EyeWorld/ASCRS reporting live from Hawaiian Eye 2020 in Kauai, Hawaii, Sunday, January 19, 2020

The Hawaiian Eye meeting focused its Sunday programming on a variety of practice management topics and also featured a special guest speaker.

‘The Changing Ophthalmic Practice Environment’

A panel session on Sunday morning, led by Allison Shuren, MSN, JD, Washington, D.C., and Candace Simerson, FASOA, COE, CMPE, Marana, Arizona, featured discussion on the evolution of payer policies.
Other panelists included Patti Barkey, COE, Jacksonville, Florida, John Berdahl, MD, Sioux Falls, South Dakota, H. Bard Coats, MD, MBA, Las Vegas, Nevada, Kevin Corcoran, COE, CPC, CPMA, FNAO, San Bernardino, California, Allen Ho, MD, Philadelphia, Pennsylvania, and Cynthia Matossian, MD, Doylestown, Pennsylvania. Ms. Simerson started out by noting that large payers and the government are probably the biggest policy influencers. The individual would not change how policy is developed, she said.
The first topic discussed was pharmacy benefit management programs. Ms. Simerson and Ms. Shuren shared several points on the issue: practices are struggling to actually get the prescribed drugs to their patients; payroll costs increase as practices add designated staff members who oversee prior authorizations, medication substitutions, etc.; specialty pharmacies are on the rise, but the general public doesn’t understand their role and many times prefer their personal, traditional pharmacy; the delay in care created by these impediments creates a risk concern; and drug substitutions are on the rise, no longer just generic substitutions.
On this issue Ms. Barkey said, “a lot of things are out of our control.” At the end of the day, the patient experience is expected to be in our control by the patient, she added. If the patient is given a prescription and is told by the pharmacy that they can’t have it, they will come back to the physician and their staff, she said, adding that it’s important to create systems to better understand this process.
If you make the decision to prescribe newer/certain drugs, you have to have a process in place to make that happen, Ms. Barkey said. It’s also important to remind staff that they’re not prescribing physicians, so you have to have a process for reviewing alternatives when a medication isn’t available, she said. And if you’re going to prescribe newer drugs, you have to have someone in your office in charge of this process, she said. It will cost you more, but otherwise, patients are going to be angry, she said.
Another topic addressed was immediate sequential bilateral cataract surgery and some of the obstacles that might be affecting this in the United States.
Dr. Berdahl said that one of the reasons surgeons don’t do cataract surgery on the same day for both eyes is because they would lose too much money. He noted a study by Alcon on patients’ concern surrounding cataract surgery. The biggest concern, he said, was “when can I get back to my normal life.” If the cataract surgeries are a week to month apart, that’s a big chunk of time, Dr. Berdahl said.
“To me, this is a place where we can find common ground,” he said. The key would be a fair payment model to allow doctors to get reimbursed properly to allow patients to get back to normal life as soon as possible, he said.
Dr. Matossian agreed with Dr. Berdahl, and she noted that with current formulas, IOLs, guidance systems, and other technology, you can get closer to refractive targets. “I think the only hurdle that’s remaining is the insurance issue,” she said. If we can get that resolved, there would be huge benefits for patients to have sequential cataract surgery, she said.

Editors’ note: The panelists have financial interests with a variety of ophthalmic companies and consulting services.

Special guest speaker

This year’s special guest speaker was Alison Levine, the first American women’s Everest expedition team captain. Her accomplishments include climbing the highest peak on every continent, skiing across the Arctic Circle to the geographic North Pole, and more. She also wrote a book titled “On the Edge,” which explores leadership lessons from Mount Everest and other extreme environments.
Ms. Levine also has experience in the ophthalmology industry, working for 12 years with a number of different pharmaceutical companies.
She began by discussing the American women’s Everest expedition team, adding that she initially turned down the offer of being team captain, because she felt like she wasn’t going to be good enough and it felt like more of a challenge than she was ready to take on. But she then realized that there would only be one first American women’s Everest expedition, so she agreed to take the position.
Ms. Levine went on to discuss putting together both funds and team members for the expedition and detailed the specifics of climbing Mount Everest, including the various camps and elevations. You have to let yourself get accustomed to the altitude very slowly, she said. Anytime you’re above 18,000 feet, your body is starting to deteriorate, and your muscles are getting weaker, she said, so you have to keep going back down to base camp to recharge, she said. We often think that progress happens in only one direction, she said, but sometimes you have to move backwards to go forwards. She said that “backing up is not the same as backing down.”
Ms. Levine shared photos from various areas on the climb, noting hazards like crevices (that have to be crossed on ladders), moving ice chunks, and more. She also shared examples of having to push through incredibly difficult situations. “When you’re in a leadership position, even when you feel like absolute hell, you still have to get out there and do your job,” she said, noting that everyone in the room listening to her speak is in a leadership position. Every member of the team has a responsibility to help that team move toward a goal and to look out for one another, she said. As a leader, you can’t expect everyone on your team to endure anything that you’re not willing to endure, she added.
On Mount Everest, you have zero control, Ms. Levine continued, with a major factor out of individual control being the weather. Within minutes, everything can change, she said, so you have to take action based on the situation at the time and not based on the plan.
Ms. Levine went on to discuss her attempt to summit Mount Everest with the American women’s team in 2002, including a scary moment when her oxygen malfunctioned. Her team made it to the South Summit, but shortly after that, storm clouds started to come in, and they had to make the tough call to turn around only a few hundred feet from the summit. “Turning around and walking away is harder than continuing on,” she said, but you have to be able to make tough decisions when conditions are far from perfect. However, she stressed that every move you make will affect others as well.
It’s disappointing to spend 2 months on the expedition and miss it by so little, Ms. Levine said, but you only have enough gear, supplies, and oxygen to go through it once. Despite not making it all the way to the top, she still considered it an accomplishment to make it that far.
After deciding to turn around, Ms. Levine detailed the struggles the team still faced on the descent, including a white out that forced them to spend the night at 26,000 feet and an ice avalanche at an area they’d already passed through several times without incident.
Despite not making it to the summit on that trip, Ms. Levine ultimately was able to reach the summit of Mount Everest in 2010 in honor of her friend, Meg, who had passed away.
When you’re going to try hard things and set high goals and really truly embrace the spirit of innovation, you have to give yourself and your team the ability to fail, she said. And you have to remember that nobody gets to the top of Everest by themselves.

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