Rob Melendez, MD, MBA

WHY I ADVOCATE? Dr. Rob Melendez, Ophthalmologist #MYF2018

The AAO’s “Why I Advocate?” Challenge.  #MYF2018

Welcome Advocacy Ambassadors! #MYF2018 Follow me @DrRobMelendez

Ambassadors,

Welcome to the AAO’s Mid Year Forum (MYF) 2018! I look forward to meeting a lot of you very soon. I was part of the inaugural Advocacy Ambassador class in 2004. Fifteen years  later, I am still actively involved with advocating for my patients and our profession.

The MYF is where ophthalmology leaders meet. On Wednesday evening, we will have dinner together describing Thursday’s Congressional Advocacy Day activities. You will partner up with your state’s ophthalmology leaders where we will visit your legislator’s office. Be prepared to (typically) meet with the health legislative assistant, who is very knowledgeable about health care issues. In some cases, you will get to meet your legislator and will be given an opportunity to take a photo (remember to remove your name tag). Call Senators, Mr. Senator Henrich (NM) or Madame Lujan-Grisham (NM) or Representative Smith. When entering their office, know who you are meeting with, this will be  given to you in advance. For example,  Good morning, we are here to see the Congresswoman or the Congressman or Stuart Martinez, we are from the American Academy of Ophthalmology. Carry very little in your pockets because you will have to walk through a metal detector upon entering every building. Bring business cards if you have them.

Our main issues this year for Congressional Advocacy Day (Thursday):

1. The Technology based Eye Care Services (TECS) program is a clinical care initiative funded though the Department of Veterans Affairs Office of Rural Health (ORH).

2. Department of Defense Peer-Reviewed Vision Research Program Support FY 2019 VRP Funding at $20 Million
3. National Institutes of Health/National Eye Institute Support Funding of $3
9.3 Billion for NIH and $800 million for NEI in FY 2019
AAO Urges Congress to Increase Research Funding for NIH to $39.3 Billion and NEI to
$800 Million in FY 2019
4. Simplify the Merit-based Incentive Payment System by Expanding Credit for Participation in Qualified Clinical Data Registries
5. Physicians Need Regulatory Relief from Burdensome Prior
Authorization Requirements
6. Ensure Timely Access to Compounded Drugs for Office Use
Cosponsor H.R. 2871, the Preserving Patient Access to Compounded Medications Act
Basic Terms:
H.R.  = House Resolution
S.B. = Senate Bill
On Friday, there will be a specific program just for ambassadors called the LEAP Forward program where the emphasis is on Leadership, Engagement, Advocacy, and Practice Management
When: 8:00 – 11:30 am, Breakfast at 7:00 am
Where:  Room: Mt. Vernon Square
This is an opportunity to meet fellow residents and leaders in ophthalmology. Make sure and take lots of photos. Get a pic with the YO Chair, Dr. Purnima Patel and the highly approachable YO Committee, they will be wearing purple beads. YO, by the way, stands for Young Ophthalmologist (residents, fellows, and ophthalmologist within the first 5 years of practice). Additionally, get a photo with our AAO President, Dr. Keith Carter too.
Feel free to ask any question you like and ask for a picture and use the hashtag: #MYF2018 in all of your social media posts.
Wednesday: Dinner
Thursday:
Daytime: Walk the halls of your Congressmen and Congresswomen.
Opening Session in the afternoon.
Dinner: Be sure to attend the Mid-Year Forum Reception and Banquet with our keynote speaker – physician and decorated NASA astronaut Dr. David Wolf.
After dinner: Surgical Scope Fund Reception at the Press Club-great place to meet other residents and leaders.
Friday:
LEAP Forward Program 8-11:30 am
Lunch Meeting…

The Future of Artificial Intelligence in Ophthalmology

12:15 p.m. – 2 p.m.
Moderator: Rahul Khurana, MD – Editor in Chief, The ONE Network, American Academy of Ophthalmology

The next transformation in ophthalmology is the application of artificial intelligence in diagnosing and treating disease in clinical practice.  It is beginning to be used in retinal disease for detecting diabetic retinopathy and diabetic macular edema from fundus photographs, and its potential is to provide more efficient and objective analysis of images and prediction of disease progression.  The session will explore what artificial intelligence means for practicing ophthalmologists, its promise and limitations, and what the future holds.

 

Debrief Session 2:30 – 3:30 pm (Must Attend)
Council Meeting
OPHTHPAC Reception.  We will be at the Potomac View Terrace of the American Pharmacists Association building
Dinner: on your own.
Saturday:
Council Meeting (Join us!)
Download the “AAO Advocacy” app.
Follow me on Twitter for more tips on getting more involved with Ophthalmology and the Academy. Start with your state society. @DrRobMelendez
See you soon,
Rob.
Robert F. Melendez, MD, MBA
-AAO Secretary for Online Education (ONE Network and EyeWiki)
-Comprehensive Ophthalmology, Eye Associates of New Mexico
-Clinical Assistant Professor, University of New Mexico Health Sciences Center, Department of Surgery/Division of Ophthalmology
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Transformational Leadership starts with transforming yourself…Be more than a manager, be a Leader.

Check back and learn more about leadership.

 

Managers count value

Leaders create value by…

 

“I’ll handle A and you handle B.” A Leader.

Empower others to succeed on their own.

 

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Is Twitter Dying for the Ophthalmologist??

Is Twitter dying for the Ophthalmologist?

Rob Melendez, MD, MBA and Pavan Angadi, MD

We performed a study to investigate whether ophthalmologists are joining Twitter at an increasing rate and to determine whether they are more active on the site. We searched  for ophthalmologists using the following terms: “ophthalmologist”, “ophthalmology”, and “eye surgeon.”  We found that ophthalmologists started joining in 2007 when Twitter started and the number of new users was at their maximum in 2009 (56) and has been declining since then and  in 2017 only one ophthalmologist joined Twitter (See Figure 1). There were obviously more ophthalmologists on Twitter, but were difficult to identify because they failed to mention in their profiles that they were an ophthalmologist. This raises the issue of why some ophthalmologists are on Twitter. The ones who did not self identify themselves as ophthalmologists are likely on Twitter more for personal use and not professional reasons to educate others.

We also investigated how active these ophthalmologist have been in 2016 and 2017. We found that the average number of tweets/month in 2016 was 60.6 and in 2017 it increased to 80.4 (38.6% increase). We also found that the total number of active users increased from 138 in 2016 to 169 in 2017 (22.5%). We also identified the total number of tweets from these  ophthalmologists in 2016 was 3739 and 5865 in 2017, which was an 56.9% increase. We found that although the number of new users on Twitter has declined since 2009, the existing users of Twitter has increased. Given the paucity of ophthalmologists on Twitter, suggests that it is a great opportunity for more ophthalmologists to become leaders on Twitter to educate others. We also identified which types of ophthalmologist are most active on Twitter (see Figure 2).

 

 

Figure 1. Number of Ophthalmologists on Twitter and what year they started.                                                Figure 2. Ophthalmologist Twitter Users by Subspecialty

What is wrong with Volume to Value based care? Focus on Hypervalue

What is wrong with Volume to Value based care? Focus on Hypervalue

Rob Melendez, MD, MBA  @DrRobMelendez

The phrase “volume to value” is a misnomer. It implies that we are not currently providing any value to our patients and that we are providers who are simply focused on RVUs and FFS. I am appalled by such a phrase. Our focus should be on the term that I will use “hypervalue.” Hypervalue is a term that raises the bar for patients at all levels of patient contact using lean management principles. We need to improve the healthcare system for one reason: to improve the health of our patients. As we have seen over the last 5 years, clicking on boxes to simply satisfy a payment requirement hasn’t increased value for the patient. These programs drive some people to play the game to simply get paid. Our standards should be so high for our patients that when the government mandates so-called value targets, it will pale in comparison to what the increased value or hypervalue that we are providing for our patients. For starters, Let me review two hypervalue concepts for our patients.  1) Improving communication with the providers and patients. 2) Using technology to reduce waste and to analyze how we are caring for our patients.

  1. Communication: We need electronic health records (EHR) that communicate with other providers and healthcare systems to streamline healthcare. Often times, duplicative testing is being performed and we are not aware of the other ordered test. We also need to continue to improve communication with our patients. The Mayo Clinic has an excellent app for their patients to access their exam notes, labs, appointments etc. This app is an example of hypervalue for our patients. I personally have seen this app in action.  Our practice currently uses a patient portal system to communicate with patients which brings value to the patient. We chose to implement EHR in 2005 before we had to because it provided a mechanism to access medical records across our 15 clinics around the state of New Mexico as well as the ability to analyze where we can improve processes and patient care points. Sadly, the cost is enormous for EHR. The costs of EHR can range from the cost of computer equipment, training, IT support and maintenance and beyond. The benefits of EHR are evident today, but when were first started, the costs outweighed the benefits. For example, the IRIS® Registry created by the American Academy of Ophthalmology is a prime example of the huge advantage of EHR. This will increase value to patients, hypervalue. Just think, you now have the ability to easily determine how many of your glaucoma patients had a visual field in the last year and how many of your patients with Diabetes had macular edema to cite 2 examples.
  1. Technology: Can you imagine a time where patients can input their medical histories online before seeing the doctor via home computer, tablet, or phone with an app? It’s available now, but cost prohibitive in some cases. We trialed a kiosk in the waiting room with little success. It required extra people to teach the patients how to use it. I believe this will come back with time. Think how you first felt when you had to use the kiosk at airports to check yourself in, it was frustrating at first and still is at times. I remember a time in high school when I was a clerk in a grocery store and personally unloaded the customer’s shopping cart and checked them out myself. Now a days, businesses are trying to use technology to improve efficiencies and convenience for certain type of customers with fewer items. Hypervalue would be providing the technology option plus a person to educate the user one to several times until they learn how to use it. The benefit of updating your information before the visit would be to decrease wait times in the clinic. What if there was a faster way to verify insurances before the visit? Perhaps there is, so please share any insights. As we move from so-called volume to value, let us remember that the patient is always first and trying to improve their experience while improving their health is paramount — Focus on hypervalue.

RVUs = Relative value units

FFS = Fee for Service

EHR = Electronic Health Records

#hypervalue

The Art of Delegation

 

The Art of Delegation
Rob Melendez, MD, MBA
As you move along in
your leadership position as chief resident, stop and reflect on ways to involve
others more in your goals. As a leader, one of your jobs is to promote others. Seek to
include others in as many projects as possible. For example, as you begin
planning your goals for this year from creating a wet lab for your program to cre
ating a mock session for oral boards, invite others to chair one of those committees. If you do not have committees created, then take this time to create them. You will always have the title of chief resident and reap benefits from it, but think of others too who need help building their own leadership skills and portfolio.
Take assessment of your residency program to determine the weaknesses and create committees to create solutions for those deficiencies. By involving others, you are also practicing the art of delegation. This requires you to be willing to do any job yourself that you ask others to do. Delegation is not simply pawning a job off to someone that you would not do. Show extreme enthusiasm for any project to motivate the other residents. Remind them that you want them to take the lead on a specific project to help the program. If they are not motivated enough by improving your program, remind them that it will help them when they are applying to fellowship and for their first job. Obtaining planning and organizational skills during residency is great practice and will serve them well in future leadership positions. When we join a practice, we will be asked to oversee a project to improve the practice or department. Every resident should be given the opportunity to lead in a project to improve your program. I suggest creating a list of projects and solicit the residents’ ideas too and ask which one they want to implement. Can you imagine if every resident had one mini project to improve in their program? Our goal is to help every program improve and as a result will improve ophthalmology at large. Involve others.

What is groupthink?

Groupthink

Rob Melendez, MD, MBA

 

This term was coined by a social psychologist Irving Janis (1972). Groupthink occurs when a group makes faulty decisions because group pressures lead to a deterioration of “mental efficiency, reality testing, and moral judgement.” Consider avoiding groupthink in your practice and while serving on committees.

 

When a practice experiences groupthink they can become too optimistic to the point that they take extreme risks. Individuals can also discount warnings and do not reconsider their assumptions.

 

Symptoms of Groupthink

  1. Having an illusion of invulnerability
  1. Rationalizing poor decisions
  1. Believing in the group’s morality
  1. Sharing stereotypes which guide the decision
  1. Exercising direct pressure on others
  1. Not expressing your true feelings
  1. Maintaining an illusion of unanimity
  1. Using mindguards to protect the group from negative information

 

Recommendations to avoid Groupthink:

 

  1. Use a policy-forming group which reports to the larger group
  1. Having leader remain impartial
  1. Using different policy group for different tasks
  1. Dividing into groups and then discuss differences
  1. Discussing within sub-groups and then report back
  1. Using outside experts
  1. Using a Devil’s advocate to question all the group’s ideas
  1. Holding a s “second-chance meeting” to offer one last opportunity to choose another course of action.

 

Irving, Janis. (1972). Victims of groupthink. Boston: Houghton Mifflin; Irving, Janis. (1982). Groupthink: Psychological studies of policy decisions and fiascos. 2nd ed. Boston: Houghton Mifflin.

 

 

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