ASO EyeWatch December 2019 edition

Message from the President Peter Sumich

Season’s greetings to all members.

 It’s been a busy year with so many macro and micro challenges along the way.

There are the ‘big’ things that gain your attention through the media or our newsletters and then the ‘smaller’ housekeeping issues or ‘spotfires’ that need to be put out along the way. Often, we don’t report them to members because the big things take precedence. I like to think of ASO like a Norton anti-virus program always working in the background! For example:

Snellen acuity

One small spot fire which we needed to extinguish was the attempt by a government quality and safety commission to attach the diagnosis of cataracts to Snellen acuity. Once this becomes governmental policy it tends to find its way into descriptors for Medicare and health insurers. As we all know, Snellen acuity is an incomplete visual measure which misses all of the real world impacts of cataract on driving, evening vision, reading speed and subjective vision quality. Any attempts to attach Snellen to Cataract is purely a bureaucratic tool. At best it is a one-dimensional measure of vision to assist governments with waiting lists and insurers with exclusions.

Bundling

There is a constant attempt by health insurers and the MBS review to “bundle” items. Much of this debate occurs on Twitter and at the level of policy making bodies such as Consumers Health Forum and left-wing health economists. These folks populate the think tanks who influence journalists. These opinion makers must be combatted because they gain media coverage and influence government policy with impressive white papers which end up in government departments and ultimately in government policy.

For example, bundling cataract surgery with the anaesthetic fee and hospital fee for a single Global fee. The reason given to the media is to improve transparency for patients for their total bill and reduces out of pockets. However, the intention of the insurers will be to “Bundle and cut” in other words 1 + 1 = 1.3. Furthermore, there will be conflict amongst the three groups to work out which portion of the fee belongs to whom. I was engaged in consistent Twitter debate with several of its proponents especially Stephen Duckett. I also rebutted the idea at the Consumers Health Conference in Melbourne which was essentially a doctor bashing exercise in the guise of a policy forum. AMA President Tony Bartone and I sat there rolling our eyes.

My view is that bundling promotes less transparency because patients don’t have any idea what their bill is comprised of. Furthermore, the insurers will add the three elements together and cut the total to save themselves money. I brought up this issue with several of the politicians in Canberra and the health ministers office to ensure they are aware of our objections and reasoning. It is so important to make sure there are two sides of the story given to the decision makers in Canberra otherwise all they hear is the mainstream media which is of course dominated by the insurers and the think tank “experts”.

I also advised the Surgical Assistants Association on the dangers of bundling and they were even less keen than us on the bundling idea as proposed in their MBS review. The Council of Procedural Specialists could see it was the thin end of the wedge. The 2000 affiliate surgical assistant members communicated the possible changes to their lead surgeons, and to the hospitals in which they worked, and a posse of vocal objectors emerged. This groundswell of support was just before the last election and needless to say the idea of 5000 angry surgical assistants all around the country was not appealing. A quiet win that went unreported where ASO, COPS and aligned individuals made a difference.

I could prattle on but your time is short and Xmas rush is looming!

Message from the CEO

Recently I met with senior representatives of Optometry Australia (AO) at RANZCO headquarters in Sydney to discuss optometrist injecting for Macular disease. Your RANZCO CEO and I met with their own OA CEO, their policy advisor and their clinical advisor. It was polite but somewhat tense.

Those who have awareness of the huge threats that exist in running IT systems, have embraced malware protection. In the medicopolitical sense, National Governments and their health agencies have been “hacked” by those who seek to take control from doctors and hand it to less qualified providers. As Peter says above, your malware protection, in a professional sense, is the ASO! It must be updated yearly. Maybe we should call it Norton 360 Ophthalmology!

The discussion centred around Recommendation 19 of the Ophthalmology Report 2019 of the Ophthalmology Clinical Review Committee of the Medical Benefits Schedule (MBS) Review Taskforce. In outline, this recommendation proposed the task substitution of nurses and optometrists for Ophthalmologists in the treatment of complex eye diseases of the macula.

The OA group proposed that, the way to effectively overcome the “shortage of numbers of and services by Ophthalmologists” in the area of macula disease was to support the use of Optometrists in this area, particularly in relation to injections. Further, “the use of Optometrists in this area, by virtue of their specific training and focus, was a safer option than the use of nurses”. The group went on to reassure us that only a small number of Optometrists would seek to provide this treatment.

CEO RANZCO pointed out that the position of the College was quite clear. Specifically, the College did not support the unilateral treatment of complex eye diseases by anyone other than Ophthalmologists. This was based entirely on the paramount importance and primary consideration always of patient safety.

I, in turn, assured the OA group that the ASO position was exactly the same as that of the College. Again, based primarily on patient safety but also on the appropriateness of training and ongoing accreditation. I went on to suggest that they confirm and then resolve a number of issues first:

  • What is the actual problem they want resolved?
  • If there really was a problem, what was causing the problem?
  • If there is a true problem, is it clinical or financial?

We believe that there are no problems above that cannot be solved by ophthalmologists working with the Government. Medical retina services are widespread and with current MBS funding are affordable for most patients. The optometrists offered to work in the public hospitals in place of ophthalmologists however we pointed out that there are enough ophthalmologists in public hospitals to conduct the service if the State governments would increase their funding.

Therefore, there is no actual problem that they can resolve and no problem that can’t be solved with existing services if the government funding was made available.

The OA group left clearly disappointed and clearly angry with our strongly united and combined ASO/RANZCO response. They clearly indicated that OA was ‘not finished with this issue’ and would pursue the issue aggressively and politically by whichever means.

I am certain they will. While your President will tell you I am mostly an amiable individual, I must say that I was offended on your behalf when the OA clinical representative indicated how ‘simple’ the intravitreal injection procedure was by hand miming and demonstrating an injection with his fingers and thumb. “Just like this” he said.

To those who are truly not able to grasp the requirement for specialist medical training and knowledge behind an apparently simple procedure it is hard to convince them otherwise. It was a clear demonstration of the reason Macular management must remain under the purvey of ophthalmologists. We will await the next chapter in this Pandora’s box of professional fantasy.

Like your malware protection, you may never see it in operation, but your ASO is always out there working for you!

Merry Christmas!

 Kerry Gallagher
CEO

Welcome Back Katrina

We welcome back Katrina Ronne into the position of General Manager Policy and Strategy after her Maternity Leave. “I’m excited about the upcoming opportunities and challenges facing Ophthalmology in 2020 and eager to work with Government, ASO members and other stakeholders to help shape eye health policy that protects patients and their access to world class eye health care.”

Trainees are the future of Ophthalmology

We want to support our ophthalmology trainees during some of the toughest times in their medical career, their training!

Last month, in conjunction with our alliance partner MDA National, the ASO launched a complimentary membership initiative for Trainees. Trainees will receive t heir first 12 months of membership free with both ASO and MDA National. That is a collective saving of close to $300 and a priceless amount of protection.

Help us to get the word out to all our Ophthalmology trainees about this great offer please share with them our flyer and encourage them to join the ASO.

Click here to view the offer

Superannuation and your children

We know…..not another article encouraging you to spend more money on your kids, yes you have already covered private school fees, now double degrees at university and yet we want you to spend more… though it could be in a tax deductible manner.

Read more
http://www.cutcher.com.au/blog/medical/super-and-your-children

A wealth of Resources at your fingertips

After many months of work the ASO has launched its new website and membership area.

The site is full of patient resources around informed consent, understanding health insurance and the rights and entitlements of health consumers. We encourage you to utilise these tools to improve the health literacy of your patients.

Access these tools here: Patient Resources

Have you completed your profile?

Our website area also includes a public Find an ophthalmologist tool. We encourage you to update your profile, in particular: your business address, link to practice website, and also your areas of sub-specialty which will allow patients and GP’s the ability to match your services with patient needs.

The ASO has been offering free headshots at our recent events which have been extremely popular – if you missed the deadline to download your headshot please email us at info@asoeye.org. Please also use this opportunity to update your profile photo in the new membership system here: https://asoeye.org/log-in/

As the year 2020 fast approaches so does the ASO Business Skills Expo.

Building on the success we had in Melbourne this year we are holding the Expo at the Grand Hyatt for a second year on 20 and 21 June 2020! Our focus topics continue to be:

  • Marketing
    Tips and how to’s
  • Finance unlocked
    Break-out sessions for New Fellows & established eye surgeons
  • Practice management & staffing
    Hear from real-world case studies
  • Our insiders talk medico-politics       
  • MBS riddles explained        
  • Campfires Q&A sessions for New Fellows
  • Work/life balance
    Physio demos, self-care & more
  • Day surgeries in practise
    Get down to the Nitty gritty with our panel of experts

2020 will be bigger and better so please mark 20 and 21 June in your new year’s calendar! 

The boost your practice needs

Behind every successful ophthalmologist is a team of highly trained practice staff.

Are your staff accessing the training they need?

Thanks to our partnership with established online training provider Eye Learning, ASO members have exclusive access to training courses for ophthalmic assistants and ophthalmic receptionists at a discounted rate.

Click here to open flyer.

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