by Niko Corley
Director of Legislative Affairs, Medical Association of the State of Alabama

The past two years have seen a couple of states pass legislation to lower eye surgery standards by allowing optometrists to perform laser and scalper surgery and eyeball injections. In Alabama however, the Alabama Academy of Ophthalmology (ALAO), the Medical Association of Alabama, the Alabama Dermatology Society (ADS) and other medical specialties have so far successfully pushed back against such inappropriate scope expansion attempts. Together, we are stronger.

While the total number of states having granted optometrists surgical privileges is a small minority at less than 10, their having done so still raises concerns for anyone who supports high standards for surgical care. Medical school is important and medical residency is important, as together they prepare physicians to best care for patients as safely as possible. As we see each year with the various “scope creep” proposals however, not a year goes by that some group or another (usually several) don’t propose legislation to grant non-physicians who haven’t graduated medical school or medical residency de facto medical degrees via legislative act.

But time and again, we’ve seen the best way to combat scope creep is locally. When individual physicians seek to inform their Senator and Representative of the impact of a particular piece of legislation, most often those men and women will listen. More physicians became involved this year than we have seen in the past and that is exciting to see! Now we must keep up that momentum moving forward.

Each physician only has one Senator and one Representative in the State Legislature. If a physician doesn’t know his or her local legislators, it is important he or she do so, and do so now. Getting to know just two more people is not much to ask, even of physicians, especially given those two people vote on matters directly affecting medicine and patient care.

The collective, collaborative efforts of our medical societies can continue to protect patients so long as we continue to increase physician outreach to legislators. You are your patients’ best defense. There just is no replacement for grassroots contacts from constituents, especially physicians, as few legislators are experts in healthcare matters and so they welcome feedback (to connect with your local legislators and begin to foster a relationship, email the author of this article).

As the 2021 session comes to a close, our work is only beginning. We must build on the tremendous work our allied organizations have already put in the past few years and amplify the voices of physicians and patients concerned about the future of care delivery. Together, we can continue protecting patients and defending high standards for eye care in Alabama for years to come.

Contact Niko Corley at ncorley@alamedical.org.

Senate Bill 174 by Sen. Whatley, McClendon, Scofield, Shelnutt, Beasley and Holley has been introduced into the 2021 legislature and sent to the Governmental Affairs Committee for consideration.

The bill proposes adding the following procedures to the practice of optometry:

• Injections, excluding injections into the posterior chamber of the eye to treat any macular or retinal disease.
• Incision and removal of chalazion.
• Removal and biopsy of skin lesions involving the lid and adnexa.
• Laser capsulotomy.
• Laser trabeculoplasty.
• Laser peripheral iridotomy.
• Corneal crosslinking.

In addition, the bill would give sole authority to the Alabama Board of Optometry to determine what constitutes the practice of optometry.

The Alabama Academy of Ophthalmology opposes this bill.

Please contact your senator to tell them the danger this would represent for Alabama patients. You can visit https://alabamamedicine.org/advocacy/find-your-legislator/ to find the contact information for your local senator.

The Centers for Medicare & Medicaid Services (CMS) released the updated calendar year 2021 fee schedule on Jan. 5. This update was expected after Congress passed legislation in December to reduce scheduled payment cuts.

As a result of the Consolidated Appropriations Act of 2021:

• CMS incorporated a 3.75% positive adjustment into the 2021 physician payments. CMS had planned cuts of 6% to 10% for ophthalmology in the final 2021 Physician Fee Schedule released in December. Due to the 3.75% adjustment, ophthalmologists’ reimbursements will largely be improved and some practices may even see increases. The effect will vary by practice and provider.
• Payment for the add-on complexity code (G2211), which was significantly negatively impacting the conversion factor, was delayed for three years. The Academy will continue to fight for fair reimbursements for ophthalmologists.
• The original 2021 conversion factor was set to be a reduction over 10% from the 2020 rate. However, due to Academy efforts along with the Surgical Care Coalition and physicians across the country, CMS announced this week that the 2021 conversion factor would be $34.89, a 3.3% reduction from the 2020 rate.

Because of the unprecedented nature of the disruption to everyone’s financial status, early in the course of the pandemic the leadership of ALAO decided to temporarily halt any fundraising campaigns, knowing that our core constituency was focused on more important things. But, and there is always a but, we also have to be pragmatic and we know that the issue of inappropriate scope expansion will not go away.

Our advocacy team assures us that those who seek to reach equivalence to you through legislation have not given up. We will face what is likely to be a very aggressive push for dangerous expansion of surgery to non-surgeons when the 2021 Alabama Legislature starts.

So despite the fact that we are all still in the midst of fighting the pandemic, we must again turn our attention to the threat at hand.

I need two things from each of you. First, contact your state senator and representative and tell them why "Surgery by Surgeons" is a no-compromise position from us. Take them to coffee, call them, whatever it takes to get that message across. We will be working with the Medical Association of the State of Alabama and our advocacy team to set up video conferences with legislators as well.

Second, pay your membership dues and make a contribution to either our PAC or Surgical Scope Defense Fund (or both!) PAC contributions must be reported to the Alabama Secretary of State but SSDF contributions are not. If you have concerns about your name getting out, give to the SSDF. We cannot use these funds for campaign contributions, but we will put them to good use supporting our advocacy efforts.

Our website allows one-time and recurring donations. Even if you had signed up before, because we changed banks after the first of this year, you will need to go to the site and reenter your donation information.

Our 2021 Membership Dues year will open on Oct. 1, with statements being sent out in January. You may go online anytime after Oct. 1 to pay your dues.

Your membership and your donations make us strong in the fight against scope of practice infringement. Please thoughtfully consider donating today!

Russell W. Read, MD, PhD

Make a Donation

The Alabama Hospital and Healthcare Guide 2019 is now available from Medical Publishing, LLC. The link has been placed on the Member Resources page.

Alabama Senate Bill 114, a dangerous scope of practice expansion that would have allowed non-surgeons to perform eye surgery did not advance out of the Senate Health Committee and thus has died this legislative session. The Alabama Academy of Ophthalmology thanks everyone who worked to defeat this threat to patient safety.

Today the Alabama Academy of Ophthalmology unveiled its website redesign. Intended to provide more up to date information for members of the Academy, the website redesign features improved navigation on mobile devices and a more modern design.