History of OOSS – From Pioneer to Paragon
The Founding Traditions
The year was 1981 and the ophthalmic ASC industry was in its infancy. There were no regulatory controls or state codes for the outpatient surgical centers and no industry guidelines. Medicare reimbursement was an unknown.
A few prescient ophthalmic ASC owners recognized both the potential of the industry and the need to establish standards and guidelines to ensure patient safety, and a solid foundation for growth.
“We thought our colleagues could use some help figuring out how to accomplish the task of putting together an ASC,” recalls David J. McIntyre, M.D., FACS, the first secretary-treasurer of OOSS and a longtime leader in the organization. “We wanted to set up centers in a good way to protect patients and the industry.”
McIntyre had recently opened an ophthalmic ASC in Washington state. Doug Williamson, M.D., had a thriving ophthalmic ASC in Florida. Miles Galen, M.D., was working in New York, and Jerry Tennant, M.D., had a facility in Texas. These four physicians quickly formed the core of what was to become OOSS. Williamson, who practiced for 42 years before retiring in 2005, became the first president.
As McIntyre recalls, there were perhaps six or eight ophthalmic surgeons present at the initial organizational meeting, but that number quickly grew to more than 75 participants by the first public meeting. Within a few years, OOSS had 300 members. What had started as a simple idea to create an informal information pipeline quickly morphed into the first and only medical society dedicated exclusively to the interests of ophthalmic ASCs and their patients.
Almost immediately, the founders of OOSS recognized the importance of establishing relationships with government agencies and working together to develop constructive regulations that would benefit patients without impeding industry growth.
“We recognized very early that it was our job to help educate the government,” McIntyre recalls.
OOSS hired a young lawyer, Michael Romansky, as its Washington Counsel, and thirty-eight years later Mike remains the face of our legislative and regulatory program. Advocacy became the primary mission of OOSS, as it remains today.
During its first two decades, OOSS enjoyed a series of crucial legislative victories: securing increases in facility reimbursement for cataract and other ophthalmic services; expanding the ASC procedures list to include virtually all eye surgeries; and preserving the right of surgeons to own ASCs and other health facilities. By the late 1990s, however, membership growth had stalled and even begun to decline.
A Turning Point for OOSS
In the early 2000s, OOSS membership had declined, and revenues were scarce. The OOSS Executive Committee, which included then-President Jerry Levy M.D., Paul Koch M.D., Paul Arnold M.D., William Fishkind M.D., and Michael Romansky J.D. met in a strategic planning session in San Diego in 2003 with one objective: to determine whether the organization should continue to exist as an independent society dedicated solely to furthering the interests of patients and surgeons who practiced within and owned ASCs, or whether it should merge with one of the larger ophthalmology organizations.
“My view as president was that we were unique in that we represented ophthalmic surgery centers – not ophthalmologists,” Levy said. “We felt that if we joined one of the larger organizations, we’d be subsumed – and not be able to follow our mission.” In a decision that was as bold as the one the founders made when they created the Society, the leadership decided that OOSS should indeed become a greater organization with a mandate that extended beyond lobbying for higher payments and enhanced quality in the ophthalmic ASC. This decision was based upon the clear understanding that OOSS is unique in its membership and in its mission. “The San Diego meeting was definitely the turning point that put us on the path toward becoming the organization that we are today,” Levy said.
The next step was to professionalize the management of the organization by hiring an energetic and full-time executive director. The new executive director would have a broad mandate to transform OOSS into a more comprehensive association that offered its members—and prospective members— robust educational programming, a substantial and impressive web presence, benchmarking program, and other member benefits that would drive membership growth and provide funds to support our legislative and regulatory program.
In 2004, OOSS hired Claudia McDougal as its first full-time executive director, a position she held until her retirement in November 2013. She was instrumental in bringing OOSS to a sound financial footing. She also created an organizational structure that has given OOSS viability long into the future. Romansky worked with McDougal and a newly formed executive committee led by then-President Bill Fishkind to transform the organization. Together, they engaged Kent Jackson, Ph.D., to guide strategic planning, branding, and membership development. (When McDougal retired in 2014, Jackson succeeded her as OOSS’ executive director.) With the full engagement of a re-energized board, the team re-established OOSS as the powerhouse it is today. In January 2014, then Associate Board Member, Albert Castillo joined Romansky and Jackson as a member services consultant; he is presently OOSS’ Director of Membership Services.
Advocacy Always a Top Priority
OOSS successor presidents share the common belief that the Society is strong because of its engaged membership and collaborative industry relationships. The strength of OOSS is defined by its people.
Bruce Wallace III,
Bradley C. Black,
Y. Ralph Chu,
Maria C. Scott,
These strategic, aggressive, and savvy Presidents have carried on the traditions of their predecessors, with one primary goal: improving payment and reducing unnecessary regulation of ophthalmic ASCs through a strong and vibrant Washington advocacy program.
A non-exhaustive list of OOSS’ legislative and regulatory accomplishments include the following:
- 1982 Medicare ASC benefit established, with cataract facility fee of $336 (almost $1100 today)
- 1990 Medicare ASC procedures list expanded to include virtually all ophthalmic surgical services
- 1991 Stark law enacted to ban physician ownership in healthcare facilities – ASCs exempted
- 1999 HHS Inspector General establishes “safe harbor” to protect surgeon investment in ASCs
- 2000 Congress mandates that ASCs receive a cost of living adjustment every year
- 2002 CMS creates $50 bonus payment to ASCs that implant new technology IOLs
- 2009 CMS links ASC payments to hospital outpatient rates, ensuring that ASC rates increase as do hospital payments
- 2015 On OOSS’ recommendation, CMS withdraws onerous ASC quality reporting requirements, e.g., hospital visits following cataract surgery, complications within 30 days of surgery, improvement in visual function within 90 days following cataract surgery
- 2016 CMS issues “request for information” on advisability of paying a facility fee for office-based cataract surgery – OOSS says “No!No!No!” resulting in no action taken by CMS
- 2019 CMS establishes ASC cost of living adjustment at the Hospital Market Basket (same update factor as hospitals)
- 2019-21 CMS expands payments to ASCs that implant expensive single-use devices
- 2021 CMS expands payment for intracameral use of drugs with indication for pain
Partnering with Allies
OOSS leaders developed strong relationships with the American Academy of Ophthalmology (AAO) and the affiliated American Academy of Ophthalmic Executives (AAOE), the American Society of Cataract and Refractory Surgery (ASCRS), the affiliated American Society of Ophthalmic Administrators, and the Ambulatory Surgery Center Association—synergistic partnerships that continue to serve members, patients, and the health care industry. Since 1982, OOSS has dedicated a significant portion of its annual budget, board and staff resources to supporting the quality initiatives of allied organizations like AAAHC, the Joint Commission, and the ASC Quality Collaboration, assuring that the OOSS commitment to patient care, surgical efficacy, and operational integrity endures as hallmarks of the ophthalmic ASC model. Former OOSS President R. Bruce Wallace III, M.D., FACS, was instrumental in developing an enduring partnership between OOSS and the AAO for the fall Symposium, beginning in 2010. “The partnerships are a win-win situation for the Academy and for OOSS,” said Wallace. “There was a synergistic relationship right off the bat. It’s been a way to help out the Academy and for us to gain exposure at the largest ophthalmic meeting in the world.” As OOSS Past President Bradley C. Black, M.D., notes, the collaborative relationships between AAO, ASCRS, and OOSS also give the organizations more collective clout before legislators and governmental regulators. “When we sign a letter to a congressman and our message is consistent across the entire ophthalmology and ASC communities, it means a lot more,” said Black. “It gives our voice more strength in D.C.”
Expanding OOSS Missions Through Today
Beginning in 2008, OOSS developed a comprehensive and extremely effective benchmarking program for members, enabling ophthalmic-driven ASCs to measure their own performance over time and compare with similar ASCs across the country. To optimize staffing and operational performance, OOSS, in partnership with AAO/AAOE, launched a joint ophthalmic ASC/Practice salary survey in 2014. Special topical and trend surveys allow OOSS to collect data on specific issues and initiatives important to the ophthalmic ASC to anticipate change and to position OOSS members for the future.
And every three years, as part of a tri-annual strategic planning process, OOSS conducts a future survey, gauging the perception of OOSS members related to economic outlook, investment patterns, performance objectives, and anticipated challenges. In combination, the entire range of action research conducted by OOSS is of direct value to members and enables OOSS to maintain its unique leadership position.
Education has also been a major initiative of OOSS. As a result of increasingly formalized quality and safety standards and a climate that encourages technological advances, outpatient ophthalmic surgery has become the surgical standard in the United States. Mindful of the responsibility that goes with model leadership, OOSS works closely with industry partners to provide timely, high-quality education and information that serve the needs of the entire ASC team, from owner to surgeon to staff. Partnered courses delivered live, via webinar, and online focus exclusively on the needs and interests of the ophthalmic ASC.
OOSS’ effectiveness in our advocacy, practice management, and education programs is enhanced by our physician and administrative leadership’s ability to respond rapidly and aggressively to changing political, economic, and social environments. In 2020, Diane Blanck became the organization’s third executive director. With a decades long background in marketing, Diane led OOSS through the challenges of the COVID epidemic. Rather than retrench as many medical organizations did, OOSS went into high gear. OOSS shifted its focus to supporting members and industry through the government directives and COVID relief funds, providing education, communication and tools for all ophthalmic ASCs. OOSS developed new programs and opened access to all who needed help, launching virtual meetings, webinars, surveys, and alliances. In spite of global challenges, OOSS membership grew and the society’s number of partners doubled.
Today, OOSS has nearly 400 member centers across the US, engaging over 5,000 ophthalmic ASC professionals, including surgeons, administrators, nurses, technical staff and industry partners. The organization has evolved into a powerful advocate for the clinical and socioeconomic interests of all ophthalmologists, including cataract and refractive surgeons, and vitreoretinal and glaucoma specialists—while remaining true to its founding mission to promote education, quality, and efficiency. OOSS is now part of the conversation, locally and nationally, that is increasingly recognizing the advantages of the ophthalmic ASC—a paragon for delivery of high quality, affordable surgical care. In 2022, over 75% of cataract surgeries are performed in an ASC, making the advocacy priorities of OOSS for its patients and physician-owners as critical as it was in 1982.
In Memory of the Founder of OOSS
Douglas Eugene Williamson, M.D. of Venice, Florida passed on March 24, 2022, at the age of 94 years. Dr. Williamson was internationally renowned for being the “pioneer of outpatient cataract surgery” as he built the first eye surgery center in the United States in 1970, called the Venice Eye Clinic, and performed the first outpatient cataract surgery in the United States. He was the founder and president of the Outpatient Ophthalmic Surgery Society, which fostered the building and proliferation of eye surgery centers across the world. Following the advice of Dr. Williamson, Project ORBIS began providing flying eye surgery and education to developing nations worldwide. He testified in front of Congress in hearings instrumental in obtaining approval of Medicare reimbursement for cataract surgeries performed in ambulatory surgery centers.