One-on-One with AAO President Tamara Fountain, MD

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Mark Dlugoss: Thank you Dr. Fountain for joining The Ophthalmologic Project for its initial podcast. So my first question is for those who don’t know you–could you provide a short profile of who you are, your background, where you practice, how long you’ve been a member of AAO, et cetera, et cetera.

Tamara Fountain, MD: Sure. I live and work in Chicago. I’ve been here for about 25 years. I’m on part-time faculty as a professor at Rush University Medical Center in downtown Chicago. And I also maintain a private practice in oculoplastics on the North Shore of Chicago in the North Shore suburbs. And I’ve been a member of the Academy since I was a first- or second-year resident, which is over 30 years ago. And the annual meeting coming up in New Orleans will be my 30th anniversary of going to annual meetings. I think I’ve only missed one Academy in all of those 30 years. So, it’s been a long, it’s been a long loyal road for me as part of the Academy, but yeah, I spend my time in the, in the Midwest, where it’s cold, a good part of the year and its certainly cold right now.

Mark Dlugoss: What drove you to be actively involved with the AAO and how rewarding have you found this involvement? Both personally and professionally?

Tamara Fountain, MD: What drove me? I don’t know if I was, I think I wasn’t really driven. I think someone dropped me off. It’s more like, really early on when I was a fellow. In fact, I was recommended by an outgoing member who had been in my, in my medical school. She was a few years ahead of me, but she knew of me. And when she left this fledgling nonsense young ophthalmologists committee, back in 1995, she gave the committee my name as somebody who might be interested in replacing her. And so I was asked to join, this was 25 years ago and I just haven’t looked back since it was a lot of fun to be part of the young ophthalmology committee. It was the first time anybody ever paid me to go anywhere. I remember how excited I was filing my first expense report, but from there on out, you know, I just, it was, I loved the common mission.

I liked working in groups. I liked the task and goal-focused nature of the work we were asked to do. And it gave me a chance to look at the profession of ophthalmology on a more macro level. I mean, it’s obviously rewarding. We all do it. The impact that we have patient by patient in our days, but this for me was just an opportunity to look at the profession from a more diffused look. And, you know, if it wasn’t rewarding, believe me, we physicians wouldn’t do it. I mean, it doesn’t pay anything at all. So those people who tend to stay involved in member organizations like this are somewhat of a self-selected bunch because they have found some sense of reward in the volunteer service that they give often to the bewilderment of their family members or partners and colleagues in their practices who wonder how on earth they could spend so much time away from the clinical practice of medicine when the pay is so poor for that. But clearly, we have found some secret costs that, that appeals to us in some other ways,

Mark Dlugoss: Over your 30 years now going to Academy, how have you seen the Academy grow over those last 30 years? I mean, from my perspective, I remember my first Academy meeting was in 96, I believe, 1996. And, I’ve seen the Academy grow so much in ophthalmology growth for that matter over the last, you know, 30 years, almost 25 years. So how much, how much have you seen it grow from being on the inside?

Tamara Fountain, MD: Yeah, there’s been a lot of change for certain. I mean, my first Academy was in 1991 and I think everybody remembers the first time they ever walking out on the exhibit floor. I mean, for anybody who’s ever been to a trade show of any sort, it is just overwhelming that scale of it all. And so I think that’s just a fond memory for most of us back in those days. I think the Academy, there was no such thing as sub-days when I first started going to the Academy. And so it really pretty much started on, on Sunday and went through, I believe it might even have been Thursday morning the Academy ended. So the days of the week were different. When we first started, I remember they had a Wednesday afternoon concert that was put on by position musicians who were pretty good.

I have to say they all sounded really good far beyond my, my level of expertise in the violin. But over the years as the Academy evolved and they introduced the whole idea of sub-day and it kind of leapfrogged a little bit. So, they seem to start taking days off of the end of the meeting and putting them on to the beginning. So the traditional Sunday to Thursday changed to Saturday to Wednesday, and now we recognize it as Friday to Tuesday, and going forward the Academy, it’s probably going to shorten that another day. So we’ll be seeing probably Tuesday, go away. As far as the Academy meeting, we heard from our members, as well as our exhibitors, that Tuesday was just a difficult day for many people, people wanted to get back into the offices. So we’ve evolved. We’ve always, as a medical organization, tried to anticipate and listen to the feedback that our members were giving us as far as what they wanted and how they wanted it in their educational offerings.

Mark Dlugoss:  What would you say to your colleague ophthalmologists who may be pondering involvement with AAO on a regular basis like you have over the years?

Tamara Fountain, MD: Well, I would say it isn’t, it isn’t for everyone. I recommended colleagues who have exited after their commitment was over and others who just said no from the get-go. So, whatever I say, I guess is just meant for me, just because I like Rocky Road ice cream doesn’t mean you should, but if you like working in groups, if you relish learning new things and providing insight after your workday and on weekends, then I think the Academy is a wonderful organization to which to give your time and talent. And it also gives you an opportunity to impact your patients on a more broad scale.

Mark Dlugoss: Okay. And your President-Elect address at the AAO Virtual Annual Meeting, you said the past year, 2020 was a time of “disruption and devastation brought on by COVID-19.” You said that despite that crazy year we’ve had, you presented a pretty optimistic viewpoint in which ophthalmology should view this time period as an opportunity. Can you elaborate more about your remarks regarding this potential of opportunity?

Tamara Fountain, MD: Okay. I know that I didn’t mean to be hyperbolic with that–the disruption and devastation–but it was a tough year, it was a challenging year, no matter where you were on the globe, no matter what your station in life, no matter your occupation, it was a challenge for everybody on this earth, I would say. So, you asked about how can I be optimistic? I think one area, one silver lining, and there are, there were many, we had to look for them, but there were, there were some from the 2020 year. And for one that comes to mind quite quickly is telemedicine. I mean, that’s a notable and obvious example. I mean, without COVID, we would not be embracing it like we’ve been able to do there were limitations. And now with the floodgates opening, we have the motivation to pursue this avenue.

Now for ophthalmologists, we have limitations on how much a remote visit information can give us. We’re limited in our visual acuity measurements, we’re limited in obtaining interocular pressure measurements and other interocular examination elements. However, I think that with the innovation in wearables and the monitoring of health metrics going forward, that now that telemedicine is a much more obtainable avenue, that the innovation will then come, we’ll figure out how we can get a vision from the patient. We are going to figure out how we can monitor interacting with customers remotely. And I think that these trends were there, but like many other sort of trends in our society accelerated many of those. And I think this is one, one area that we saw that it forced us all to look at how we live our lives. And as professionals, it’s forced us to look at how we live our work lives, as it relates to clinical workflows, you know, what’s the purpose of the waiting room.

Can we utilize more electronic avenues for our forms to limit the amount of time that the patients are in our waiting rooms? Do we need to re-look at how frequently we see people and call them back in certain elements, be postponed, or at least the frequency of follow-up lengthened. So I think it’s forced a reckoning on how we do everything, which, you know, sometimes inertia sets in, we don’t tend to evaluate things or reevaluate our lives, our work lives, or our personal lives, unless there’s a compelling reason to do so. And COVID and 2020 were certainly compelling for many of us.

Mark Dlugoss: That’s amazing when you think about that, because, you know, it helped everybody think about how can we streamline our operation to make it even better. So that’s, that’s a good thing As we begin the year 2021, what would you like to achieve as a president in the coming year?

Tamara Fountain, MD: Yeah, I get that. I get asked that question a lot. And unlike some organizations, the presidential role for the Academy, you’re really an ambassador for the organization. You’re the person that people see you, you do have influence, and your opinions are certainly valued and probably listened more to during that year than any other time. But as a certain past-president explained to me when you’re president, you are the queen in my case, and David Park is the prime minister. And so my job is to support David Park and AAO staff and conducting the affairs of the organization. And while I might have a platform of sorts, it’s really business as usual. I think one of the focuses is to make sure, given that I’m not able to be in-person for many of the state and sub-special society meetings that a president is typically invited to.

I’m going to make sure that I maintain those ties. And in some ways, there is an opportunity here, whereas I physically could not be in two places at one time. Now I have the opportunity to maybe deliver a state society address to the Kentucky Society on a Friday evening, and then give the keynote oratory for an international trauma conference in Singapore the next morning. So in some ways, the virtual platform allowed a greater reach. It’s not the same sort of intimacy that we’re used to, but I think there’s an intimacy nonetheless. So I think I will not be limited at all in my ability to maintain the outreach to organizations. That’s typically part of the presidential role. One thing I do want to follow-up on this year is out of the racial unrest in our country. Last year the Academy established two task forces.

The first one was an independent body that we have asked to look inward at the Academy. We have in our mission to promote and support diversity and inclusion in our organization. We have that written down. It’s one of our aspirations, but are we really living up to that? We like to think we are, but we’ve asked this task force to look at the representation of Academy leadership, the representation of committee chairs, the representation of people we asked to speak at the podium at our national meetings. We want to make sure that we represent the diversity of our membership in the forward-facing aspects of our society. So that taskforce will be reporting back to us, hopefully by the year on how we’re doing as an organization and what areas in which we can improve. The second taskforce is looking specifically at the racial inequities and health outcomes within the ophthalmic space.

We know that the burden of glaucoma is born more by our African American population. We know that the burden of diabetic retinopathy is born inequitably by people of Latin X backgrounds. And so we want to more granularly look at that data in a way that will allow us to devise strategies to narrow those gaps going forward. So that’s the second taskforce that we hope to report out also by mid-year. I’m hoping that each taskforce will have some concrete steps that we can take going forward. And I hope to help to oversee that and make sure that those are at least started during my year of presidency.

Mark Dlugoss: That’s great news to hear Dr. Fountain. Really great news. So would you consider that a challenge to accomplish all the new year to come?

Tamara Fountain, MD: No, it’s not a challenge. It’s part of, it’s part of our plan. It’s part of our agenda. If you will. I do see some headwinds that we’ll be facing, and they’re not much different than the headwinds that we’re typically facing, but I think some of the challenges are going to be sharpened because of the fallout from some COVID, you know, physician therapy, physician reimbursement is a perennial focus of the Academy, and that’s pretty much the whole raison d’etre for AAO DC office. And we have constantly been advocating for the preservation of, you know, physician reimbursement. You know, ophthalmology is one surgical specialty that is less likely I should say, to be employed by hospitals. So we’re, you know, by and large, much more likely to be our own bosses or small business owners compared to other surgical specialties. And that makes us unique in a way that we can control our work environments perhaps more than hospital-based surgeons, but it also leaves us a little bit more vulnerable because as we run our practices, you’re going to be more, we have to figure out how to run our businesses in a profitable manner.

And the overhead is not going down for nearly any of us. And so we’re having to figure out how to make do with less and less reimbursement as time goes on. So we are advocating where we can in Washington to try to preserve a fair reimbursement for physicians so we can keep our offices open. We have to work within the house of medicine because in many ways a government is only going to want to give so much money to healthcare in general. And in some ways, we’re competing with our brothers and the cost, the house of medicine for, for these scarce dollars. But, you know, we hope to, we hope to make a good case to the government that especially in the fallout from COVID, that this is not the time to be putting additional financial pressures on physicians who are tasked with helping the country recover from this pandemic.

Mark Dlugoss: Great. That’s great. Great to hear. The reimbursement situation has been a major problem for as long as I’ve been in ophthalmology. Well, as you know, COVID 19 has had a major impact on ophthalmology, especially physicians in individual practices. What is the Academy doing or working with the practices to get them through these trying times?

Tamara Fountain, MD: Oh gosh, we have a whole division AAOE–that’s the American Academy of ophthalmology Executives, and it’s really our practice management arm. We have a board position Ravi Goel is the senior secretary for practice management. And under that umbrella, we have coding specialists. We have regulatory people. So almost from March 13th, you know, we all can kind of look back on the day when we knew that our lives were changing. We scrambled to make sure that we were there for our members to make sure that our members could take advantage of the various financial lifesavers that were being thrown to make sure that we were able to take advantage of the PPP loans and to obtain PPE for our practices. So PPP and PPE, along with just general recommendations about how to deal with staff, how to deal with testing.

Tamara Fountain, MD: I mean, there was no playbook for anything like this, and we were sort of building the airplane as we were flying it, and it was not unique in that regard, but I think we had some dedicated professionals who recognize what the need was and did their best to curate the torrent of information coming through on COVID-19. So, that our practices could compete in this arena. And traditionally this practice management resource database is available to people who are members. They have to pay yearly dues, but we recognize the need was so acute for the profession that all of the COVID-related practice management guidelines, I’m pretty sure were placed in front of the firewall. You did not need to be a member. They were provided free of charge. It was our mission to the profession and to our patients to help all of our members, regardless of whether they were AAOE members or not. And so I think that’s been very well received and now that we’re in a new year and we’ve got a new stimulus package coming, I think the practice management arena will fire up again with the webinars that have been very, very popular, helping our members understand what financial resources are available and how they can take advantage of them.

Mark Dlugoss: Great. Just a side question, has the government with their relief package been very helpful for ophthalmologists?

Tamara Fountain, MD: I would say that, yes, not everybody has taken advantage of the financial resources to the same degree. And there was some initial confusion with the initial rollout on how you applied and what were the loan payment terms etc. and the loan forgiveness terms. But, you know, a lot of that has been settled at this point. So I would say that most practices who took advantage of the stimulus money were satisfied with the way they were distributed.

Mark Dlugoss: That’s good to hear. Well because of COVID-19, I know AAO, as well as other ophthalmic societies and medical organizations. Especially is all over, face the prospect of their annual meeting turning virtual. How successful was the AAO meeting, considering the situation since we went virtual, how successful was it from your perspective?

Tamara Fountain, MD: Well, my perspective there was, it exceeded expectations and we made the decision, or actually we were forced to go virtual because it was physically going to be impossible to have our meeting in Las Vegas since it was shut down. And we’re prevented from congregating, I think more than 50 people in one space. So we had no choice, but to pivot to virtual. Now for a few years now, we have had an on-demand, virtual component of instruction associated with our annual meeting. And we would take a number of our lectures to be provided, after the meeting. So it wasn’t our first experience with online on-demand content, but obviously we never ever experienced the need for virtual meetings. So hats off to the meetings division, that was all they did for pretty much 24/7, from the time that we made this decision to the time it went live.

And so we had about 9,000 total registrations for the virtual meeting. And to put that in some context, we got about 67% of the normal in-person expected registration from our domestic members. So two out of three American members who would normally have gone to Las Vegas signed in virtually. We didn’t have quite those numbers with our internationals, only about 25%, which in some ways was a little counterintuitive to me. I would’ve thought that without the barrier of having to travel across an ocean to get to the meeting, that we might’ve had more people sign up for the virtual meetings. But I think what that tells me in a way is that our international members tend to value the travel to the meeting and being there in person for whatever reason. So we did see a greater fall off in our international uptake for the meetings, but the feedback, in addition, was very, very positive.

We had the expected tech glitches that every virtual meeting has, but what people loved about it was the on-demand ability. I mean, when you think about this podcast when it runs, people are going to have the opportunity to pause, to rewind, to fast-forward if they like, and we’ve come to expect that whether we’re streaming on Netflix or listening to our podcasts, and people love the ability to sit down after the kids were in bed at night and pull up a lecture, and if they didn’t hear something, they could rewind it. So we have had such tremendous feedback that we want to keep some aspects of this on-demand capability. On the other hand, we also had people who said, you know, I like this virtual content, but boy, I cannot wait until we can get back together in person again.

So I think there are definitely camps of people who will find it more convenient to obtain their educational content from the convenience of their homes at the time that they want to. But I also am absolutely convinced that for many of us, there will be nothing that will substitute for being in person for those, you know, running past somebody in the hallway and having a one-minute conversation with a former resident that you haven’t seen in 20 years. And so those are almost impossible at least as of now, to replicate in a virtual environment. So I think going forward, our meetings department will rise to the challenge of providing the parts of the virtual meeting that people absolutely loved, while we’re still also available to meet on-site. So I’m optimistic about what kind of creative ways we’re going to find going forward to harness this enthusiasm for parts of virtual meetings.

Mark Dlugoss: I think the virtual meeting was a complete success. Like you said, the face-to-face encounter with fellow physicians, you know, that’s a different dynamic that you’re going to lose because of that. And that’s, if anything, one reason to bring them back next year, you know?

Tamara Fountain, MD: Exactly, exactly. I think we’ll have some. We are fully expecting to meet in New Orleans this year, and I know that there’ll be lots of hugging going on because we’re all, I think in need of a personal interaction and reconnection in a big way,

Mark Dlugoss: Just prior to the 2020 AAO virtual meeting, the Academy launched the year of the eye initiative, can you outline the initiative and what this could mean to ophthalmologists?

Tamara Fountain, MD: So the year of the eye, so 2020, I’m amazed at how many of my non-ophthalmic friends aren’t quite understanding the significance of 2020. They kind of caught their heads and I say, you know, like 20/20 vision, they’re like, “Oh, oh okay”. So, you know, maybe this was more important to us ophthalmologists than others, but I mean, some could say we waited 1,999 years for this auspicious year when we had all sorts of ways of, you know, playing on the 2020 scene. And so we thought this was a great opportunity for us to have a campaign to highlight some of the great leaders in our field. People have given to the profession of ophthalmology, as well as to highlight more than we usually do, sort of a public service arm of what ophthalmologists brings to the table.

Tamara Fountain, MD: And so that was the original intent of the year of the eye campaign. And obviously come March 7th to 10th, our communications division was a little bit distracted by this new virus and how it was turning everything upside down. And so the public arm of the year of the eye, we had to suspend and pretty much all hands on deck, we’re getting the public information about COVID that we did still run internally with our own publications and our electronic bulletins that we pushed to our members every week or so. We still did rotate through the physician innovators and, you know, they would rotate through on the scroll on the homepage and our members could click on the face and find out more about that person. So we still did that part of the campaign, but because of COVID, a large part of that year of the eye had to be suspended.

Mark Dlugoss: Yeah. But it’s rolling out now, correct?

Tamara Fountain, MD: I think we’re still, you know what, I think I have seen still some of that information and, you know, EyeSmart, we might not call it the year of the eye, but we’re probably still going to maintain the same information and resources to the public. If you’ve ever been on EyeSmart and, you know, I don’t go as often as I probably should, but I was on there not too long ago. There was just almost an overwhelming amount of information from eye protection to the frequency of exams to what does it mean when I have trouble reading when I turned 40. You could go on Mark, and find a video for how to properly uncork the champagne bottle. So I’m impressed with the information and the usability of that information. It’s presented in a way that I think is easy to follow.

It’s intuitive, and we’ve devoted a lot of resources to making that content accessible to patients both literally as well as figuratively. And we’ve coupled that with our own IWiki resources, which is sort of like a Wikipedia for ophthalmic issues. And a lot of times, if I’m looking for something in clinic real quick, and I type in a search term into my search engine, I would get often coming up first now instead of the regular Wikipedia, entry for the disease entity. So we’ve obviously positioned ourselves well to be one of the top hits coming in when people type in different ophthalmic terms.

Mark Dlugoss: It’s amazing. I know the Academy over the years has presented amazing stuff and talking to your communications staff over the years, your whole communication staff does an incredible job of offering these kinds of programs, enlightenment for not only the practices but for patients as well. And the doctors should take more advantage.

Tamara Fountain, MD: I think so too. So I think if anything, this is a great public service announcement. For our EyeSmart campaign.

Mark Dlugoss: And rightfully so, I think. Okay. Well with the Biden administration taking office this month, what kind of relationship does the AAO expect to have with the new administration, especially with the FDA and the CMS, and what kind of pros and cons are facing the AAO in regards to this new administration?

Tamara Fountain, MD: So we try to work with every administration and the head of CMS at the time. One of the things I think we can expect a change with the new administration is, you know, one of Biden’s priorities is to make Medicare work better for more Americans to salvage the best parts of the ACA and to extend that into Medicare. So, whereas the past administration may not have been as focused on Medicare expansion. I think that that’s one change that we’ll see with the Biden administration. He’s made that very clear that that’s a top priority. And so we would like, as they’re making major structural changes to Medicare, to improve Medicare, that we want to make sure we’re represented at the table and we can help to be part of the process as they roll out that expansion and improvement. I think, his overall motto, if you will, or his tagline is “build back better.” So if they’re making substantial changes to Medicare going forward, we obviously, since such a large percentage of our patients are Medicare, and it’s probably the largest payer to all of our practices, that’s obviously going to be an area we’re going to focus our attention.

Mark Dlugoss: I think we touched base on this next question, but I just want to get more elaboration, you know, the Centers for Medicare and Medicaid Services released its scheduled fee and we talked about it not doing well for ophthalmology. This year is supposed to be a 6% reduction. Was there anything positive for ophthalmology in the fee schedule?

Tamara Fountain, MD: Oh, actually, absolutely. In fact, I want to be clear that just last week, that initial projected 6% reduction, they haul to bat. So what they did was they did away with one of the features that was going to reduce our conversion factor, and they put that on hold for three years. So that freed up some money. So we’re not looking at a 6% reduction at this point. In fact, it’s going to be much much less, and then for some practices, it depends a little bit on the patient mix and the level of coding that an individual practice has, but there might be some ophthalmology practices that might see a slight increase, but it’s going to be a significant improvement on that 6% reduction as of right now. So we’re not going to see those drastic cuts, that 6% that were originally planned, and that’s in part due to the dogged efforts of our DC office, as well as our members. We pushed out pleas to all of our members to let their Congresspeople know what the impact of these cuts would be, particularly in this environment of COVID.

So we’d like to think that the grassroots efforts for our members, as well as the organization of our DC office, helped to avert these cuts, but you know what, we cannot rest for a moment. We understand that primary care is lobbying for a big increase in their payment almost on day one of this new administration’s term. And in general, the government does not want to expand the pie. They use this term called budget neutrality. So if one part of medicine gets paid anymore, in general, the government wants that to come then at the expense of another part of medicine. So you can see how we’re kind of pitted sometimes against our colleagues in medicine. We are trying to argue that, you know, maybe we should, under certain circumstances, increase the pie altogether, but we know that that’s always been a difficult campaign and it’s going to be even more difficult to convince the government to spend more on healthcare now than they do given the big bill for COVID that’s going to be coming, not just for our government, for all governments across the world. So, you know, we’re lobbying, you know, it’s like asking for more allowance as a teenager when both your parents just lost their job, you know, it’s not a good time to make the plea heard for payment increases, but we are going to be there lobbying on behalf of the professionals as possible.

Mark Dlugoss: Okay. Beginning of the year 2020 many ophthalmic, I guess, visuals predicted there would be a shortage of ophthalmologists who would be able to provide clinical care to a continually growing number of patients, meaning, the elderly and is AAO doing anything to address this demographic among eye care physicians. And I mean by that, is growing the number of physicians. I know each university has only a certain number of residents, and are they talking about growing the number of residents per year, stuff like that.

Tamara Fountain, MD: Well yes, in general, residency spots across the country are funded through CMS, which, you know, takes a congressional approval of that, and they have not expanded the funding for that for many years. On top of that, we have had a significant increase in the number of medical school slots. We have new medical schools, some medical schools increasing the size of their classes, which has brought more students into the position pipeline. But then there’s still a funnel because we haven’t proportionally enlarged the slots for residency. So we, unfortunately, have every year now, medical students who have completed all the requirements of medical school and graduated successfully, and simply cannot get a residency spot because there are more medical students than there are residency spots. So that’s an issue that, that even the government recognizes and I believe a year or so ago, they did approve additional funding for around a thousand residency spots to be distributed across the country.

Now, I don’t know how those will be divvied up. My guess is that the government’s