 All right, we're going to get started. We've got three presenters today, so we want to stay on time. Our first presentation is by Julia Burge. She's going to tell us about her experience in DC at the Mid-Year Forum. Hello, everyone. So we just wanted to give everyone here in Utah who didn't have a chance to go out to DC and update on what happened and what we talked about at the Mid-Year Forum. So as a resident, there's kind of this advocacy ambassador program where they support. There's about 150 residents that all get together, which is kind of a cool setting for all of us to kind of reconvene. You meet a lot of people and meet people that you met on the, or see people that you met on the interview trail, but learn about some current legislative issues and then how, going forward in this career, you can really try to make a difference and be involved in some of the bigger decisions that impact your daily practice and really important issues to be involved in. So advocacy is just another way for us to kind of have our patients' interests in mind, be the voice for our patients, and see on the kind of ground level what issues are at hand and bring it to DC or other legislative or lawmakers and really say, these are the things that, in theory, maybe seem good, but in practice, aren't really working. So it's an important thing for us, because we're the only people that are in this unique position to have this voice for the patients. And so the advocacy ambassador program in the Mid-Year Forum are a collaboration between the American Academy of Ophthalmology, the state ophthalmology societies, the different training programs in the ophthalmic sub-specialty and specialized interest societies. So there's the Congressional Advocacy Day, which is kind of the first day where all of the different state representatives go and meet with their various members of Congress and the House representatives and discuss issues. We met with, well, we didn't meet face to face with the senators or the representatives, but we met with staffers from Senator Hatch's office and from the House representatives Chris Stewart and Jason Chafetz and then, and I'm for blanking on the other senators, Mike Lee. We know that's, yeah. So the issues that were really kind of the main messages that we brought to the table and talked to them about was the kind of the big one that a lot of people are upset about or kind of that really have the potential to impact a lot of people in ophthalmology is the CMS funding of Medicare. So they made these massive reimbursement cuts for glaucoma and retina procedures. And the problem is that they, CMS did this really outside of the realm of their, really not within their rules of how they are judging and kind of qualifying procedures. So they kind of just went in and made these cuts really without any sort of background or just randomly in some sense and didn't follow their own rules, which is a problem going forward that there is no kind of set way that will go about making these cuts or valuing procedures. So it's kind of a big issue, not only for the providers that do these procedures, but also just moving forward how our time and our procedures will be valued and ophthalmology has gotten faster, it's gotten more efficient, but there is especially in some of the glaucoma procedures, I mean, these are very complicated surgical procedures and the follow up and postoperative care is also quite complicated. So that's a big issue that we're trying to, that we brought to the attention of the representatives and some offices were more kind of in tune with what was going on and versus others. It was kind of interesting to see the difference in the different representatives' offices about in terms of the staffer's knowledge and kind of how up to date they were on everything. The other big issue too is the meaningful use and kind of how we can make this really much better and not such a penalizing thing going forward that for people doing in a kind of ophthalmic settings or small offices that it can be really, really difficult. We were with Dr. Matt Weed who has a practice in Probo and he had some daily examples of how he's gone through every step of the meaningful use. He kind of has a small practice and basically got a letter in the mail saying you didn't complete it. No answers why you're getting cut this much. So these are kind of issues that affect a lot of practicing ophthalmologists. Other kind of things that we brought to the table were continued funding for vision research through the National Eye Institute and the Division of Defense and then truth in advertising which has been one for many years but on a federal level so just saying surgery really needs to be done by surgeons and just being honest about what training people have and how really that that's in the best interest of all the patients. And then also there was another kind of talking point about improving contact lens safety for consumers. So just companies that are these kind of massive contact lens producers that they don't necessarily have standards in terms of when their contact lenses expire, how they're getting the prescriptions to patients contacting ophthalmologists and saying is this prescription acceptable and just there's a lot of things that they could do better to make the contact lens kind of world a little bit better for the patients. And then the other kind of part of it was talking about how yes we can go out and talk but a lot of times it does take money to fight some of these things and the big thing in ophthalmology has been kind of scope of practice and on individual state levels there have been kind of some conflicts between surgeons by surgery by surgeons and that's been a big issue but basically there's a surgical scope fund hop the pack and then state eye packs and so kind of talked about those and I think going there and seeing how DC is run it becomes very clear that lamious and money and all of this actually is kind of what makes it run for better or for worse and so it's important to be involved and so thanks to the University of Utah and Marianne for having me. Made it kind of quick because we have a lot of other presentations but does anyone have questions or questions about the issues that were kind of addressed there? So you may or may not be aware that there were pretty significant cuts to glaucoma and retina this year and it's interesting because even the retina glaucoma society is also the Academy, they're aware that those procedures are overvalued and these are their kind of retina that are surgical procedures and what happened here is really interesting normally CMS when they make cuts they look at two things they look at time a procedure takes and then they also look at complexity and in this case it was sort of end of the fiscal year where they had to basically you know not necessarily a bad thing but kind of meet a quota of cuts and so what they did for the retina glaucoma procedures they purely cut based on the amount of time it takes they didn't take into account any of the complexities so a trabeculicomy for instance with the incredible amount of post-op visits compared to other surgeries that ended up just being cut in the same way that you would cut something like removing a simple skin tag and that was really the main issue it wasn't so much that there is a cut because we do recognize just like early on in cataract surgeries cataracts became more efficient you know there was this golden age that the reimbursements were still quite high even though the procedure itself was increasing in its efficiency so that was really kind of an interesting insight into that funding and then also just a comment on meaningful use so all of the there are currently three different kind of incentive ways for physicians to either make more money get more reimbursement from Medicare or alternatively now it's starting to be penalized if you're not participating and they're all now coming under single umbrella theoretically where they're doing away with these three different ways to get more reimbursement and now that's all coming under MIPS and MACRA and so if you do see little bits coming out about that it's worth familiarizing yourself with the new acronyms and also the new requirements so thank you for that, it was wonderful. Thank you. Okay.