Annual Report 2016: Advocacy

Annual Report 2016

CapitolThroughout the year,  the Academy’s legislative and grassroots efforts  act as the voice of the specialty on Capitol Hill  and in the state houses.  The Academy’s legislative advocacy work ensures  lawmakers are knowledgeable about  the issues affecting otolaryngology and understand how pending proposals could impact your practice and your patients.  These initiatives, combined with the  Academy’s Health Policy efforts, create  a continual advocacy mechanism to ensure  the specialty is well represented with policymakers and providing Value4U.
 
 

Advocacy leaders and staff work in myriad areas to provide value. The work falls into two primary categories—Health Policy: agencies and payers; and Legistative: federal, regional, state, and local. These pages outline each area of endeavor.
 

LEGISLATIVE AND POLITICAL

  • Advocated on behalf of the specialty via 129 Capitol Hill meetings and 76 political fundraisers.
  • Co-signed 34 coalition letters with others in the healthcare community on varied topics, including tobacco control, hearing health, MACRA implementation, and scope of practice.
  • Testified before the Food and Drug Administration regarding Good Manufacturing Practices and Proposed Stratification of Hearing Aids.
  • Submitted numerous comment letters in anticipation of the National Academies’ report on “Hearing Health Care for Adults: Priorities for Improving Access and Affordability.”
  • Successfully thwarted attempts by allied professionals to inappropriately expand their scope of practice, as well as efforts to re-define audiologists as “physicians.”
  • Supported and advanced “truth-in-advertising” proposals to ensure patients are fully informed in their healthcare decisions.
  • Joined AAOA, AAFPRS, and others to oppose, on multiple fronts, proposed changes to USP 797 and related changes to in-office compounding regulations.

GRASSROOTS AND STATE TRACKERS

  • Advanced PROJECT 535, a BOG-sponsored initiative ensuring each Member of Congress is connected to an AAO-HNS Member. In the program’s first year, key contacts in more than 50 percent of states/congressional districts were identified.
  • Activated nearly 1,800 members of the ENT Advocacy Network, urging them to contact their legislators via eight “Calls to Action.”
  • Held monthly conference calls with more than 130 volunteer State Trackers to identify legislative trends developing at the state level.

ALL-STAR ADVOCATES

Effective legislative and political advocacy relies on you, our Members. To more broadly recognize AAO-HNS Members who support the Academy’s entire spectrum of advocacy programs, a new “All Star Advocate” distinction was established in 2016. AAO-HNS Members who carry the All-Star Advocate designation help to advance the specialty’s priorities by:

  • Joining the ENT Advocacy Network. This “opt-in” network provides Members with timely updates and legislative “Calls to Action.” Advocacy Network members also receive information regarding the breadth of the Academy’s advocacy efforts via the monthly e-newsletter, The ENT Advocate.2016GovAffairs_Chart
  • Participating in PROJECT 535. This initiative aims to recruit a “key contact” for each U.S. Senate and House Congressional seat. Pairing Academy Members with lawmakers in each Congressional district improves our outreach and effectiveness when major issues impacting the specialty are debated by Congress. Remember, elected officials value the input of their constituents/voters when considering legislation, and physicians are important community leaders. Your opinion carries weight! Thanks to the commitment of our AAO-HNS Members, approximately 54 percent of all 535 U.S. Congressional and Senate districts are currently “matched” with an otolaryngologist-head and neck surgeon.
  • Meeting with lawmakers at home via the In-District Grassroots Outreach (I-GO) Program. This critical program enables AAO-HNS Members to contact, establish relationships, and meet with federal legislators in their home state/district.
  • Donating to the ENT PAC, the political action committee of the AAO-HNS. ENT PAC is non-partisan and issue-driven, which means we strive to support only pro-otolaryngology incumbents/candidates. By pooling the voluntary contributions of AAO-HNS Members, we are able to further amplify the strength of the specialty’s collective voice on Capitol Hill.
Leadership_Ruiz

U.S. Rep. Raul Ruiz, MD, from California’s 36th District (front row, fourth from left) with ENT PAC Leadership Club donors and All-Star Advocates.

The AAO-HNS thanks the physician volunteers who help ensure the success of the Academy’s various advocacy programs. With the 115th Congress scheduled to convene in January, we encourage all of our Members to get involved with any (or all!) of our legislative, grassroots, and political advocacy efforts. The Academy will provide the direction and resources—we just need your commitment to advocating on behalf of the specialty.

Contact govtaffairs@entnet.org for more information or to sign up!

EXAMINING THE ACCESSIBILITY AND AFFORDABILITY OF U.S. HEARING HEALTHCARE

Over the last year, several Administration-related entities have been examining the topic of “access to hearing healthcare services and/or devices,” and what steps could be taken to mitigate perceived barriers associated with accessing such services. The AAO-HNS has been an active participant as this multifaceted investigation has evolved, having provided feedback and/or comments to the President’s Council of Advisors on Science and Technology (PCAST), the National Academies of Medicine (NAM), and the Food and Drug Administration (FDA). Provided below is a brief overview of the Academy’s efforts on behalf of you, your practices, and your patients.

  • President’s Council of Advisors on Science and Technology (PCAST) – In October 2015, the PCAST issued a report titled “Aging America & Hearing Loss: Imperative of Improved Hearing Technologies” that outlined the advisory group’s recommendations for broadening access to various hearing aid and/or hearing aid-like devices in the United States, including the potential for “over-the-counter” sale of certain hearing aids. After careful analysis, the AAO-HNS submitted a formal comment letter supporting most of the report’s recommendations while emphasizing the importance of a medical evaluation requirement.
  • National Academy of Medicine (NAM, formerly the Institute of Medicine, IOM) – After a year of information gathering and analysis, the Committee on Accessible and Affordable Hearing Health Care for Adults released a report in June 2016, titled “Hearing Health Care for Adults: Priorities for Improving Access and Affordability.” The extensive report made several recommendations aimed at easing perceived barriers for patients to access various hearing healthcare services. The Academy was pleased the report did not recommend changes to Medicare’s current physician referral requirements (e.g., direct access). Although the report was initially expected to have a substantial impact on a wide range of hearing health-related advocacy efforts, the report has not generated much interest among lawmakers to quickly implement its recommendations. However, stakeholders in the hearing health community convened in December 2016, to discuss “next steps” and areas of possible collaboration.
  • FDA – In April 2016, AAO-HNS/F Executive Vice President/CEO James C. Denneny III, MD, testified at an FDA Public Workshop on “Streamlining Regulations for Good Manufacturing Practices (GMPs) for Hearing Aids.” And, as follow-up, the AAO-HNS submitted a formal comment letter to the agency (on the same topic) at the end of June. Overall, the AAO-HNS has indicated its support for easing federal regulations associated with access to various hearing devices (hearing aids and/or PSAPs), as long as the requirements for an initial medical evaluation are upheld.

Hearing-RiB-1Given the potential impact of these collective efforts, the AAO-HNS continues to closely follow all three entities. And, it remains possible that these reports could have broad implications pertaining to the AAO-HNS’ ongoing efforts (re: audiology scope/direct access) on Capitol Hill. However, the combined efforts of the PCAST, NAM, and FDA to analyze the provision of hearing healthcare services, and the AAO-HNS’ subsequent support for many of the collective recommendations, represent a positive shift from the status quo. As today’s technology evolves at an unbelievable pace, the AAO-HNS and its Members must continue to provide patients with the best pathway for safe, affordable, quality care. Positive patient advocacy includes reevaluating the role of technology and identifying common ground.

It’s Value4U and the right thing to do.

To learn more about the AAO-HNS’ efforts relating to the delivery of hearing healthcare services and/or to read the aforementioned comment letters, contact the Legislative Advocacy team at legfederal@entnet.org or visit www.entnet.org/advocacy.

The Academy’s Health Policy Team works with the Physician Payment Policy (3P) Advisory Workgroup to represent the membership at large and ensure appropriate advocacy for Members’ interests. This includes developing and fostering relationships with top officials at Medicare and national private payer organizations and advocating for appropriate reimbursement for otolaryngology-related procedures. Coordination with other Academy committees, specialties, and surgical specialty societies is critical to the work of the Health Policy Team and 3P. Below are  accomplishments over the last year.

HEALTH POLICY RECAP: PRIVATE PAYER2903

  • Reviewed nine national medical payer policies and provided feedback on the following topics: functional endoscopic sinus surgery (FESS), debridement prior authorization, implantable bone-conduction and bone-anchored hearing aids, cochlear implants, balloon sinus ostial dilation for chronic sinusitis, diagnostic fiberoptic flexible laryngoscopy, diagnostic nasal endoscopy, and injectable bulking agents for vocal cord insufficiency. Highlights from three positive changes as a result of Academy advocacy efforts in collaboration with private payers are noted below.
    • Anthem ultimately accepted the Academy’s request to consider the use of SPECT/CT fusion imaging as medically necessary in the evaluation of parathyroid glands in individuals with hyperparathyroidism when used for anatomic localization prior to parathyroid surgery.
    • In response to Academy comments, Anthem also revised their Allergy Immunotherapy policy, changing coverage for the provision of increased allergen/antigen preparation for the first year of treatment.
    • Based on concerns raised with UnitedHealthcare (UHC) regarding the number of debridements (CPT 31237) that are reasonable following FESS procedures, UHC removed CPT 31237 from the list of services that require prior authorization, effective October 1, 2016.

HEALTH POLICY RECAP: CODING/REIMBURSEMENT8015

  • Concluded work of FESS Task Force, comprised of experts  from the Academy, ARS, and AAOA, resulting in the  creation of five new and modification of seven existing nasal/sinus endoscopy codes, presented at the CPT Editorial Panel in  October 2016.
  • Surveyed 25 codes through the RUC survey process including Laryngoplasty, control of nasal hemorrhage, and Tracheostomy codes.
  • Developed three new Category III codes for insertion, revision, and replacement of chest wall respiratory sensor or lead for Hypoglossal Nerve Stimulation, available for reporting July 1, 2016.
  • Drafted two CPT Assistant articles: Removal of Impacted Cerumen (69209) and Drug-Eluting Sinus Implant (CPT 0406T, 0407T).
  • Updated three CPT for ENT articles (Cerumen Removal, Laryngoscopy, and Transtympanic Therapeutic Injections).

HEALTH POLICY ADVOCACY RESOURCES

Overview Fact Sheetmips23P_Icon-NEW-Print3P and the Health Policy staff created  Position Statements, template appeal  letters, advocacy statements, and other resources to help practices receive  appropriate reimbursement  from private  payers, maintaining  credibility  with national and local representatives  on socioeconomic and federal  regulatory issues.  The accomplishments  below highlight responses  to the needs and  requests from Academy Members to receive relevant and valuable resources.

REUSE OF SINGLE-USE DEVICES: RESPONSIBLE RECYCLING OF MEDICAL INSTRUMENTATION

In July and August 2016, a special project Task Force developed an educational product on multi-use of single-use devices (SUD) designed to address FDA regulation, patient safety, and impact the Academy membership in a resourceful way.

The Task Force developed a white paper that focused on SUDs that helps managing healthcare costs and operating sustainability. This details how it is “critical to recognize not only the importance of disinfection and sterility, but also the preservation of structural integrity to ensure delivery of the originally intended therapeutic result with no additional risk to the patient.”

Further, the white paper addresses the obligations of physicians and practitioners to their patients on informed consent.

You can find this white paper and other valuable resources in the November issue of the Bulletin.

ACADEMY COLLABORATES WITH UNITED HEALTHCARE TO CHANGE DEBRIDEMENT PRIOR AUTHORIZATION

The Academy raised concerns with UHC to request the removal of the number of debridements (CPT 31237) from their prior authorization list that were reasonable following functional endoscopic sinus surgery (FESS) procedures. After the Academy provided medical literature as supporting evidence, UHC decided to remove CPT 31237 from the list of services that require prior authorization. Further, UHC updated their FESS medical policy to reflect the latest (2015) versions of Clinical Indicators. Both advocacy victories were effective October 1, 2016.

To find more information on this policy, a UHC Prior Authorization Requirement FAQ, and a list of UHC Prior Authorization Requirements, visit www.entnet.org/content/private-payer-advocacy.

HEALTH POLICY REGULATORY ADVOCACY

3P and the Health Policy Team provide value for you by advocating to appropriate regulatory agencies on behalf of all Academy Members. Below is a snapshot of some of the policies the Academy has advocated on your behalf during the past year, which are scheduled to take place starting January 1, 2017.

2017 is proving to be a pivotal year of change for otolaryngologist–head and neck surgeons. Starting January 1, 2017, otolaryngologist–head and neck surgeons will begin participation in at least several new programs, all of which may require modifications to practice patterns and substantial investments on the part of practices. These include the MIPS and Alternative Payment Model (APMs) programs, which are replacing the SGR as the payment mechanism for Medicare; reporting Chronic Care Management (CCM) G-codes; and clinicians in certain states will begin reporting on claims data on post-operative visits furnished during the global period of a specified procedure using CPT code 99024 as part of a CMS required data collection for all 010 and 090 day global surgical codes.

In the past year, the Academy has actively worked to reduce the regulatory burden facing otolaryngologist–head and neck surgeons. The Academy has:

  • Submitted 11 comment letters submitted to CMS on coding and payment related policies, including the proposed new Merit-based Incentive Payment System (MIPS), Alternative Payment Model (APM) and Episode Grouper programs.
  • Actively worked with Congress, including participating in meetings with representatives from the Doctors Caucus, to ensure robust oversight in the implementation of the MIPS and APM programs.
  • Personally met with Patrick Conway, MD, Deputy Administrator for Innovation & Quality, CMS Chief Medical Officer, to discuss concerns regarding the implementation of the MIPS and APM programs.

NEW ACADEMY PRACTICE MANAGEMENT RESOURCES

  • In response to Member inquiries and new regulatory requirements, the following additional resources were developed:
    • 2016 quality reporting programs factsheets
    • 2017 MIPS and APM program overview factsheets
    • ICD-10 FAQs
    • Private Payer Advocacy Toolkit
  • 3P and the Academy also developed:
    • Five new Position Statements
    • 12 revised Position Statements (As part of a collaborative effort with the American Academy of Otolaryngic Allergy and the American Rhinologic Society, the Academy revised the Position Statement on balloon sinus ostial dilation [BSOP]).
    • Two reaffirmed Position Statements
    • Three updated Clinical Indicators

To locate these and other resources, please visit www.entnet.org/content/practice-management.

These efforts contributed to CMS modifying the MIPS reporting periods for FY 2017, including the introduction of two new reporting periods.

The Academy also reviewed, analyzed, provided a summary to Members and provided comments to CMS on the final 2017 Hospital Outpatient Prospective Payment System and the 2017 final Medicare Physician Fee Schedule (MPFS), including calling on CMS to drastically modify the proposal to force all clinicians to report G-codes to collect data on all 10 and 90 day global surgical procedures. Academy staff have also participated in 25 coalition meetings since March 2016 to advocate additional issues of importance to our Members.

In 2017, several new programs clinicians may participate in include:

GLOBAL SURGICAL DATA COLLECTION

For procedures furnished on or after July 1, 2017, practitioners in practices of 10 or more in Florida, Kentucky, Louisiana, Nevada, New Jersey, North Dakota, Ohio, Oregon, and Rhode Island will be required to report on claims data on post-operative visits furnished during the global period of a specified procedure using CPT code 99024. The specified procedures are those that are furnished by more than 100 practitioners and either are nationally furnished more than 10,000 times annually or have more than $10 million in annual allowed charges. CMS will not implement a 5 percent withhold for clinicians that do not report 99024.

MIPS AND APM REPORTING

In 2017, eligible clinicians will begin reporting performance categories as part of the MIPS program or will participate in an Advanced APM. Starting January 1, 2017, clinicians have the option to pick their pace with three reporting periods for MIPS: Report one Quality, Advancing Care Information (ACI), or Clinical Practice Improvement Activity (CPIA) measure at any point in 2017; Report MIPS measures for any consecutive 90 days in 2017 (must begin reporting by October 2, 2017); or Report MIPS measures for all of 2017 starting January 1, 2017.

CHRONIC CARE MANAGEMENT (CCM)

paceClinicians can report a new add-on G-code to describe work performed by the billing practitioner once, in conjunction with the start or initiation of CCM services. This new G-code was supported by the Academy as a method to pay separately for CCM services furnished, making reporting of the code less burdensome, and promoting use of the code for appropriate beneficiaries.

As you prepare for changes coming in 2017, the Academy will continue to advocate on your behalf to ensure the regulatory burden placed on practices is as limited as possible, allowing you to continue to care for your patients.