Risk Management

Message from the Chairman –Cost of Avastin

When the Centers for Medicare &

Medicaid Services (CMS) announced earlier this year that Medicare reimbursement for Bevacizumab (Avastin®) would decrease from $35 to $7 a dose, it sent shock waves through the retina community. Although ophthalmologists, like other physicians, have grown accustomed to lower fee

reimbursements across the board, this particular action posed such a significant threat to our ability to provide care to our patients that it was imperative it be reversed.

Major ophthalmic societies, including the American Academy of Ophthalmology, the American Society of Retina Specialists, the Macula Society, and the Retina Society, united in a coordinated effort to convince Medicare to reverse the decision. Key members of OMIC’s Board, including Dr. David W. Parke II, CEO of the American Academy of Ophthalmology, and Dr. George A. Williams, a leading retina surgeon at William Beaumont Hospital in Royal Oak, MI, contacted Medicare officials to help educate those involved of the unintended consequences of such a fee decrease. Ironically, these included increased cost to Medicare if doctors suddenly switched to Lucentis and millions of elderly patients were unable to afford the copayment for this much more expensive drug.

This is where OMIC’s risk management team excelled in communicating with ophthalmologists about this issue. OMIC’s 2007 recommendations for intravenous Avastin warned practitioners that the drug must be prepared by a licensed and trained professional in a compounding or hospital pharmacy to avoid the liability risks associated with off-label ophthalmic use.

Coming from the nation’s largest insurer of ophthalmologists and retinal subspecialists and disseminated via OMIC.com, one of the most frequently visited ophthalmic websites in the u.S., OMIC’s recommendations were influential. In concert with other actions initiated by the AAO and the three retina societies, OMIC provided background information that helped in the effort to persuade CMS to reverse its decision. In November, CMS directed practitioners to “return to their previous reporting practice for small intraocular doses of Bevacizumab (Avastin®) furnished prior to October 1, 2009.”

Dr. William L. Rich, AAO’s Medical Director for Health Policy, expressed it best, “The AAO, all three retinal societies, Congress, and our patients are all very thankful for this reversal. It benefits patients, doctors, and taxpayers.”

I am proud of OMIC’s role in the success of this collective endeavor. When we work together, we can achieve significant advancements for the ophthalmic community and our patients. We can reduce our risks, minimize threats to our livelihood, and protect the quality of care for our patients. Victories such as this are not just “feel good” stories about ophthalmologists working together to effect change, but also examples of the strategic and financial advantages we have gained by creating our own ophthalmic malpractice carrier.

Richard L. Abbott, MD OMIC Chairman of the Board