• The British Columbia Society of Eye Physicians and Surgeons (BCSEPS) has recently lost their long battle with Doctors of BC and Tariff Committee at an oral Internal Review hearing regarding the recently implemented cataract fee code cuts. Despite a positive presentation at the hearing, the committee denied BCSEPS a more impartial hearing via a tripartite committee, which would have been the result if the committee had found that Doctors of BC should not have accepted Tariff’s recommendation to cut the fee.
• BCSEPS argued that they have tried to address intrasectional disparity by offering to redistribute funds within the section but were refused by government (whereas other sections had done so), and that the cut had no justification based on the terms of the Physicians Master Agreement.
• BCSEPS Executive have selected final candidates for the Cataract Guidelines Revision working group, and as the process progresses will provide further updates to COS. They have also recently written to MSP requesting clarification on billing for uninsured services performed in connection with insured services, as Bill 92 brought into question the permissibility of this, with serious penalties for infractions.

• EPSOM collaborated with the CNIB and FFB for a public presentation on Feb. 27, 2019 regarding inherited retinal diseases. Presentations by Drs. Ravi Dookeran and Josh Manusow were very well-received.
• At the recent CNIB gala on March 13, 2019, EPSOM purchased a table and had a delegation of board members attend. Since the Minister of Health, Cameron Friesen was introducing the evening event, the EPSOM delegation made a point of personally meeting and thanking the Minister for his interest in eye care services in Manitoba. On behalf of EPSOM, Dr. Tenley Bower did an exciting presentation on the Boston K-pro which she is now able to offer patients in our province.
• Dr. Jennifer Rahman was a guest on the CBC weekend morning show on March 10, 2019 to talk about World Glaucoma Week.
• EPSOM is working on a couple of local surveys regarding improving operating room efficiencies and future planning.
• EPSOM is working on a newsletter for Spring 2019.
• EPSOM continues to collaborate with the Manitoba Association of Optometrists who are expressing interest in establishing an Eye Health Council for Manitoba.

• Over the past month the binding arbitration agreement – part 1 has been released. In the agreement Ontario MDs will see the imposed fee reduction of 4.45% (present for the past 3 years) eliminated as of April 1, 2019. This agreement included some increase in pay for 2019 going forward, but it is unlikely Ophthalmology will see any increases due to relativity (noted below).
• The second part of the agreement will work on payment relativity. All increases in fees will be directed towards sections that are felt to be under funded. Unfortunately, this will ignore portions of our specialty that are underfunded such as pediatrics and plastics. There does not seem to be any mechanism or will to adjust intra-sectional relativity, but this issue remains unclear at present.
• Ophthalmology has been asked to find a number of millions in savings over the next year. This again remains unclear in the amount as well as the method at present. This may include limitation on the numbers per year per patient for certain services, delisting, or other unspecified mechanisms.
• Work is continuing with regards to the vision therapy file, but there remain many delays secondary to OD participation.
• EPSO will hold a day at Queen’s park to meet the Health Minister among others. This will take the form of a breakfast.
• The EPSO website continues to expand and provide a resource for our group along with the public.

In September 2018, AMOQ met with the Office of Health Innovation and they have accepted the request for Quebec’s Institut national d’excellence en santé et en services sociaux (INESSS) to prioritize the evaluation of MIGS technology.

• A new pediatric ophthalmology program was created 1 year ago and has been struggling on several levels. The program was partially funded (money for equipment, partial office lease coverage, funded orthoptist and partial secretary funding) but the practitioner is fee-for-service.
• There was a proviso in the contract that 80 per cent of the visits must be pediatric patients. Due to the length of time it takes to see a child vs an adult, the ratio has been closer to 50:50 and the health region has not been happy with the metrics. This has led to considerable stress on all sides.
• New Brunswick ophthalmologists are now under a 6 month “extended probationary” period where we are trying to create referral guidelines and establish the general ophthalmologists as the gatekeeper for this program. There is also working being done with the practitioner to eliminate as many adult patients from the practice as possible, while still being able to generate a reasonable income.

PEI’s manpower situation has improved. Dr. William Best will be starting his practice in mid-August. Dr. Ibrahim Elaraoud is presently a locum until October 2019. Currently, options are being explored to convince Health PEI to offer Dr. Elaraoud a permanent position within the province, this will improve the manpower situation.

• As of June, there will be only two ophthalmologists in Cape Breton.
• Intravitreal injections are a growing concern.
• In Nova Scotia, optometry will be working with government legislators shortly to approve scope of practice changes concerning glaucoma and uveitis management. These changes were eventually agreed upon by the province’s ophthalmologists and have been awaiting implementation. Optometry has however informed ophthalmologists that they intended to pursue the prescribing of oral medications at the same time regardless of our approval/disapproval. The justification is the shortage of viroptic, shortage of ophthalmologists and subsequent long wait times for consultations. Their primary justification is to be able to prescribe oral anti-virals and antibiotics for lid margin disease, but they have not indicated that they will only be requesting prescribing privileges for these medications. They have informed us that half of Canadian provinces allow optometry to prescribe oral medications.
• There is minimal to no support for this request amongst the province’s ophthalmologists as viroptic should soon be available, most shingles do not present to optometry and we feel there is more potential harm than benefit.