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President's update
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A bi-monthly blog detailing the latest news and perspectives from the president of the Colorado Society of Eye Physicians and Surgeons.

 

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President's Update: July/August 2018

Posted By Administration, Tuesday, August 14, 2018

The ongoing mission of CSEPS is to promote excellence in patient care through advocacyeducationand fostering professional fellowship.  We strive to achieve this noble mission through a variety of methods that are relevant and practical to you as a practicing eye physician in Colorado. So what have we been doing to attain these goals recently? 

 

Advocacy

We are constantly monitoring potential legislation that may impact you and your ability to provide the best care for your patients. With the adjournment of the 2018 legislative session on May 1st, our focus is shifting toward the election cycle and maintaining a base of support for ophthalmology at the capitol.  Building relationships with freshman legislators and reinforcing friendships with veteran lawmakers is crucial to ensuring strong support for ophthalmology in our state.  

 

As president of CSEPS, one my priorities is to double down on these efforts to maximize our voice at the capitol. Our society leadership has excelled in this endeavor in years past, but I need your help to ensure success in the future. During the current election cycle we need CSEPS members who can help develop and bolster these friendships for our profession. Our society can provide you with the campaign check, you just need to give 30 minutes of your time to meet and sit down with your local legislator and provide some real-life experiences of what a Colorado ophthalmologist does to improve and save vision in our state.  Although this may sound daunting to some, I am still amazed at how laid back and rewarding these interactions can be and what a lasting positive impact we can leave. If you have an interest in getting involved as an advocate, please email our executive director, Chet Seward at to get more information. 

 

Education

In September, CSEPS will again partner with the University of Colorado Department of Ophthalmology to deliver their 22ndannual Ophthalmology Symposium.  The ACCME accredited course will include a mixed format of didactic lectures, open forums on high yield topics, and challenging case discussions.  Course lecturers include department faculty as well as five invited nationally renowned experts from different ophthalmology subspecialties. Members of CSEPS receive a discount on registration for this course. Complete meeting information and registration is available, so register now


Fostering professional fellowship

Last month, CSEPS held a lively social mixer at Top Golf in Centennial. Despite the heat, members in attendance enjoyed some excellent food and drink while socializing with colleagues. While the top golfers will not be revealed on this newsletter, I am confident everyone released a healthy amount of stress on the golf balls that day.  Stay tuned for future social events coming up in the fall/winter.

 

Finally, I want to thank you for your membership in CSEPS – it is an essential step toward achieving our collective vision for our profession and the patients we care for.

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President's update: May/June 2018

Posted By Chet Seward, Friday, June 8, 2018

Colorado ophthalmologists went to Capitol Hill in Washington D.C at the AAO Congressional Advocacy Day last month. Joined by over 400 colleagues from every state, we met with our nations legislators and staff to advocate for our profession and our patients. 

The five principal agenda items this year were:

  • Maintain access to compounded and repackaged drugs – particularly for intravitreal injections
  • Simplify Merit-based Incentive Payment System (MIPS)
  • Support the VA’s Technology-based Eye Care Services (TECS Program)
  • Secure regulatory relief from over-burdensome prior authorization requirements
  • Support funding increases for the NIH/NEI and the DOD’s Vision Research
Colorado Advocacy Ambassadors Drs. Erin Sleck, Michael Wildes and Cullen Ryburn.

It is always a point of pride to witness our consistently strong delegation from Colorado at this crucial event.  In addition to practicing CSEPS members, this year we were accompanied by three residents from the University of Colorado to serve in the Academy’s Advocacy Ambassador program. This innovative program is designed to educate and motivate our young ophthalmologists on the vital importance of advocacy for our profession.  These young doctors are often the most convincing voice in legislative meetings. As a product of CSEPS mentorship and this program myself, I firmly believe we must continue to cultivate this upcoming generation as our future leaders.

For those unable to make it to D.C this year, we were extremely fortunate to have AAO president Keith Carter, MD, visit our great state just a couple weeks ago.  He provided CSEPS members in attendance with an extremely informative briefing on the Academy’s agenda items in 2018.  Some key tasks included building “big data” through the IRIS registry and utilizing its power to improve clinical outcomes and fulfill billing requirements, online education revamps/updates, preparing for a shift in reimbursement methods, and grappling with scope of practice issues not only for optometry, but physician extenders such as nurse practitioners and physician assistants as well.  

Dr. Carter also provided an in-depth review of surgical scope victories and defeats throughout the nation in years past as well as ongoing and proposed future battles. Fortunately, in Colorado, we have enjoyed good relations with our optometry colleagues with no major scope battles in recent years.  These battles can be extremely challenging and costly to defend patient safety and maintain surgery by surgeons.  I encourage you all to contribute to the Surgical Scope Fund, which provides targeted support to these battleground states every year.  Furthermore, consider contributing to OPHTHPAC and our state EYEPAC, which provides support to physicians and political candidates who support ophthalmology’s interests on the national and state level, respectively.

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President's update: March/April 2018

Posted By Chet Seward, Friday, April 13, 2018

Spring is a beautiful time in Colorado as the temperatures climb, trees begin to awaken, and native wildflowers bloom as the snow fades into swelling rivers. It’s a great time to venture outdoors more and experience the expansive beauty of our wonderful state. It is also a crucial time for advocacy for our noble profession and the patients we take care of on a daily basis. The recent news of Anthem’s denial for coverage of monitored anesthesia care (MAC) during cataract surgery is just one glaring example of why we must be vigilant to combat assaults on our ability to safely and effectively care the for the eye health of our patients. 

On a national level, the AAO Mid-Year Forum meeting will take place April 18-21, 2018 in Washington, DC. The pinnacle of this event is the Congressional Advocacy Day where I will join a delegation from CSEPS to meet with our national legislators from Colorado to build support for key ophthalmology issues affecting our field across the country. 

Here in our great state of Colorado, we continue to closely monitoring several relevant legislative measures including the recent signing of HB 1012 by Governor Hickenlooper on March 29. CSEPS helped support this bill which prohibits vision care plans from setting onerous and overreaching requirements on eye care providers. As part of our continuing mission, CSEPS will continue to work through advocacy and lobbying efforts on your behalf to support measures that support your practice and oppose those that work against it. 

Finally, I want to thank everyone that attended our first ever legislative reception on April 12. It was a strong showing on behalf of ophthalmology.

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President's update: Jan/Feb 2018 – One step

Posted By Leo Seibold, MD, Wednesday, February 7, 2018

Greetings fellow Colorado ophthalmologists, 


Leonard Seibold, MD

It's hard to believe we are already into February of the new year! Time certainly waits for no man, and only seems to pick up steam with each passing day. With this in mind, we have to remind ourselves to seize the opportunities of each day before we find ourselves at the end of year wondering where it all went.  
As I take the helm for CSEPS in 2018, I would like to congratulate and thank our outgoing president, Alan Kimura, for his skillful leadership in the year past. He epitomizes what an advocate should be and has remained committed to service for our profession and our patients.

One of the most inspiring speakers during the AAO leadership development meeting was a man who is helping to lead the fight against human trafficking in the United States. As a successful businessman he had no experience whatsoever in fighting these atrocities, but he knew it was wrong, and he simply took "one step" to do something about it. That "one step" led to the next one, and so on until his rudimentary but inspired efforts led to the creation of an international foundation dedicated to this humanitarian mission. It was an inspiring story that resounded with me and exemplifies the profound impact of simply taking that initial step. 

The mission of CSEPS is to promote excellence in patient care through advocacy, education, and fostering professional fellowship. We can only accomplish this through your membership and engagement. So as your new CSEPS president for 2018, I invite all of you to join me in taking just "one step" forward for our noble profession. No matter what your past involvement has been, there are a number of ways you can do that this year.

  • If you have been sitting on the sidelines, take that first step toward joining ranks with your fellow ophthalmologists as a member of CSEPS. 
  • If you have been a member but never participated in any program, make your one step be attending one of the many educational, practice management and social events held throughout the year. 
  • If you are already a participating member, consider making that next step in serving on our board of directors or becoming an advocate at the state or national level.
  • Connect with your local representative and invite them to your clinic and operating room to bolster support for ophthalmology and our patients in the legislature. 

Sometimes that first step is the most difficult one to take, but it may start you on the path to achieve feats you never thought possible. So, take that first step with me, and let's see what we can accomplish together in 2018.

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President's update: Nov/Dec 2017

Posted By Alan Kimura, MD, MPH, Monday, December 11, 2017
Our profession of ophthalmology remains strong in Colorado.
There is plenty of credit to go around.

We are fortunate to have many committed physicians across this state working daily to restore and preserve vision. It is impressive how hard we work for our patients not only in clinic and surgery, but also to sustain our own practices. 

Autonomy, mastery and purpose are the pillars of physician engagement at work
The higher purpose of serving our patients, is attained only after achieving mastery of a number of domains. To complete residency/fellowship, and then build a successful practice, takes nearly half of our lifetime.

Surely, the vehicle for a career in medicine remains the practice – the way forward to achieve true mastery in the 21st century is to revitalize our practices for an increasingly data-driven, value-based and patient-respectful delivery of care. 

I am taking our practice through a journey of growth and renewal, collaborating with peer practices, and studying modern business practices (Toyota “lean”, and data analytics, to inform our business strategy). Our practice’s unique path of transformation is a creative expression of our autonomy.

The case for continuing your annual support of CSEPS
One ophthalmology practice alone, however competent, cannot stand alone in today’s healthcare ecosystem. 

Many other states faced scope of practice expansions in 2017, so we need members to stay engaged, to fend off these and other threats to our livelihood.

We should be grateful that CSEPS has a very strong executive director and lobbying team in the State Capitol, with their ear to the ground. CSEPS remains vigilant and has proven highly effective in defending our profession in both the legislative and regulatory arenas.

Challenge ourselves to reach higher, to serve our communities better
The USA has prioritized healthcare delivery over the social determinants which maintain health (housing, jobs, food, transportation). In a comparison with other industrialized nations, the USA’s outsized spending on healthcare in relation to the value achieved (life expectancy, infant mortality, etc.) is more readily explained. As a result, there remain many uninsured and underinsured people in our communities unable to access or afford our services. By the time they present for care, the missed opportunities to affordably treat disease at an earlier stage are lost, leading to greater costs borne by the payers of care (ultimately all of us). 

The opportunities to provide care for the uninsured remain an unmet community challenge. We have tried unsuccessfully to organize a free ophthalmic surgery day over this past year, and hopefully a collective, renewed effort will succeed in 2018.

Thank you all for your hard work on behalf of our patients in 2017
It has been my privilege to have served our profession as president. As my year comes to an end, I ask only for your continued strong support of CSEPS annually. CSEPS is the only professional organization built to defend and promote ophthalmology’s interests – enabling us to fulfill our purpose as healers.

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President's update: Sept/Oct 2017

Posted By Chet Seward, Sunday, October 15, 2017
What to do with your practice amidst all the turbulence in health care coming from Washington, DC? Many others ask this question, as one-sixth of US economic activity flows through the health care ecosystem. Uncertainty in the fate of the individual insurance markets, and Medicaid cost sharing with the federal government, all create problems closer to home at the state-government level. Furthermore, MACRA and MIPS bonuses and penalties loom on the near horizon for physicians directly.

I invite you to imagine what is possible, and importantly, under our own control, when we shift the focus of health care reform and value-based care from externally imposed to internally driven improvements. By working upon your own practice, you begin to solve the challenges that characterize your practice’s unique combination of strengths and weaknesses. There is plenty to do to improve your practice for intrinsic reasons, but also to survive the transition from fee-for-service to value-based payments. Inefficiencies within your practice are a threat to your practice, like never before.

The foundation for physician-directed practice improvements rests upon three pillars: autonomy, mastery, and purpose. Much has been written lately about these elements relating to “physician engagement with work.” We need to find these three elements in our daily work, and over the course of our professional careers, to ultimately find fulfillment. Activities that do not feature these three principles, especially for high-achieving professionals like ophthalmologists, lead to frustration, and ultimately increase the risk of burnout.

When working hard to create your own solutions to problems, you find pleasure in the exercise of autonomy. As your practice becomes more proficient, the pleasure of mastery is manifest. A higher-performing practice allows the individual and organization to fulfill its purpose. Yes, it is possible to find joy in our work, rooted in these three supports.

What does this look like in practice? The choice of solo versus group practice boils down to how strongly one values autonomy. There are definite trade-offs to either choice. For some, achieving mastery is found by working alone, while for others, mastery is better enabled through the advantages of a group practice. Whether in solo or group practice, a lifetime of feeding one’s curiosity, and an ethos of continual learning and self-improvement eventually leads to mastery. At a minimum, one must continually evolve their clinical and surgical skills, as well as basic business skills – but at some point in one’s career, we grasp the importance of community and advocacy to achieve a higher purpose – service to others.

As president, I highlight that CSEPS is the cement of this foundation. CSEPS provides opportunities to create vital social bonds with like-minded professionals. CSEPS also provides forums to learn from outside experts, such as AAO Past-President Ruth Williams’ cutting-edge talk on private equity last month. Finally, CSEPS is the only purpose-built organization that exists to defend our professional autonomy, supporting our individual and collective efforts to achieve professional mastery, and ultimately fulfill our purpose as healers.

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President's Update: July/August 2017

Posted By Chet Seward, Wednesday, August 9, 2017

Changing our focus for this CSEPS President’s newsletter, instead of outward-looking federal and state advocacy, let’s look inward into our own ophthalmology practices. 

Our 11-physician practice is headed into our Annual Partners’ Retreat in August. This critical inward look at our practice is a yearly exercise – a vital task of any organization, no matter its size. Indeed, it may be even more important for a solo or small practice that may not frequently ask hard questions of it’s self. It is axiomatic that no organization looks to find fault in itself, or to force a foray into the unknown.

A common entry point into organizational, or personal, self-assessment is the SWOT Analysis. SWOT is an acronym for strengths, weaknesses, opportunities and threats. It is a simple framework for taking stock of the company and planning for its future. Examples of questions common to many businesses, including healthcare are included in the SWOT 2x2 matrix below. 


Source:http://www.cbpp.uaa.alaska.edu/afef/swot.h1.jpg.

Strengths and weaknesses are internal factors, whereas opportunities and threats are external to the practice. The easier work, or the fun part, is to list your practice’s strengths and opportunities. The more difficult, painful and therefore most likely to be ignored are your practice’s weaknesses and threats to its existence.

The stress for every organization doing the necessary, hard work of looking inward at its weaknesses is perilous for those leading this inquiry. There are strong inertial forces deeply invested in maintaining the status quo. Significant resistance and pushback is the expected default position, often making significant change an uphill climb. Sisyphus, the character from Greek mythology is forced to roll a massive boulder uphill, only to have it fall back upon him, in a never-ending cycle of labor and futility. So, why would anyone undertake such an endeavor?

An organization that either undergoes a process of internal, or external review, of itself will identify areas that diminish its performance. These internal weaknesses are barriers to achieving greater success, or risk their organization’s demise, if continually swept under the carpet.


Source:https://www.planplusonline.com/wp-content/uploads/2014/06/The-Simplicity-on-the-Far-Side-of-Complexity_blogheader1.png

It is a false economy to not invest the time and energy performing this vital self-assessment. It is less effort to coast, rather than actively steer the organization. However, the state of ease we all seek, entails first passing through a difficult period of disruption. This is called “simplicity on the far side of complexity”.

As for the external threats to your medical practice, I circle back to the reason for CSEPS existence -- CSEPS is the only purpose-built professional organization representing Colorado’s ophthalmologists. CSEPS dues support extremely hard-working staff and lobbying activity, directed by a voluntary board of directors (peer ophthalmologists). CSEPS is in a bi-directional exchange of information between the grassroots ophthalmologist and the national organization, the AAO, via the Council. CSEPS is also your voice at the critical state-level, where both legislation and regulation often create the greatest impact upon your practice. 

So, I hope I have stimulated your thinking on this vital topic. I encourage you to have this conversation within your practice. We all collectively benefit by having more robust and adaptive ophthalmology practices, acting in concert, to provide the best care for our patients. Thank you all for your hard work in the communities you serve.

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President's Update: May/June 2017

Posted By Chet Seward, Wednesday, May 24, 2017

Colorado sent its largest delegation of ophthalmologists to the nation’s capital April 2017 to attend the AAO Congressional Advocacy Day & Mid-Year Forum. This “fly-in” is the American Academy of Ophthalmology’s signature federal advocacy event. While emails to Congress are appreciated, there is nothing as powerful as when physicians give up a day of their practice to perform face-to-face advocacy. (See all of the photos from our trip here.) Physicians are the subject matter experts on medicine, but have greater impact upon legislation when we can tell our own stories of practicing medicine under the ACA, MACRA and MIPS.

Multiple generations of actively practicing ophthalmologists bore witness before our Congressional representatives. The more experienced doctors were delighted with how those attending for their first time learned the craft. The younger physicians spoke to their future careers in medicine caring for an ever-aging population with chronic eye diseases. Recognizing the need to develop the next generation of ophthalmology leaders to be effective leaders, a cohort called the Advocacy Ambassadors was brought to Washington, DC. Both CSEPS and the University of Colorado sponsored an ophthalmology resident to be part of the Colorado delegation. This program has been very successful on many levels and will continue to thrive.


Members of the Colorado MYF delegation. From top left back row: Drs. Leo Seibold, Prem Subramarian, Lacey Echalier, Ron Pelton, Niranjan Manoharan, Peter Hovland, Front row left: Drs. David Johnson, Rebecca Braverman, Robert Fante and me.

Not only were all the ophthalmic specialties represented, but also academic and private practices were present. The breadth and depth of clinical experience at the table were CSEPS’ strength. All our challenges with insurance networks, pre-authorization, timely drug access, EHR and reporting burdens, so well-known to us, are a small part of the discussion informing federal legislation – unless there is very strong representation by the grassroots ophthalmologists. Several hundred ophthalmologists descending upon The Hill on a single day provides great weight to assist AAO’s Washington team in leveraging ophthalmology’s position.

While not every Colorado ophthalmologist can sacrifice a day away from their practice to attend this annual event, there are ways to directly or indirectly support the effort to protect our field. The most important is to simply commit to being a dues-paying member of CSEPS every year. I also encourage you to contribute to EYEPAC and the CSEPS Small Donor Committee so that we have the necessary resources to make contributions to Colorado candidates that support our priorities. CSEPS defends ophthalmology interests at the state level, and simultaneously provides representation of Colorado at the national level in the AAO Council. Our Congressional members return to their districts throughout the year, and we would be happy to assist you with talking points when you meet with them.

In summary, the AAO Congressional Advocacy Day and Mid-Year Forum in 2017 was both very successful, and very enjoyable. Thank you, again, for your membership dues -- CSEPS will continue to support your practices and our patients’ interests at the state and federal level.

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President's Update: March/April 2017

Posted By Chet Seward, Friday, March 24, 2017

The raison d’etre for the existence of an organization over that of an individual is clear – to accomplish what a single person cannot by acting alone.

In the case of ophthalmology in Colorado, the Colorado Society of Eye Physicians and Surgeons (CSEPS) is the collective voice of Colorado’s ophthalmology community. But CSEPS is part of a larger ophthalmic community nationally.

The state ophthalmology societies rely upon each other to act collectively in a number of ways. Sometimes it is to develop model legislation useful in other state capitols. At other times it is to provide mutual protection of our interests and that of our patients.

Our colleague from Colorado Springs, Ron Pelton, MD, PhD, represents our interests in the AAO State Affairs section. His letter highlights the need for each of us to do our fair share in contributing to the mutual defense of our profession, our patients, and our practices.

Please join me, and all the members of the CSEPS Board, whom are contributing to the Surgical Scope Fund. While you’re at it don’t forget about supporting advocacy efforts here in Colorado by donating to the CSEPS EYEPAC and the CSEPS Small Donor Committee. All of these funds are critical to help protect you and ophthalmology’s priorities.

Thank you kindly for contributing to the Surgical Scope Fund now, and making a positive impact for our patients and our profession. 

Alan Kimura, MD, MPH

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President's update: Jan/Feb 2017

Posted By Chet Seward, Friday, February 17, 2017
Greetings, my fellow hard-working ophthalmologists in Colorado!

It is an honor and privilege to be the next President of the Colorado Society of Eye Physicians and Surgeons. CSEPS is the only purpose-built professional organization designed to represent our profession at the state level. In turn, CSEPS is a component in the larger American Academy of Ophthalmology’s Council, where our collective voice is expressed through our CSEPS Councilor Rebecca Braverman, MD.

At this time in history, we have a new President of the United States, a new Congress, and a newly confirmed Secretary of Health and Human Services. Dr. Tom Price, an orthopedic surgeon, has been a vocal critic of the Affordable Care Act, previously as a US Senator. Much uncertainty over repealing and replacing the ACA exists. But it is clear that the inherent complexity of our $3,200,000,000,000 healthcare spend is fragmented by different views of politics, economics and culture – making consensus difficult.

As the new contours of our political landscape emerge on the federal level, there is perhaps more impactful legislation to attend to at the state level. We have bulked up and are punching at a higher weight class for our size: we have a refreshed CSEPS Board with a great mix of experience and new ideas, an excellent lobbyist at the Colorado State Capitol (Chris Howes), a knowledgeable CSEPS Legislative Committee to take positions on healthcare bills, and above all a great Executive Director (Chet Seward).

I look forward to this next year, working with all of you talented, incredibly hard-working and dedicated physicians. But it is not enough to attend to our patients in clinic and the operating room. We exist as part of a larger healthcare ecosystem.
In the ensuing weeks, I’ll reveal this year’s ambitious agenda for CSEPS.

Thank you again.

Alan Kimura, MD, MPH

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