issued by the governor’s office, Johnson has over 20 years of experience as a public health leader in local, state, national, and international organizations. Most recently, she served as the health commissioner for the city of Milwaukee following her appointment in January 2021. Prior to serving the city of Milwaukee, Johnson led the Washington-Ozaukee Public Health Department for more than a decade as the director and health officer. Johnson also served as a health policy fellow and advisor for U.S. Congressman Ron Kind and helped develop policy for the House Committee on Ways and Means.
“Over the past 20 years of my career in public health, I have worked to address the challenges and health disparities facing Wisconsin’s rural, urban, and suburban communities alike—disparities that were laid bare by the pandemic,” said Johnson. “I am excited and honored to join Gov. Evers’ administration to lead DHS, where I look forward to using my expertise and knowledge to continue this important work.”
Johnson has her master’s degree in public health from Tulane University of Public Health and Tropical Medicine and holds certifications as a public health professional and certified education specialist.
Gov. Tony Evers Unveils 2023-25 State Budget ProposalThe spending bill includes healthcare workforce Initiatives; Medicaid expansion
Earlier this month, Governor Tony Evers introduced his 2023-25 Biennial Budget proposal – the state’s two-year spending plan – before a Joint Session of the Wisconsin Legislature. The Legislature’s Joint Finance Committee met shortly afterwards to formally introduce the bill.
As was the case with the governor’s previous budget proposals, the Republican-controlled Legislature is expected to essentially scrap most of the Evers budget and craft their own version by working off current spending levels. However, it is likely the Legislature will adopt some of the governor’s initiatives.
According to Evers, his budget includes proposals that would increase access to affordable healthcare coverage, improve the quality of healthcare services in the state, and expand the scope of benefits available through Medicaid. Please find below a brief overview of items included in governor’s budget proposal that may be of interest to WAO members and the greater healthcare community:
The Legislature will take roughly a month to review the bill before the formal budget process begins. In late March or early April, the Joint Finance Committee (JFC) will hold informational hearings on the bill with testimony from state agencies. This will be followed by a series of public hearings on the budget around the state. Beginning in May, JFC will begin meeting two or three times per week to take up and vote on individual budget provisions, with the goal of completing their work in early June. The legislation will then be considered and voted on by the full Legislature, with lawmakers aiming to pass it and send it to Gov. Evers before the end of the current fiscal year on June 30.
Below you will find links to Gov. Evers’ Budget Address, a “Budget in Brief” Summary Document, the full Executive Budget Document, and a copy of the actual legislation:
The WAO Government Affairs Team continues to fully analyze the recently introduced budget bill and will keep the membership updated throughout the budget process.
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 Madison working on issues of importance to WAO members that impact the practice ophthalmology. Our comprehensive advocacy program aims to:
Of course, our most effective advocacy efforts aim to engage WAO members to capitalize on their medical expertise and experience– including creating opportunities for our physician members to meet with their local lawmakers.
In fact, now is the time for you to build relationships with your state lawmakers ahead of scope battles that are likely to unfold during the 2023-24 session of the Wisconsin Legislature. Optometrists could very well pursue legislation to expand their permissible scope of services in Wisconsin, as they have in several other states. In fact, there are now ten states – with Virginia and Colorado being the latest—that have expanded their optometric scope of practice laws to specifically include certain office-based laser procedures for glaucoma and post-cataract care. There are also current efforts underway in Nebraska and Washington state to pass similar optometric “scope creep” laws. Wisconsin could be the next target…
In addition, nursing special interests will almost certainly reintroduce their “APRN bill” – a proposal to create a new advanced practice nurse practitioner (APRN) license and authorize APRNs to prescribe medication and generally practice an expanded scope of care without direct physician supervision. A similar proposal introduced last session ignored the need for critical title protection for physicians.
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.
With potential scope of practice legislative battles on the horizon, it’s more important than ever for WAO members to connect with their state lawmakers to discuss the critical role of ophthalmology, as well as the level of education, training, and knowledge required of ophthalmologists.
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 meeting and will provide full support, including legislator bios, advocacy tips, issue briefings, and supporting documents.
Fierce Healthcare – By Frank Diamond | Jan 6, 2023
Noncompete agreements have become so ubiquitous that a proposed rule published by the Federal Trade Commission (FTC) yesterday will affect almost all industries, experts say.
Healthcare will be no exception, Carrie Amezcua, an attorney with the law firm Buchanan Ingersoll & Rooney, told Fierce Healthcare. She said healthcare industry executives should keep a close eye on the debate about the rule.
The public has 60 days to submit comments before the FTC can make it final.
“It could still change—it could still be challenged actually—because it goes too far from what the FTC has the authority to do,” said Amezcua, who usually represents employers in disputes over noncompete agreements.
Backlash to the rule has already begun. In a statement, the U.S. Chamber of Commerce called the regulation "blatantly unlawful."
The rule falls under Section 5 of the FTC Act, which bans unfair methods of competition. So, not-for-profit healthcare systems would not be covered by the rule, said Amezcua.
“For physicians, if they are working directly for a hospital, and that hospital is a nonprofit, that hospital is not actually covered by the FTC act. So that hospital is not subject to this rule,” said Amezcua.
About 45% of primary care physicians employed by group practices are bound by noncompete agreements, according to one survey (PDF) by researchers from various universities.
Amezcua added: “Insurers are not exempt from the FTC Act. They would be subject to this rule in its final form. And right now, it is written as a complete ban on noncompete agreements, post-employment. You could still have a noncompete during your employment. But you can’t have the provision that says you can't work for another company for two years after you leave.”
Once used to keep high-level executives and salespeople from running off to competitors with sensitive and proprietary company information and clients, the agreements have evolved to a point where many workers making minimum wage at fast food establishments aren’t able to change jobs because they’d signed a noncompete agreement.
The FTC said employees often agree under duress: Either sign or lose your job.
Elizabeth Wilkins, the FTC’s director of the office of policy planning, said in a statement that “the proposed rule would ensure that employers can’t exploit their outsized bargaining power to limit workers’ opportunities and stifle competition.”
If enacted, the rule would boost wages by about $296 billion a year, according to the FTC.
Echoing Amezcua’s remarks about FTC overreach, Sean Heather, the Chamber's vice president for international regulatory affairs and antitrust, said in the statement that “Congress has never delegated the FTC anything close to the authority it would need to promulgate such a competition rule.”
Kristen Limarzi, a partner at Gibson, Dunn & Crutcher, was once a senior official in the antitrust division of the Department of Justice. Limarzi told Fierce Healthcare that she’s not convinced by the economic research the FTC used to justify the rule.
Limarzi said that “FTC Commissioner Christine Wilson argued in her dissent that the empirical evidence is more mixed and that studies show noncompete provisions can incentivize employer investment in things like worker training that ultimately benefits both employers and workers. The impact of a noncompete in any particular industry is likely quite fact specific. But the FTC rule would impose a nationwide ban.”
But Heather also said that “attempting to ban noncompete clauses in all employment circumstances overturns well-established state laws which have long governed their use and ignores the fact that, when appropriately used, noncompete agreements are an important tool in fostering innovation and preserving competition.”
However, evidence seems to be mounting that states will not side with the U.S. Chamber of Commerce when it comes to noncompete agreements, and in fact, might impose even more restrictions than the FTC rule would.
The proposed rule “is a floor and not a ceiling,” said Amezcua. “So, some states have even more restrictions right now, like California, on noncompete agreements. That would stay and be enforceable regardless of what the final rule says.”
North Dakota and Oklahoma also, in effect, ban noncompete agreements. Some states—such as Illinois, Colorado and New Jersey—have not out-and-out banned noncompete agreements yet have nonetheless made them much harder for employers to defend.
New Jersey legislators introduced a bill that caps noncompete agreements at a year post-termination and would make employers pay the former employee their full salary, including benefits, for that year unless the employee had been fired for misconduct.
In other words, everybody—not just the top executives making millions of dollars—would get a golden parachute, or at least be afforded a soft landing.
In a tweet, President Joe Biden praised the rule.
"For decades, I’ve fought for the notion that if your employer wants to keep you, they need to make it worth your while with good pay and benefits," Biden said in the post. "Consistent with my Executive Order, today's FTC announcement to limit non-compete agreements is a huge win for workers."
Fierce Healthcare reached out to America’s Health Insurance Plans, the Alliance of Community Health Plans, the American Medical Association and the Association for Community Affiliated Plans for comment on the potential rule's impacts on the industry and had not received a response at the time of publication.
Wisconsin Academy of Ophthalmology
563 Carter Court, Suite BKimberly, WI 54136Ph: 920-560-5645 • WAO@badgerbay.co
