New President Has Vision for the AAO

Rod Franklin

February 07, 2012

February 7, 2012 — In her new role as president of the American Academy of Ophthalmology (AAO), glaucoma specialist Ruth Williams, MD, vows to maintain a high priority on quality measures that are likely to have an effect on Medicare payments in the current atmosphere of healthcare reform.

Dr. Ruth Williams

Another continuing theme in 2012 will be the academy's organized response to state legislative campaigns that seek to expand the role of optometrists beyond vision correction services and into the realm of eye surgery, which traditionally has been the domain of ophthalmologists, she said in an interview with Medscape Medical News.

"I am personally in the midst of leading a practice through the incredible changes that are happening in our healthcare environment," said Dr. Williams, who also serves as president of the Wheaton Eye Clinic in Illinois, which employs 35 eye care physicians at 4 suburban offices. "I personally feel the pain."

Dr. Williams has served during the past year as the AAO's Board of Trustees president-elect. She also was its secretary of member services from 2005 to 2010, and served as an academy trustee-at-large from 2000 to 2004. That experience, combined with duties she performed at organizations such as the American Medical Association and Women in Ophthalmology, has helped hone her insight into the specific needs of the academy's diverse, 30,000-plus membership.

She is quick to acknowledge fair treatment as one of those needs. With healthcare reform changes materially affecting reimbursement levels, Dr. Williams intends to keep the AAO's related advocacy work in Washington, DC, at the top of this year's to-do list.

"We're very interested in developing quality measures for ophthalmology, and to move the measure of quality from process measures to quality measures," she said. "How do we measure the quality of what we do? The reason this is so important is that it will be linked to payment in the future. It's important that we're the ones defining what quality measures should be, not some external force," she noted.

"There's a great deal of pressure on Congress to decrease the cost and reimbursements of healthcare in general. This can only mean one thing for ophthalmology, and for everyone: There's going to be a reimbursement compression. Nobody likes to admit that or think about that, but the academy has been very active in protecting payments to ophthalmology."

Recent efforts on the part of academy members have yielded results in this area. Activists who got involved with Congressional rulemaking issues in 2010 helped win a 5% Medicare payment increase for ophthalmologists that was implemented when the Centers for Medicare and Medicaid Services (CMS) agreed to recognize new practice expense data.

Academy members also have participated in recent efforts to come up with a permanent fix to Medicare's sustainable growth rate formula, which is used by the CMS to manage the inflation of public spending on physician services, but is largely viewed by AAO members as a flawed control mechanism.

Coordinating the talent necessary to fight for fair treatment and patient protection is a challenge that is bound to dovetail well with Dr. Williams' abilities as a leader and facilitator, according to Lynn Gordon, MD, PhD, professor of ophthalmology, Jules Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles.

"There are so many changes in healthcare," Dr. Gordon said in an interview with Medscape Medical News. "There's so much uncertainty. It really takes individuals with a lot of finesse to navigate the changing landscape and to lead organized medicine. I believe that Ruth has that type of visionary leadership, and the skills to finesse the changes that are occurring. The AAO has a huge position in advocacy and requires people that are very skillful to deal with those issues."

For today's ophthalmologist, those advocacy skills are similarly germane to the question of professional boundaries. Dr. Williams believes that the lines of professional demarcation in eye care should be protected, and are well embodied by the AAO's Surgery for Surgeons campaign, which is designed to educate legislators on the implications of extending surgery permission to optometrists who have not been intensively trained to provide such care.

"The reality is that ophthalmologists and optometrists work together day to day, and those relationships will increase with time," she said. "I think the real issue is, what is the appropriate nature of those relationships, and what's best for patients? The academy is clear on one issue, and that is that surgery should be done by surgeons. This is a very simple issue for us, and it's very, very simple for the public."

Members of the AAO provided input in 2010, when lawmakers introduced bills to alter the scope of practice for optometrists in Massachusetts, South Carolina, and West Virginia. According to Dr. Williams, it is likely that academy members will work this year to influence similar legislation in Iowa and elsewhere.

A mother of 3, Dr. Williams studied at Rush Presbyterian St. Luke's Medical Center in Chicago, Illinois, and interned at West Suburban Hospital Medical Center in Oak Park, Illinois. She completed her ophthalmology residency and numerous fellowships in glaucoma at San Francisco–based medical institutions.

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