Greetings AVAO Members and Potential Members:


It has been an honor and a privilege to have served as your President for the last two years. Our AVAO Executive Board is actively engaged to represent the interests of VA Ophthalmologists and ensure the highest quality eye care for veterans. To accomplish these goals, monthly AVAO conference calls are held to discuss important topics, challenges and current issues facing VA Ophthalmologists. These calls provide a forum for discussion that include AVAO leadership, VA National Program Director of Ophthalmology, Ophthalmology Surgical Advisory Board (SAB) Chair, Ophthalmology Field Advisory Committee (FAC) Chair, VA/DoD Center of Excellence Leadership, the AVAO Councilor to the AAO, JCAHPO Representative and the Secretariat for State Affairs. The collective experiences and expertise of this energetic group provides excellent dialog and input on national policy and legislation relevant to veterans' eye care. This annual report will summarize highlights from this past year.


AVAO Activities at the AAO Annual Meeting


AVAO members, who are attending the AAO Annual Meeting

in Chicago, should plan to participate in the following AVAO activities

on Monday, October 17 



Annual AVAO Breakfast Business Meeting

Hyatt McCormick CC 12C/Grant Park C



*Seating is limited. Please RSVP for this meeting by evite.

Paid membership required to attend.



VA/DOD Noontime Symposium


Resident Training Programs in VA and DoD:  Issues and Challenges for the Future

12:45pm to 1:45pm

Room:  N427a



Annual AVAO Evening Social Reception

Hyatt McCormick CC 22A/Clark A


5:30pm – 7:30pm

(RSVP by evite and paid membership required to attend)



Communication:


The AVAO Executive Board meets via monthly conference calls. Communication with members is

through AVAO e-mail group, VISN Consultants, and the AVAO web site: www.AVAO.org.


Physician Pay for VA Ophthalmologists


The report of the most recent review of physician annual salary ranges was released, August 2016. The VA utilized collective salary survey data from the AAMC, Hospital and Healthcare Compensation Service (HHCS), Sullivan, Cotter and Associates ( S&S), Medical Group Management Association (MGMA) as benchmarks for prescribing annual pay ranges. Ophthalmology remained in Pay Table 3 with an increase in the upper limits on salary for each Tier. The results are summarized below:


PAY TABLE 3 – CLINICAL SPECIALTY

TIER                       MINIMUM                   MAXIMUM


TIER 1                   $100,957                         $348,000 ($300,000)

TIER 2                   $120,000                         $365,000 ($310,000)

TIER 3                   $135,000                         $385,000 ($320,000)


The other specialties in Pay Table 3 include:  anesthesiology (pain management),   cardiology (non-invasive), emergency medicine, gynecology, hematology-oncology, nuclear medicine, oral surgery and pulmonary.



Membership


Membership renewal forms have been sent to you along with this President’s Report. Please remit your membership dues as soon as possible, and RSVP for the Annual Business Meeting and AVAO Reception.  Membership renewals can also be processed online with a credit card payment, by logging into your profile on the AVAO website (www.avao.org). If you do not recall your username or password, please contact Deborah Nysather at dnysather@aao.org. The AVAO Treasurer, Dr. David Vollman, will also collect dues (check, credit card or cash) at the Annual Business Meeting.


The AVAO is a non-profit organization that is completely self-supported and cannot accept any commercial support. Your dues directly support our annual AAO events, management expenses, monthly Executive Board conference calls, contributions to the Surgery by Surgeons campaign and to the Joint Commission on Allied Health Personnel in Ophthalmology (JCAHPO) education foundation, and support for an Advocacy Ambassador to attend the AAO mid-year forum.  A full Treasurer’s report will be reviewed at the Annual Business Meeting.



New AVAO Secretary


The AVAO Executive Board will elect a new secretary during the Business Meeting.   I would like to thank Dr. Thorstenson for his service as secretary for the last 2 years and we look forward to his future contributions to the Executive Board.  Election for a new secretary will occur at the AAO Annual Meeting 2016.  A ballot will be prepared prior to the meeting listing the candidates that have submitted a nomination form. We encourage highly motivated individuals with a desire to impact issues that affect VA ophthalmologists and veterans’ eye care to submit their nominations. Feel free to contact me at millicent.palmer@va.gov.



AAO Councilor


Dr. Paul Greenberg our AAO Councilor.  The following Council Advisory Recommendations (CARs) were approved this past year:


•16-02 Maintenance of Certification: Stop the Madness Approved

•16-03 Promoting Eye Health Care Equity Approved

•16-04 Strengthen State Government Affairs Approved

•16-05 Pilot Program for Multi-National Societies Council Participation Approved


The AAO response to the expansion of RN scope of practice in the VA is pending.



AAO Advocacy Ambassador Program


AVAO continues to support the AAO Advocacy Ambassador Program which facilitates  Ophthalmology mentorship in advocacy for future leaders in our field.  This year, Dr. Rachel Simpson, from UC Davis was chosen by the AVAO Board through a nationwide competition to participate in the program.  Nomination forms for the Advocacy Ambassador Program for the 2017 Mid-Year Forum will be sent out in January 2017 for the mid- February deadline. Please encourage interested residents or fellows to apply.



Title 38 Hybrid Conversion of Ophthalmic Technicians


The AVAO continues to support the conversion of Ophthalmic Technicians from Title 5 to Title 38 Hybrid. This will establish a new occupational series for eye technicians that will include positions at various skill levels (e.g., COA COT, COMT).  AVAO and AAO provided support for the bill.  The Title 38 Hybrid conversion is in its final stages of approval. The latest information on the status of this conversion will be presented at our Annual Business Meeting.



Pharmacy


AVAO members worked with the Ophthalmology Field Advisory Committee (FAC) and VA Pharmacy Management Board (PMB) to add desired medications to the VA National Pharmacy and to provide guidance on medication usage protocols. Dr. Linda Margulies will provide an update at our business meeting during AAO.



Association of University Professors of Ophthalmology (AUPO) meeting


AUPO represents academic departments of Ophthalmology by providing information, support, and leadership opportunities to department chairs, program directors and faculty to promote the highest quality in education, research, ethical practices and clinical care.  Since the VA funds over 300 residency positions and many university faculty hold joint appointments with VA affiliates, the AVAO continues to support a strong relationship with AUPO. This year, AUPO celebrated its 50th anniversary during its annual meeting in January. I was invited to participate on a panel discussing the role of optometry in the VA.



VA Pulse: https://www.vapulse.net








The VA Ophthalmology Pulse group was created by Dr. Jennifer Lindsey in October of 2015 with the posting of resources for the ICD-10 conversion. Over the past year, it has continued to evolve with the addition of many more resources that developed out of inquiries and interests expressed by VA Ophthalmologists. These resources are tagged and readily searchable, even from your mobile devices; therefore, no need to be logged into the VA system for access.

Examples of available resources include:


•VA Eye Care 2011 update from VHA Handbook 1121.01 – Covers productivity expectations, space requirements, all things VA Eye

•SOPs for RME

•Job opportunities

•Sample PDs for lead and supervisory technicians

•Protocol for autologous serum

•VA directives for video recording, compounding solutions


In addition to informational resources, the VA Ophthalmology Pulse group has also hosted polls and discussions on a variety of topics, such as, femtosecond laser,  I-stent surgery, and consent for intravitreal injections, to name a few.  A recent highlight was the posting of the “Bionic Eye” video featured by Secretary McDonald during his remarks to the Blinded Veterans Association ‘s annual meeting, August 2016. The Argus II retinal prosthesis system was implanted in a navy veteran with retinitis pigmentosa by Ninel Gregori, MD, Chief of Ophthalmology, Miami VA.  A phenomenal and historic achievement!


The VA Ophthalmology Pulse group serves as an excellent means of staying connected nationwide to discuss and share ideas and resources. Become a member of the group and log-on.


Please email or Lync Dr. Jennifer Lindsey for questions or the addition of resources that may be beneficial to you and your colleagues.



VA/DoD Vision Center of Excellence


Dr. David Eliason was appointed as the Deputy Director of the DoD/VA Vision Center of Excellence in February of 2016. 


Biographical sketch:


David Eliason earned his medical doctorate from the University of California, Irvine and concurrently was awarded a Doris Duke Clinical Research Fellowship at the University of Iowa.  He completed his internship in Internal Medicine at St. Mary’s Medical Center in San Francisco and a residency in ophthalmology in 2007 at the University of California, Davis.  He worked for eight years as a full-time faculty member of the Department of Surgery at the Veterans Affairs Medical Center in Salem, Virginia.  During this time, in addition to his clinical and surgical duties, he was responsible for medical records oversight, faculty mentoring, and clinical research.  He has been an instructor in clinician-patient communication courses and has also been a trainer of Patient Aligned Care Teams at the Salem VA Center of Excellence.  


VCE 2016 Update:

1.The Defense and Veterans Eye Injury and Vision Registry (DVEIVR) are available to DoD, VA, and affiliated university clinicians and researchers for data reporting.  Multiple projects are currently in progress evaluating the longitudinal effects of eye injuries on Service members and veterans.

2.The VCE partnered with Salus University, the Philadelphia VA, and the Hearing Center of Excellence (HCE) to screen college-attending veterans for vision, balance, and hearing loss.

3.The VCE has initiated a regularly-scheduled report to the VA National Program Directors of Ophthalmology and Optometry documenting those Service members who have sustained significant eye injuries. 

4.The VCE produces monthly CME eye trauma teleconferences for both DoD and VA clinicians to review current cases of ocular trauma in the DoD focusing on the nature of the injury, the treatment provided, and the clinical outcome.

5.The VCE is sponsoring its second annual Industry Day in Sept 2016 involving large technology companies and blind veterans to identify challenges the blind face in accessing technology.

6.The VCE is completing its third clinical recommendation: Care of Oculomotor Dysfunctions Associated with Traumatic Brain Injury.

We extend our congratulations to Dr. Eliason and look forward to working with him. 


Research


Ongoing research is an important part of our work as VA ophthalmologists. I just wanted to take this opportunity to recognize several important investigative works from this past year.


Lynch MG, Maa AY. The Use of Telemedicine to Extend Ophthalmology Care. JAMA Ophthalmology. 2016; 134: 543-544. Highlights the success of the Technology-Based Eye Care Services (TECS), an innovative eye care delivery program developed by the Atlanta VAMC.


Maa AY, Patel S, Chasan JE, Delaune W. Lynch MG: Retrospective Evaluation of a Teleretinal Screening Program in Detecting Multiple Nondiabetic Eye Diseases. Telemed J E Health. 2016; 23: 1-8. This study reported the detection of nondiabetic eye diseases that were found using the tele-retinal screening technology for diabetic retinopathy. This system may hold promise for detecting other important treatable causes of vision loss when supplemented with history and other testing elements. 


Lynch MG, Maa AM, Delaune B, Chasan J, Cockerham GC: Eye Care Productivity and Access in the Veterans Healthcare System. In press. Military Medicine.   Ophthalmic technicians significantly impact clinical productivity of ophthalmology and patient access to clinic visits. The data suggests that two technicians per ophthalmologist should be set as a minimal requirement.


Thakore RV, Greenberg PB, Behrens JJ, French DD: Variation in Ophthalmologist Use of Endothelial Growth Factor Therapy among Medicare Beneficiaries. Research Letter. JAMA Ophthalmology On-line. June 30, 2016.  This study found a wide variation in use of anti-VEGF agents across the U.S. An overall increase use of afilbercept was noted from 2012-2013. The authors recommend the identification of factors that can be used to encourage the use of lower-cost, safe and effective drugs that will significantly reduce health care costs.


Payal AR, Sola del-Valle S, Gonzalez-Gonzalez LA, Cakiner-Egilmez T, Chomsky AS, Vollman D, Baze EF, Lawrence MG, Daly MK.  American Society of Anesthesiologists

Classification in Cataract Surgery: Results from the Ophthalmic Surgery Outcomes Data Project. J Cataract Refract Surg. 2016 Jul; 42 (7) 972-982


We congratulate the authors and other members that are involved in research endeavors.



AAO Leadership Development Program (LDP)


David Vollman, MD, MBA, (LDP XVII) and Andrew Thliveris, MD, PhD (LDP XVIII) are recent graduates from the Leadership Development Program (LDP XVI).  This highly competitive one year program was designed to enhance participants' knowledge of AAO roles, broaden understanding of current Ophthalmology issues, improve communication and media skills, and develop leadership qualities.  



Closing Remarks


The events and accomplishments in this report are the outcomes of dedicated service of AVAO officers and members.  I would like to again thank the Executive Board for volunteering their personal time, diligent efforts and special expertise when addressing complex AVAO issues and projects.


I commend the leadership and commitment within AVAO.   Many thanks to each of you for your service and dedication to provide the highest quality eye care for our veterans.  Please show your support for AVAO by submitting your dues payment today, attending the Monday morning AVAO Business Breakfast meeting, the Noontime Symposium, and the evening AVAO Social Reception.  We need your involvement!


Please contact any member of the Executive Board to become more involved in any of our AVAO projects, or if you are interested in a leadership position.


I am looking forward to continue to work with the AVAO executive committee.


With gratitude………


Millie



AVAO Executive Board

President: Millicent Palmer, MD

Vice-President: Andrew Thliveris, MD, PhD.

Treasurer: David Vollman, MD, MBA

Secretary:   Lyle Thorstenson, MD

  Councilor to AAO: Paul Greenberg, MD

Surgery Advisory Board Chair, Marty Farber, MD

Immediate Past Presidents: Joy Dixon Strawn, MD, Linda Margulies, MD


FAC Chair/JCHAPO Representative: Mary Lynch, MD

National Program Director: Glenn Cockerham, MD


Other Conference Call Attendees

AAO Director, Congressional Affairs:  Rebecca Hyder 

AVAO Client Services Manager:  Deborah Nysather with SF AMS 

AVAO Coordinator: Liz Sharpe with SF AMS 




 

The President’s Report 2016