April 2018 - Vol.18
BULLETIN Access all areas Broken Hill becomes the first regional outreach for MIGS
FEATURE STORIES ASO leads ‘It’s your right to switch’ campaign Ready, set, learn…the ASO Business Skills Expo A look inside ophthalmology
Our goal is 100% membership and YOU can help get us there. That’s right. If every single member of the ASO encouraged one non-member to join the Association we would be able to achieve an unprecedented 100% level of membership. Imagine what we could achieve then.
Talk to your non-member colleagues today.
Contents CEO Report
Feature - MIGS goes bush
News - Ophthalmology training post claims: RANZCO responds
Feature - Our private health insurance information campaign for patients
Event - ASO Business Skills Expo 2018
Feature - Inside ophthalmology: An update on special interest areas
Research update - Patients sought for NAION trial
RANZCO CEO Update
News - Staff training offer for members 19
Is your membership renewal up-to-date? Renew via our Members’ Only area online www.asoeye.org or call (07) 3831 3006 ASO is the peak professional body for ophthalmologists practising in Australia. We provide you with ADVOCACY
News - AMA Report Card on private health insurance
ASO exclusive member benefits MDA National – discount on professional indemnity + free education seminars BMW Advantage program Business development tools: - Access to our annual Business Skills Expo and Business Skills Seminar - Financial forecasting software - Caduco calculator - Advice for starting new practice - checklist for new practice requirements, and online presentations on tips for starting out
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This ASO Bulletin is published by the Australian Society of Ophthalmologists as information for members. The views expressed in the publication are those of the authors and not necessarily of the Society. All liability is expressly disclaimed for any loss or damage which may arise from any person acting on any statement or information contained herein. The inclusion of advertising in this publication does not necessarily constitute the Society's endorsement of the product or service advertised. ACN 610 338 755 • ABN is 29 454 001 424
The art of quiet advocacy “All Quiet on the Western Front” Erich Maria Remarque, (1897-1970), German novelist, English translation of the book title, published in 1929. Originally titled, “Im Westen Nichts Neues” (No News in the West).
often speak to the Board of Directors about the need for ASO representatives to make regular visits to Canberra. It is through these visits that we can access politicians from all parties and build a recognition of who the ASO is and what we do. Even more important though is the opportunity to access the government of the day. In face-to-face meetings with federal departments ASO is able to showcase the speciality of ophthalmology, highlight its role in the health system and explain just how policies - either planned or those already in place impact on ophthalmologists and their patients. The regularity of these visits is critical to their value. We need to be in Canberra often, which means even if there is no “live” issue to lobby about. Indeed, these are the times when our presence may have its greatest effect. No one likes confrontation and over the years I have found that Ministers and their departments; and politicians in general, are at their most receptive when there is no blatant agenda on the table. You have organised to meet with them simply to inform and to discuss. It is from these meetings that important partnerships are often made; because a rapport built over time and without altercation cannot be underestimated.
the face-to-face aspect, but what happens in between times is also key. The time between visits is when essential ground work is done; reinforcing messages from the previous visit; ascertaining what issues are on the rise; identifying and approaching any additional allies who may be emerging; neutralising any negative sources; and offering quiet reminders that the ASO is here to assist.
Lobbying happens intermittently but advocacy is a full-time pursuit. ASO strives to always be monitoring media, the views of our membership, consumer (patient) feedback and awareness, as well as hospital and health system activity to ensure that we are effective in our advocacy. The goal is to be aware of issues before they happen. To take action early. To be clear on the outcome we are seeking to achieve. And to know exactly how we are going to achieve it.
You must keep your
While I have been writing this, those very powerful and eternally appropriate words of Bill Glasson keep repeating in my ears, “It’s always about the patients. It’s always about the patients!”
The visits to Canberra represent
mind on the objective, not on the obstacle. William Randolph Hearst 19th Century American businessman, politician, and newspaper publisher.
Planning and preparation for each visit also involves significant administrative support. Meetings are often difficult to secure and it is vital that any time we spend in Canberra is utilised to its full potential. The allocation of Society funds to this fundamental element of our lobbying work is seen as a priority, but one that must show a very clear return on spend.
ASO Bulletin April 2018
advice and resources
news and updates
making a difference
Connect with us Facebook â€“ Australian Society of Ophthalmologists Twitter - @ASOeyesurgeon
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MIGS goes bush Months of planning, some powerful teamwork, and the donation of four top-of-the range microstents were behind an Australian-first last month.
Dr Agar and team performing the first MIGS in Broken Hill. Photo: Branko Licul, Far West Local Health District.
roken Hill, the mining city nestled in the heart of outback New South Wales, was host to the country’s first standalone Minimally Invasive Glaucoma Surgery (MIGS) outreach on Monday 19 March. This was the first time any MIGS device had been used to treat patients in a remote setting in Australia, and the first time the Hydrus® Microstent, the device developed by Ivantis, Inc. had been utilised outside a major metropolitan city. Delivered by the Outback Eye Service, in partnership with Broken Hill Health Services and Ivantis, the outreach gave four glaucoma patients
from Broken Hill and surrounding communities the opportunity to have this advanced surgery without needing to travel to Adelaide or Sydney.
ophthalmology service available to patients in western New South Wales. Dr Agar is also Director of the Ophthalmology Service at Broken Hill Base Hospital.
For several years glaucoma surgeon Dr Ashish Agar has been performing standalone MIGS on patients in Sydney and imagining how he could take it bush for the benefit of remote and regional patients.
“As the sole glaucoma surgeon on the Outback Eye Service team I’m responsible for a huge geographic area, so the challenges of treating progressing glaucoma patients are significant,” Dr Agar explains.
He is part of the Outback Eye Service, an outreach service of the Prince of Wales Hospital which had its genesis with the late Prof Fred Hollows. Outback Eye provides the only comprehensive and fully public
“Traditional drainage surgery, my mainstay glaucoma surgical operation, is not always an easy option in the bush. Apart from the slow recovery and higher risk profile, the post-op care is problematic.
ASO Bulletin April 2018
of patients and give Australian ophthalmologists advanced treatment options in rural and remote settings is very gratifying,” Mr Burgess said. Broken Hill Health Services Director of Medical Services, Dr André Nel said the success of the MIGS outreach clinic on 19 March had served to demonstrate the power of partnerships. “This exciting development has been a testament to the dedication and hard work of our staff and the work of our partners at The Outback Eye Service,” Dr Nel said on the day.
“The need for intensive management means some patients simply have to be transferred to the nearest major centre for the procedure. In this case that’s Adelaide, for up to two weeks depending on the individual case,” he says.
Ivantis Asia Pacific Managing Director Glen Burgess said the project had enabled the company to pursue its humanitarian goals. “Bringing the Hydrus® stent technology to regional Australia where we can help change the lives
“We are proud to be taking part in this revolutionary surgery on our patch and it paves the way for more ventures that will deliver exciting benefits to local patients.” Dr Agar said the MIGS outreach was a great example of industry and health services working together in the interests of community.
Plans to bring MIGS to Broken Hill began to take shape over a year ago. “Living in regional or rural Australia should not preclude patients from accessing advanced medical services locally, “ Dr Agar says. “And certainly in the case of MIGS, the benefits and savings to be made from the improved safety and recovery profile makes it an absolute no-brainer in such an environment.” Confident in the safety and efficacy of the MIGS Hydrus® technology, having used it over several years, Dr Agar says he was excited to join forces with the device’s manufacturer, Ivantis and Broken Hill Hospital management in order to bring it to Broken Hill. Ivantis offered to supply the Hydrus® Microstent devices required for the Broken Hill public operating list free of charge.
Dr Agar, local patient Beryl Thomas, and Dr Andre Nel before the clinic. Photo: Branko Licul, Far West Local Health District.
MIGS as a standalone procedure
MIGS as a standalone procedure for glaucoma “There is increasing evidence that MIGS as a standalone procedure, without concurrent cataract surgery, may lower IOP and reduce medication dependence… Furthermore, earlier intervention may help delay or avoid the need for more invasive surgery.” Kerr N.M, Wang J. & Barton, K. (2017) ‘Minimally invasive glaucoma surgery as primary standalone surgery for glaucoma’. Clinical & Experimental Ophthalmology
According to Dr Agar, the real potential for MIGS to benefit patients is when the procedure is used to treat glaucoma and nothing else. In other words, as a standalone procedure. “For almost five years now I have found that my best results with MIGS have been when I am treating the glaucoma in isolation. We have evidence gathered over many years that combination cataract and glaucoma surgery outcomes are often inferior to conventional surgery alone. It’s thus not really surprising to a glaucoma surgeon that this may also be the case with MIGS, even when we are targeting different IOP lowering pathways,” Dr Agar explains. Currently MIGS has an MBS item number for use only when combined with a cataract operation. “What this effectively means is that if you have already had a cataract operation, or you don't even have a lens opacity, then somehow your glaucoma is not going to respond to a glaucoma specific operation,” Dr Agar says. “This is an anomaly that flies in the face of real world clinical experience, and indeed seems perverse in terms of patient access.” ASO has been lobbying the Federal Government to address the inequity and Dr Agar has been closely involved with this campaign.
Ready for surgery. (L-R) Glen Burgess (Managing Director of Ivantis), Dr Ashish Agar (Consulting Opthalmologist), Dr Claire Ruan (Eye Registrar) and Lee-Ann Howarth (Clinical Nurse Specialist, Operating Theatre) before the first MIGS case of the day in Broken Hill. Photo: Branko Licul, Far West Local Health District.
“Following our last meeting with the Federal Health Minister, which was in February, we are confident that a process is now underway to resolve this important issue — and relatively soon,” Dr Agar explains.
“He fast tracked the MSAC application down to six months and was inclined to create an interim item number for standalone MIGS if MSAC would support it. He cannot do much more unless MSAC gives it the tick.”
An MSAC submission is being drafted for expedited review.
And Dr Agar is hopeful.
ASO President Dr Peter Sumich says the signs are positive. “We have had a good hearing from the Health Minister Greg Hunt who is genuinely interested in the benefits for standalone glaucoma patients,” Dr Sumich says.
“We really need to sort this out to ensure that all our patients are able to access the latest treatment options for glaucoma in a sustainable and cost-effective manner,” Dr Agar says. “We can't afford for an achievement like the MIGS outreach in Broken Hill to be a flash in the pan.”
ASO Bulletin April 2018
SPECIA LIST TR AINING SHORT FALL
Ophthalmology training post claims: RANZCO responds
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ANZCO President Associate Professor Mark Daniell says maldistribution of ophthalmology training places is an issue in Australia. A/Prof Daniell was responding to the media report ‘Medical college limits hit patients’, which appeared in The Australian newspaper on Saturday 24 March. The report named ophthalmology as one of three specialities with “a lack of training positions” set to cause long-term shortages, and claimed low numbers were already forcing blowouts in elective surgery waiting lists and gap fees. A/Prof Daniell said there was a need for additional training places for ophthalmologists in regional areas to address maldistribution. “We have a focus on training ophthalmologists who will work in regional and remote areas and on developing systems to facilitate that. We need government to facilitate additional training places in these regional areas to help meet demand,” A/Prof Daniell said on 24 March. RANZCO has developed a regional training model to address the current maldistribution issues and has called on government to facilitate this by allocating additional training places in these areas. Meanwhile, RANZCO training figures show the number of new ophthalmologists has increased by 50% since 2011. RANZCO said it welcomed any news that raises awareness of the
importance of adequate training posts for medical specialties such as ophthalmology. However, it said high waiting list figures in metropolitan areas for elective surgeries such as cataract was an issue of public hospital funding not meeting demand. “The problem in these areas is not a lack of ophthalmologists, but a lack of public hospital funding,” the College said in a statement. “We need to ensure that we make proper use of the ophthalmologists who are available, and that means ensuring that public hospitals are adequately resourced, with theatre time made available for ophthalmologists to provide surgery for those people waiting. “It is essential that we keep the needs of the patient at the forefront
of healthcare planning, particularly as timely access to ophthalmology services can mean the difference between saving a person’s sight and them suffering irreversible blindness.”
RANZCO training figures
Steve is on the move A frog named Steve is the face of the ‘It’s your right to switch’ campaign. And he’s on the move.
n Thursday 29 March just over a thousand ‘Steves' popped up in medical practices throughout the country.
ASO President Dr Peter Sumich says Steve and the ‘It’s your right to switch’ campaign is all about doctors creating conversations with patients.
Steve has a simple message for Aussie patients: if you’ve got private health insurance and your fund isn’t working for you, then make the switch.
“We have an important role to play in helping people navigate their healthcare journey,” Dr Sumich says.
As premiums jump yet again and consumer complaints about private health cover soar, the ASO — backed by five other specialist groups — is encouraging patients to stop and “take charge”. From the canvas of an A4 desk sign, Steve asks patients: “Did you know you can switch health funds at any time?” “Well, you can,” he tells them. What follows is a basic ‘how to’ guide and a pointer to more information, which can be found at private health. gov.au
“In Australia ‘choice’ is a key reason people take out private health insurance. With private cover they expect to be able to choose their doctor, their hospital, and their treatment.” “However, funds are increasingly failing to deliver on choice. Restrictions and exclusions are becoming the order of the day and that’s simply not fair,” he explains. Dr Sumich says doctors need to make patients feel comfortable to ask questions about all aspects of their medical care, including private health insurance.
Support is growing The ‘It’s your right to switch’ campaign is quickly gaining momentum. In launching the campaign early last month ASO partnered with the Council of Procedural Specialists (COPS), the Australian and New Zealand Association of Oral and Maxillofacial Surgeons (ANZAOMS), and the Australian Society of Orthopaedic Surgeons (ASOS). Before the end of March the Australian Society of Anaesthetists (ASA) had joined this list. Both Federal AMA and AMA New South Wales have thrown their support behind the campaign and a number of representative groups within the health sector have enthused about Steve and his message.
“Most patients don’t realise how easy it is to change health insurer. If they are not happy then they can move easily. You can direct them to the free government website comparator: privatehealth.gov.au” Peter Sumich
ASO Bulletin April 2018
How can you keep Steve moving? In order to make the biggest impact possible the ‘It's your right to switch’ campaign needs you. Here’s what you can do: • Display the ‘It’s your right to switch’ desk-stand’ in your practice. Contact ASO if for some reason you haven't received your desk stand yet. • Tweet, Facebook, or Instagram the campaign image to your networks today. • Start following the ASO twitter feed and like and retweet the continuing ‘Steve’ narrative. • Friend the ASO on Facebook and like, share, and comment on ASO posts about Steve and the ‘It’s your right to switch’ campaign. • By all means if you think your patients have a better name than ‘Steve’ for the frog, please ask them to share their thoughts on Facebook! It’s a great conversation starter. Connect with us Facebook – Australian Society of Ophthalmologists
Twitter - @ASOeyesurgeon
ASO BUSINESS SKILLS EXPO 2018 SAT 12 May & SUN 13 May 2018 InterContinental, Double Bay, NSW
n the weekend of 12&13 May ASO will host its 2018 Business Skills Expo. This annual 1.5 day education event is when ophthalmologists from throughout the country gather to enhance their business skills. The learning program, which includes detailed seminars, panel discussions, and the ever-popular Day Surgery Owner’s Breakfast, has been developed specifically for ophthalmologists.
It aims to arm delegates with valuable tools for meeting the many challenges of running a medical business. Expo Facilitator Dr Nisha Sachdev said months of planning had gone into making this year’s Expo the best yet. “Our program includes esteemed experts in business, accounting, law and technology. The seminars will be timely,
A weekend in Sydney Alongside skills development the Expo is a great opportunity to connect with colleagues and enjoy a little time-out from your busy practice life. Sydney’s InterContinental Hotel, Double Bay is the official ASO Business Expo venue. One of the city’s finest hotels it offers five-star luxury. Relax at the Rooftop, a chic poolside bar with views overlooking the bay, enjoy an
progressive and have skilldevelopment as a key focus because we want delegates to leave the Expo with new knowledge and fresh ideas for tackling issues within their practices,” Dr Sachdev says. "An added dimension to the program this year is our closed session for RANZCO Fellows, which will provide a valuable opportunity for discussion of Medicare and health fund issues that are making a big impact right now,” she explains.
Hurry, you can still make it!
elegant High Tea or rejuvenate and revitalise with an indulgent facial at Trumps Day Spa, or relish in an unforgettable dining experience in Stockroom restaurant. Expo organisers have secured a super ‘Expo’ room rate ($290) for ASO members staying at The InterContinental Sydney, Double Bay for the event. Book your accommodation now as rooms are limited. Register now: www.asoeye.org/expo2018
ASO Bulletin April 2018
Business skills boost
A consistent challenge medical professionals face in opening their own practice is that they haven’t been taught how to run a business. A business venture requires a completely different set of skills than the medicine they have learned to practice.
ASO Business Skills Expo 2018 Program highlights Finance
• Key finance tips for your practice • What is it worth? Getting your practice valued
• Setting up and sustaining an effective ophthalmology practice (including succession planning)
• Personal & business insurance The insurances you don’t want to forget to get
• Managing your practice’s cyber safety risks from a legal perspective
• Patient education - Effective information transfer and lessons learned
• The legal issues involved in purchasing and selling practices • Inside the new Privacy Health Act - What you need to know • Recapping Employment Law contracts - What not to miss
Do not miss! CLOSED Q&A session for RANZCO Fellows only Our ASO panel - President Dr Peter Sumich, CEO Mr Kerry Gallagher, and Vice President Ashish Agar - will give you the ‘insiders’ update on all things private health insurance & the MBS Review. In this closed session for RANZCO Fellows you will also have the opportunity to fire your own personalised list of questions at the panel. No holds barred; this session is not to be missed.
Networking hub Meet and mingle with colleagues, our exclusive Expo sponsors and our expert speakers in the networking hub.
Cocktail event Saturday night Unwind after an intense day of learning and skills development at the official Expo Cocktail Party.
Day Surgery Strategy Meeting - Sunday morning Over breakfast on Sunday get vital updates on health fund contracts (particularly the impact with BUPA’s recent changes), sterilisation and processing standards, and intravitreal injections.
5 tips to boost your practice
First impressions count
Having a fresh-look, easy-to-use website is critical for the growth of your practice. Yours needs to be responsive and work equally well on mobile devices, providing valuable information for prospective patients.
Support your staff
Investing in your team through additional coaching and training ensures a happier, more productive practice.
Use a strong and secure scheduling system to ensure practice productivity and patient flow happens seamlessly.
Medical practices often forget that their business is in customer service. Surveying your patients is the best way to ensure you’re on the right path to growing your practice.
Organise your practice for optimal patient flow i.e. reception near the entrance and exam rooms close to the waiting area.
Inside ophthalmology An update on special interest areas In recent months several members of the ASO Board of Directors have been assigned areas of special interest. This is to ensure the Society stays active and up-to-date on all facets of our dynamic specialty.
Dr Laurie Sullivan
Cataract and Refractive Surgery + Overseas Development When it comes to cataract and refractive surgery the main issue on the horizon is the Medical Benefits Schedule Review, which will obviously look at Item #42702. Many ophthalmologists will recall that #42702 had its rebate halved by the Federal Government without consultation back in 2009. This gave rise to the “Grandma’s Not Happy” campaign which ultimately succeeded in having the cut reversed. Historically #42702 has been a magnet for rebate cuts. It was cut by 32% in 1987, 10% in 1996 and even after the win of 2009, by 12% in 2010. Looking singularly now at refractive surgery, this is currently an almost entirely privately funded field. As such not much that’s swirling
in the medico-political sphere is affecting it. We did make a representation to the Victorian Department of Health and Human Services recently with regard to the non-necessity for medical lasers to be regulated under state regulations. Turning to Overseas Development, I am very concerned about government cuts to the national aid budget. I would urge the Federal Government to listen to the Australian Council for International Development's recommendation that we build towards Australia’s commitment to the WHO Sustainable Development Goal of 0.7% of gross national income being devoted to overseas development.
Dr Paul Athanasiov
Cornea The main update for cornea specialists is that Medicare funding has been approved for Collagen Cross Linking (CCXL). Subject to final regulatory approvals CCXL will be made available on the MBS at a fee of $1,200 for patients with evidence of progressing corneal ectatic disorders. Keratoconus was a key topic of discussion at the recent Cornea Special Interest Group meeting in Sydney, where cornea specialists
discussed their preferred techniques and longterm outcomes with Cross Linking. DMEK was also discussed at length as more surgeons take on this technique in place of DSAEK for routine endothelial transplant cases. Visual outcomes appear to be superior in the early post-op period but long term outcomes are not as well established as with other forms of cornea transplant.
ASO Bulletin April 2018
Dr Ashish Agar
Glaucoma + Indigenous Health The extension of MIGS into regional and remote medical settings has begun (see the ‘Bringing MIGS to the bush’ report on page 6 of this edition). Meantime, an ASO campaign to see standalone MIGS gain MBS recognition is hitting its stride (details on page 7). In terms of Indigenous health, the RANZCO Indigenous Health Committee (of which I am Chair) is currently finalising a national proposal to Close The Gap in eye health to
present to the Federal Government. This proposal has been developed in consultation with all states and territories' regional services. We are hoping to provide a concrete plan to address this important public health issue. The ASO remains engaged with the Indigenous health sector and is committed to helping advocate for ophthalmology-led solutions in partnership with the College.
Dr Tom Cunneen
Oculoplastic + Younger Fellows Last year both ASO and RANZCO made submissions to the Medicare Claims Review Panel over changes to Medicare item #45617. At the time ASO raised a strong clinical objection to removal of the wording: “skin redundancy obscuring vision (as evidenced by upper eyelid skin resting on lashes on straight ahead gaze)” in the item descriptor. The Society argued that the wording had been appropriate because when vision is obscured by skin redundancy it requires treatment. It said in these cases the operation to remove skins does not fit the definition of a cosmetic procedure. Despite these presentations the changes remain in place. I hear that some surgeons are still being asked to sign pre-approvals by certain health funds. The Federal
Health Minister has deemed pre-approvals unnecessary. Contact the ASO if you are asked to sign a pre-approval. In terms of issues affecting our younger Fellows I am discovering that workforce planning is an area of concern. Colleagues just starting to make their way in the specialty after years of training are telling me that finding work after completing their years of training is more difficult than they expected. I am keen to explore these concerns from younger Fellows in more detail and then take them to the ASO network to see how we might be able to provide a more assured and supported entry to the field for our new colleagues.
Dr Alex Hunyor
Retinal There are currently no new pressing issues in the world of retina. Later this year, attention will focus on the Medicare Benefits Schedule (MBS) Review which will no doubt examine item #43728
(intravitreal injection), which has increased significantly in number in recent years. This reflects the expanding availability of sight-saving therapies for blinding retinal conditions.
Dr Sunil Warrier
Ocular oncology Ocular oncology is a very small sub-specialty area but all of us working in this realm know how important it is. Supporting the creation of new scientific trials here in Australia, monitoring for developments overseas, and connecting with others working in ocular oncology around the globe is how we champion what we do.
In Brisbane we were fortunate recently to host two leading professors from Columbia University and an exciting development for Australia has been the launch of a multicentred trial for the treatment of metastatic melanoma. Trials like this reinforce that Australia is at the cutting edge of medicine on many fronts.
Dr Nisha Sachdev
Paediatrics The lack of sub-specialist ophthalmologists in Australia and New Zealand is a significant issue. There is huge demand for paediatric ophthalmology services everywhere, particularly in regional communities and really, it has no way of being met. As a younger Fellow working in this area, it is encouraging to me to see that a few of my contemporaries have also gravitated here. Both as a member of the ASO Board of Directors and as a member of the RANZCO Paediatric Special Interest Group Iâ€™m motivated to seek out strategies that will address the shortfall in the long-term.
Paediatric ophthalmology was given a much needed boost a few years back thanks to ASO lobbying. The MBS rebate for item #109 (initial consultation) was increased substantially, providing recognition of the time it takes to properly examine a child (more than an hour, compared with 15 minutes for an adult). The change has been a morale boost for the small number of us working in the field, but there hasnâ€™t been any change to the MBS rebate for item #105 (subsequent consultations) for a paediatric patient, which presents a failure to recognise the long-term treatment a child with ophthalmic issues requires.
Did you know? The average age of an ophthalmology Fellow is
The gender mix for the specialty is
The average number of hours worked by an Australian ophthalmologist per week is
Source: MedVersus, the resource developed by Health Leaders Australia (HLA) and General Practice Training Queensland (GPTQ). Visit medversus.com.au
ASO Bulletin April 2018
Dr Michael Steiner
COPS + AMA (NSW) A major ongoing concern for the Council of Procedural Specialists (COPS) is managed care. Recent developments from big-name health funds like BUPA highlight how moves are being made to limit choice for consumers and exert greater control over doctors and other health service providers. These developments have us wondering if medical insurance is really going to work in Australia long-term, or whether policy-makers will need to explore other options. A key goal for COPS currently is to position itself at the forefront of these discussions. We have a combined knowledge and weight
Have we got you covered?
that should earn us a spot at being part of finding solutions. That is why COPS recently made a plea to the Health Department that we be included on the ‘expert’ committee set up recently to investigate out-of-pocket costs. Groups like COPS represents working doctors and we have a great deal of practical knowledge to share. Meanwhile, the issues surrounding private health insurance and managed care are also front and centre in my work with AMA New South Wales. I believe it is very important for ASO to maintain a strong link with AMA (NSW) and I will continue to put energy into this.
Is there are an area of special interest you would like to see added to the list above? Email us at email@example.com with your feedback.
Patients sought for NAION trial
ydney’s Save Sight Institute is on the hunt for patients with suspected Non-arteritic anterior ischemic optic neuropathy (NAION) to participate in a new intra-vitreal treatment trial. Currently there is no treatment for NAION which has been shown to improve vision in an affected eye or prevent NAION patients from developing in the fellow eye. The Save Sight Institute (SSI) trial is part of an international randomised controlled trial being co-ordinated by the Neuro-Ophthalmology Research Disease Investigator Consortium (NORDIC). The intra-vitreal treatment being tested may protect the retinal
ganglion cells from apoptosis during the acute phase of NAION. NAION is the most common cause of acute optic nerve injury in patients over 50 years-old, but to date effective treatment of the condition has remained a challenge. For about 40% of patients there will be some improvement in visual acuity or visual fields without any treatment. A 2008 study showed oral prednisolone may improve a patient’s chance of partial recovery. However, in this unmasked single observer study, patients given treatment were less likely to be those with diabetes and therefore may have had a better prognosis anyway.
Sydney neuro-ophthalmologist Associate Professor Clare Fraser is leading the SSI portion of the intravitreal treatment trial. “We are excited at the prospect of having a treatment for this condition,” A/Prof Fraser said. “The trial involves three intra-vitreal injections over three months, and regular follow-up for one year,” she explained.
Trail candidates needed: Patients with suspected NAION, can be considered for the trial if seen within 14 days from symptom onset, as long as they have not already started on steroid tablets or new glaucoma drops. Candidates can be referred to the SSI through the Clinical Trials Unit. Please contact us on 9382 7300.
David Andrews RANZCO - CEO
International meetings and the future of ophthalmology
attended both the 33rd AsiaPacific Academy of Ophthalmology (APAO) Congress and All India Ophthalmology Society (AIOS) 76th Annual Conference in February. The primary reason for attending was to promote the various upcoming international meetings being hosted by RANZCO. These are of course APAO 2020 in Auckland; the International Agency for Prevention of Blindness (IAPB) 11th General Assembly, also to be held in Auckland in 2020; and the International Council of Ophthalmology (ICO) World Ophthalmology Congress in Melbourne in 2022. I would urge all RANZCO Fellows who are attending international meetings to be promoting these events to your international colleagues. The more people who attend these meetings, the more successful they will be. As these events draw closer RANZCO will be providing specific details to help you encourage others to attend. A side product of participating in these events was being able to attend a number of interesting talks on the future of ophthalmology, not just from a scientific perspective but also from a technological standpoint. I know this is an area the ASO also has a strong interest in. I’m sure most of you have been to similar talks, but my summary is that some developments are moving faster than anyone expected, and these will very soon be having a radical impact on the practice of ophthalmology. One example is screening for diabetic retinopathy by artificial intelligence (AI) programs.
From RANZCO’s perspective we need to keep this in mind as we further update our curriculum, teaching and assessment methods. But the real impact will be felt at the level of patient interaction. I believe there will certainly be more patients than ever needing services that cannot and should not be provided by allied health, even though some services will inevitably be done by others. Technology does provide better outcomes for patients, but at a cost. We are already seeing the introduction of intraocular glaucoma stents, and the debate about who pays for what portion of their use. It is clear that governments are becoming more reluctant than ever to substantially fund technological advancements. Health funds will avoid having to pay where possible. So, it will fall back to the consumer or doctor to bear the cost, or argue strongly with the others for a greater share. The two parties most
intimately involved in procedures are probably the ones with the least power, unless formally organised. RANZCO, through our special interest groups, is and will continue to set best practice standards for eye care. With these, we can argue strongly that in our developed economy patients should surely benefit from best practice. The ASO has a strong role to play in supporting appropriate reimbursement for the delivery of best practice. As the technology and procedures get more expensive, and the dollars harder to extract, it will require a strong unified voice to achieve good outcomes for patients and the profession. I look forward to continuing to work with our Fellows, many of whom wear multiple hats assisting both RANZCO and the ASO, and the ASO management in what I’m sure will be a very interesting few years.
ASO Bulletin April 2018
Training to take your practice to the next level
SO is preparing to launch a new ophthalmic staff training package for members.
Part 2 of the package is an Online Training Course for Ophthalmic Technicians.
This exciting initiative is designed to support ophthalmologists in building and maintaining strong and efficient practices.
This course will be delivered by established online learning company Eye Learning Online.
The training package, which is still in development, is likely to be delivered in two parts. Part 1 will be a Practical Training Course for Ophthalmic Technicians. This course will cover a range of training elements including medical history taking; vision assessment and basic work-up; OCT and visual field testing; and advanced diagnostic testing. Part 1 of the package will be delivered FREE to ASO members*.
It aims to provide ophthalmic knowledge and an understanding of the principles of ophthalmic assisting. Part 2 of the package will be heavily discounted for ASO members*. ASO President Dr Peter Sumich says ASO wants to support members in all the ways they need. “Providing on-the-job training for non-orthoptic staff in a busy practice is a real challenge,” Dr Sumich says. “It can be a slow process and clinic flow can really be disrupted while it’s happening,” he says.
“Knowing this is a challenge our members face we wanted to investigate training options that would reduce the burden for them.” *The training package will be available only to ASO members and the majority of doctors in a practice must be ASO members for a practice to qualify.
Boosting your practice's productivity It is important to offer support for employees that helps them flourish in their roles. Happiness at work is directly connected with a 12% higher performance rate. Studies show businesses that offer training to employees report a significant return on their investment.
Part 1 Practical Training Course for Ophthalmic Technicians
Part 2 Online Training Course for Ophthalmic Technicians
Register your interest Visit the ASO website www.asoeye.org to fill out our ophthalmic staff training expression of interest form.
Janet Harry Medico-legal Adviser, MDA National
Providing expert evidence
roviding a report as an independent expert is different to providing a report as a treating doctor. What should you do if you receive a letter from a solicitor asking if you will provide an expert report in a case in which a patient experienced a post-operative infection? Requests for an expert report may come from a variety of sources including: • solicitors seeking a report for use in litigation • coronial matters, either by the coroner or an involved party • AHPRA, regarding the conduct or treatment provided by another doctor • courts and tribunals such as Guardianship, Workers’ Compensation and Probate. You are not obliged to act as an expert. You should only accept if you consider that you have the requisite expertise and experience, and understand your obligations in accepting the request. You will be asked to provide information in your report as to your expertise and you can expect to be questioned on this if giving evidence in court. The expert is an independent witness whose role is to assist the court (or tribunal) to evaluate the medical issues involved in reaching its conclusion. The expert is not an advocate for a party. Your role is to remain objective and independent from any bias. It is the role of the court or tribunal to determine the outcome. Your role is to apply your expert knowledge in examining the facts and circumstances.
All states and territories have a code of conduct for expert witnesses and it is important to familiarise yourself with this. Generally, the code of conduct will require you to include in your report: • your qualifications and experience • the assumptions made in providing the report • any tests or investigations relied upon • a summary of your opinion and your reasoning • a summary of the instructions, facts, literature and documents you considered when reaching your opinion
• any unknown matters or further investigations which you consider are needed to avoid incompleteness or inaccuracy • if applicable, that a particular question or issue falls outside your expertise • an acknowledgement that you have read and complied with the code of conduct. When preparing your report, you should try and use clear language and explain any technical terms so that non-medical people can understand them.
ASO Bulletin April 2018
You should respond to the questions asked of you, not what you think should be asked — but you can raise any omissions which need to be examined. It is not unusual for the same set of facts or assumptions to be interpreted differently by different experts, and you should not allow your professional opinion to be swayed just because you differ from another expert. As part of the process of narrowing the issues, you may be asked to identify the areas of agreement and disagreement. This may involve meeting with the other expert(s), but you can still provide your own independent opinion on areas of difference. If you change your opinion at any stage before you give evidence, you should inform the party who instructed you.
If the matter proceeds to a hearing, then it is very likely you will be asked to give evidence and also be cross-examined in relation to your report. Accordingly, you will need to be familiar and comfortable with the process, and willing to attend court if required. You may be asked by the lawyer acting for the opposite party to meet to discuss your conclusions or to provide a supplementary report. This can be done, but it raises issues regarding legal professional privilege and not revealing any confidential information you have received as part of your instructions. Also, if you have had a consultation with a patient as part of your opinion, then you will need to consider your duty of confidentiality to the patient within
the context of your duty as an expert. These can be very complex issues and you should consult your medical defence organisation for advice. Although Australian expert witnesses currently have legal immunity, there have been cases where complaints have been made to the Medical Board about doctors who have provided incorrect advice in expert reports and when giving evidence. This article is provided by MDA National. They recommend that you contact your indemnity provider if you need specific advice in relation to your insurance policy.
Vision 2020 gets closer to goal
wo thirds of activities outlined in the 2012 ‘The Roadmap to Close the Gap for Vision’ report have now been completed and almost half of the report’s recommendations have been implemented.
Federal Health Minister Greg Hunt, who opened the conference, said the ‘Close the Gap for Vision 2020’ initiative was proof of what can be achieved when groups work together toward a common goal.
These results and the remainder of ‘closing the gap’ journey were the focus of the Close the Gap for Vision by 2020 National Conference held in Melbourne last month.
Vision 2020 Australia CEO Carla Northam said the long-run objective was within reach.
The conference brought together more than 150 delegates from throughout the country, representing a broad range of organisations and community groups connected to indigenous health.
“The Indigenous health sector, including eye health and vision care, has a long history of collaboration and using its collective expertise to strengthen health care systems,” Ms Northam said.
“We need to continue to focus on Indigenous eye health and vision care to close the gap for vision for Aboriginal and Torres Strait Islander people by 2020,” she said. The importance of measuring eye care data was a key element of the conference program, alongside extension and replication of eye health initiatives that are proving successful. ‘The Roadmap to Close the Gap for Vision’ report set out 42 recommendations in 2012 and 16 of these are still be to implemented.
Private health insurance AMA Report card aids health literacy of consumers
“Too often, patients only find out they aren’t covered when they go to use their insurance — even sometimes after a surgical procedure has taken place.” Dr Michael Gannon
n Sunday 25 March the AMA released its Private Health Insurance Report Card for 2018. The now annual report card is designed to help improve consumer health literacy, giving an overview of how private health insurance should work to benefit patients and offering comparisons on insurers and the policies they are selling. This year’s assessment has also highlighted for Australians how new arrangements being signalled by big-name insurers will result in less choice and value for policy holders. AMA President Dr Michael Gannon said consumers need easy to understand information about private health insurance and how it works to help them make informed decisions when purchasing a policy. "We explain what insurance may cover, what the Medicare Benefits Schedule (MBS) covers, and what
an out-of-pocket fee may be under different scenarios,” he said. “We also highlight the frustrating fact that what an insurer pays can vary from State to State – even within the same fund.”
Unpacking out-of-pocket costs The Report Card identifies outof-pocket costs as a longstanding concern for consumers and provides some simple but important information about doctors fees in relation to this. The make-up of a doctor’s fee is explained: “fees take into account the cost of running a practice, including professional indemnity and other insurance, wages, rent, consumables, and other equipment costs”.
“The out-of-pocket cost is the difference between the fees charged by the doctor and the combined MBS benefit and private health insurance benefit.” The Report Card explains to consumers that, by law, private health insurers must top up the Medicare payment by at least 25 per cent of the relevant MBS fee.
And it is pointed out that doctors, like other highly trained professionals, are free to set their fees at a level they believe is fair and reasonable.
ASO Bulletin April 2018
No gap and known gap made simple The Report Card takes time to offer consumers a clear explanation of the difference between the no gap and known gap arrangements with an insurer, as well what happens in situations where ‘no arrangement’ is in place.
It highlights: Lower benefits paid by the insurer mean higher outof-pocket costs for patients.
This can be confusing for patients, especially if not communicated early. It also means any increase in the doctor’s fee above the known gap,
no matter how small, results in a significant drop in payment from the insurer, and a far greater increase in the patient’s out-of-pocket cost.
Key comparisons The AMA Report Card offers tabled comparisons on the following: • Benefits paid by eight major health insurers for a select range of common procedures. • Benefits paid for select medical services by BUPA in 2018, by State. • The percentage of hospital related charges covered (this includes accommodation at the hospital, provision of nursing care, and the cost of any prostheses) across 24 different health funds.
• Percentage of hospital related charges covered by State for restricted membership funds. • Percentage of medical services with no gap among open member funds. • Percentage of medical services with no-gap among restricted member funds. Visit www.ama.com.au to access a copy of the AMA Private Health Insurance Report Card 2018.
Health insurance reforms begin
he first round of private health insurance reforms were introduced to parliament on Wednesday 28 March. Federal Health Minister Greg Hunt is banking on the changes returning some stability and public confidence in private heath cover. "These reforms will help strengthen the viability of the private health system by addressing concerns about affordability, complexity and lack of transparency of private health insurance," Mr Hunt said. The new legislation puts in place the following:
• The ability for private health insurance providers to increase customer excesses in exchange for lowering premiums for the first time since 2001. The increased excess is $750 for singles or $1500 for couples and families. • The ability for private health insurers cover travel and accommodation costs for rural and regional Australians attending health services. • More muscle for the health insurance ombudsman. On 1 April private health insurance premiums increased by 3.95%.
• Discounts for hospital coverage for people under 30.
Dr Tom Cunneen
Why I am a member of the ASO I am interested in the way political decisions are made and felt that I needed to become part of that process. At the moment specialists and patients are in a wonderful position in Australia. Patients generally have a wide range of highly trained specialists to choose from and specialists have very little interference in the way they practice. But health insurers and government administrators would love to be calling the shots, as they do in the US and UK respectively. This would be to the detriment of patient care and clinician satisfaction.
"It is organisations like the ASO who protect the relationship between the patient and the clinician and this is one of the reasons I joined the organisation. "
It is organisations like the ASO who protect the relationship between the patient and the clinician and this is one of the reasons I joined the organisation. Having joined the ASO Board, I realise that our organisational structure is nimble enough to respond to issues quickly and decisively to affect great outcomes. If membership of organisations such as the ASO (and the AMA) become increasingly well supported we'll hopefully stop needing to respond to issues because we will have been intimately involved in the decisionmaking process of governments and other interested parties from the start. Finally, while I trained in Sydney, I grew up and now practice in Perth. The geographical isolation from the rest of Australia does generate specific challenges which require local representation. Dr Tom Cunneen
Let us know what you think ASO welcomes feedback from members. We want to know what you think we are doing well, where we might need to lift our game, and how you see us delivering more for your membership dollars. Contact the ASO office on (07) 3831 3006 or send us an email at firstname.lastname@example.org
Direct line to the President If you would like to raise any industry concerns or seek advice on an ophthalmologyrelated issue you can email ASO President Dr Peter Sumich at email@example.com
ASO Bulletin April 2018
WORKING FOR YOU Here are some of the ways the ASO is working for members
Members, it’s all about you… To get most out of your membership with us make sure we have the most up-to-date information on you. If any of your contact details have changed in the past year please complete the form below. If in doubt, update anyway!
Engagement We are regularly engaging with various government departments on issues such as private health insurance sector reform and the ongoing MBS Review.
Update your details Name: Preferred email address:
Collaboration The ASO has forged strong relationships with groups such as COPS, the AMA, RACS, and AHPRA to advocate for healthcare reform. Our partnership with RANZCO continues to deliver unparalleled advocacy and protection for ophthalmology as a specialty craft group.
Information With our various communications (The ASO Members’ Bulletin, EyeWatch, and Eye Opener) we keep members up-to-date on the work we do, along with providing insight into medico politics and industry advances.
Best contact number: Practice Address:
Fill out and fax this form back to ASO on (07) 3831 3006. Alternatively, scan and email it to info@asoeye. org or simply go to www.asoeye.org and update your details via the ‘Members Only’ section.
Protection you deserve Our strong partnership with MDA National means ASO members have access to a 12.5% discount on their Professional Indemnity Insurance premium*. MDA National provides:
Advice We answer enquiries from members on a range of issues and regularly provide advice on specific practice concerns.
• e xperienced medico-legal advisers — including 24 hour advice for urgent matters • s pecial rates on MDA National's Practice Indemnity Policy to complement your own professional indemnity insurance* • speciality specific medico-legal information • education activities, resources and events. For more detail call MDA National on 1800 011 255 or visit mdanational.com.au
*Subject to certain eligibility criteria.
Award winning Australian literature The Miles Franklin Literary Award is Australia’s most prestigious literature prize. Established through the will of My Brilliant Career author Miles Franklin, each year the prize is awarded to a novel of the highest literary merit that presents Australian life in any of its phases. The ASO Bulletin has three winners of the Miles Franklin Award to give away.
The Eye of The Sheep by Sofie Laguna Meet Jimmy Flick. He's not like other kids - he's both too fast and too slow. He sees too much, and too WINNER OF THE MILES little. Jimmy's mother Paula is the only one who can FRANKLIN manage him. She teaches him how to count sheep so AWARD 2015 that he can fall asleep. She holds him tight enough to stop his cells spinning. It is only Paula who can keep Jimmy out of his father's way. But when Jimmy's world falls apart, he has to navigate the unfathomable world on his own, and make things right.
Truth by Peter Temple At the close of a long day, Inspector Stephen Villani stands in the bathroom of a luxury apartment high above the city. In the glass bath, a young woman lies dead, a panic button within reach. So begins the sequel to Peter Temple's bestselling masterpiece, The Broken Shore, winner of the Gold Dagger for Best Crime Novel.
WINNER OF THE MILES FRANKLIN AWARD 2010
Villani's life is his work. It is his identity, his calling, his touchstone. But now, over a few sweltering summer days, as fires burn across the state and his superiors and colleagues scheme and jostle, he finds all the certainties of his life are crumbling. Truth is a novel about a man, a family, a city. It is about violence, murder, love, corruption, honour and deceit. And it is about the search for truth.
The Well by Elizabeth Jolley To go in the draw to win one of these books simply text ‘Book Giveaway’ and your full name to 0425 883 304.
Miss Hester Harper, middle-aged and eccentric, brings Katherine into her emotionally impoverished life. WINNER OF THE MILES Together they sew, cook gourmet dishes for two, run FRANKLIN the farm, make music and throw dirty dishes down AWARD 1986 the well. One night, driving along the deserted track that leads to the farm, they run into a mysterious creature. They heave the body from the roo bar and dump it into the farm's deep well. But the voice of the injured intruder will not be stilled and, most disturbing of all, the closer Katherine is drawn to the edge of the well, the farther away she gets from Hester. A twentieth-century Australian classic, The Well is a haunting and wryly humorous tale of memory, desire and loneliness. *Please note members’ details are never shared with third parties. This textile is direct to the ASO office.
ASO Bulletin April 2018
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21/03/2018 8:45:45 AM
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We're focused on you MDA National supports the ASO and helps protect your professional reputation. Apply online at mdanational.com.au or call 1800 011 255 to arrange your discount *MDA National offers ASO members 12.5% discount on Professional Indemnity Insurance Premium and Membership Subscription. The reduction cannot be claimed in conjunction with, or in addition to, any other MDA National Membership Subscription and Insurance Premium reduction. To receive the discount proof of ASO Membership is required. ^Subject to certain eligibility criteria and underwriting approval. The MDA National Group is made up of MDA National Limited ABN 67 055 801 771 and MDA National Insurance Pty Ltd ABN 56 058 271 417 AFS Licence No. 238073. Insurance products are underwritten by MDA National Insurance. Before making a decision to buy or hold any products issued by MDA National Insurance, please consider your personal circumstances and read the Product Disclosure Statement (PDS) and Policy Wording and the Supplementary PDS and Endorsement to the Policy Wording available at mdanational.com.au. AD135
ASO Bulletin April 2018
Australian Society of Ophthalmologist Members' Bulletin - April 2018 Vol 18.