Published: December 9, 2016

Annual Report 2016: Research & Quality

Build a sustainable infrastructure to test, pilot, and promote adoption of research and quality products including guidelines, measures, performance improvement projects or lifelong learning projects, and evidence-based medicine to promote translational research.


H. Louise Eddy, MS, CCC/A, FAAA, executive director of Texas Ear, Nose & Throat Specialists, P.A., Houston, TX, presented during the Annual Meeting Miniseminar, “The Future Is Now, Regent: The First Otolaryngology-Specific Clinical Data Registry.”H. Louise Eddy, MS, CCC/A, FAAA, executive director of Texas Ear, Nose & Throat Specialists, P.A., Houston, TX, presented during the Annual Meeting Miniseminar, “The Future Is Now, Regent: The First Otolaryngology-Specific Clinical Data Registry.”

Research & Quality strategic goals include:

  1. Develop and maintain a clinical data registry for the specialty.
  2. Build a sustainable infrastructure to test, pilot, and promote adoption of research and quality products including guidelines, measures, appropriate use criteria, performance improvement projects or lifelong learning projects, and evidence-based medicine to promote translational research.
  3. Demonstrate the value of strong research and quality education and granting programs to the specialty.

Develop and maintain a clinical  data registry for the specialty.

REGENT℠ REGISTRY: DEVELOPMENT AND OVERSIGHT

Since the approval by the Board of Directors to move forward with the registry in September 2015, we have made tremendous progress in a short period of time. The listing below highlights our progress since December 2015.

  • AAO-HNSF secured both Qualified Clinical Data Registry and PQRS Qualified Registry status from CMS for Regent in April 2016.
  • The pilot phase of Regent concluded in June, with 21 pilot sites and 298 individual participants from five academic sites, 16 private practices, and 12 different EHR systems.
  • The Regent full launch sign-up portal deployed in July. This sign-up portal includes functionality to guide enrollees through the sign up, contracting, and membership verification processes.
  • Regent launched to the full membership July 25, 2016.
  • As of October, Regent includes more than 245 practice sites and close to 2,000 clinicians.
  • Each practice site reviews its measures data for accuracy with FIGmd and AAO-HNSF staff.
  • Concurrently, review has commenced on all of the ICD9 and 10 and CPT codes for all Regent measures to ensure the accuracy of data contained in Regent.
  • Registry Dashboards are being made available as data mapping exercises are finalized with each participating practice.
  • AAO-HNSF is preparing for PQRS 2016 reporting and MIPS 2017 as well as securing QCDR status for Regent in 2017.

Regent_LogoBuild a sustainable infrastructure to test, pilot, and promote adoption of research and quality products including guidelines, measures, performance improvement projects or lifelong learning projects, and evidence-based medicine to promote translational research.

GUIDELINE UPDATES

To date, the AAO-HNSF clinical practice guidelines (CPG) have been accessed close to 600,000 times via the National Guideline Clearinghouse and cited more than 4,000 times, according to Google Scholar. This is amazing outreach for such a small specialty. We are in the final stages of four updates and two new CPGs.

  • The update to the 2004 Otitis Media with Effusion CPG was published February 2016 and has been endorsed by the American Academy of Family Physicians (AAFP).

    “Harness the power of data”“Harness the power of data”

  • The update to the 2008 CPG on Earwax (Cerumen Impaction) has been accepted for January 2017 publication in Otolaryngology–Head and Neck Surgery. The update has been endorsed by AAFP, American Academy of Pediatrics (AAP), American Geriatric Society (AGS), American Neurotology Society (ANS), American Otological Society (AOS), and Society of Otorhinolaryngology and Head-Neck Nurses (SOHN). It is also supported by the American Speech Language Hearing Association (ASHA).
  • The update to the 2008 CPG on Benign Paroxysmal Positional Vertigo is undergoing Otolaryngology–Head and Neck Surgery review.
  • The update to the 2009 CPG on Dysphonia (Hoarseness) is undergoing external review and public comment. Once complete, the manuscript will be submitted to the journal for publication consideration.
  • The new CPG on Improving Nasal Form and Function after Rhinoplasty is to publish in Otolaryngology–Head and Neck Surgery in February 2017. To date, the new guidelines have been endorsed by eight organizations: the American Academy of Sleep Medicine (AASM), the American Rhinologic Society (ARS), the Society of Otorhinolaryngology Head-Neck Nurses (SOHN), the American Academy of Pediatrics (AAP), The Rhinoplasty Society, the American Society for Aesthetic Plastic Surgery (ASAPS), American Academy of Facial Plastic & Reconstructive Surgery (AAFPRS), and the American Society of Plastic Surgeons (ASPS).
  • The new Evaluation of the Head and Neck Mass in Adults CPG is undergoing external review and public comment. Once complete, the manuscript will be submitted to our journal for publication consideration.
  • The coming year will bring an update to Tonsillectomy in Children and new guidelines on Meniere’s Disease and the Surgical Management of Rhinosinusitis.

    Attendees asked questions during the Miniseminar on Regent.Attendees asked questions during the Miniseminar on Regent.

    GUIDELINE EDUCATION

    This year marks the launch of the new Expert Interview Series (AmX), which will offer 5-10 CME credits to users. The Rhinoplasty, Cerumen, and BPPV guideline Miniseminars have been selected for development into this new product and will be launched in early 2017.

    MEASURING GUIDELINE ADHERENCE

    As the AAO-HNSF looks to develop quality measures to help Members meet the ever-increasing demands of the Centers for Medicare & Medicaid Services (CMS) and other payers, it is important for us to look more closely at the quality improvement opportunities identified in the CPGs and see where there may be performance gaps that can be targeted for future quality improvement efforts and measure development. The Outcomes, Research, and Evidence-based Medicine (OREBM) Committee and the Creating Healthcare Excellence through Education and Research (CHEER) Network have been working on providing us with this evidence and published the following studies earlier this year:

    • Evaluation of Compliance for Treatment of Sudden Hearing Loss: A CHEER Network Study (July 2016)
    • Tonsillectomy Bleed Rates across the CHEER Practice Research Network: Pursuing Guideline Adherence and Quality Improvement (July 2016)
    • Multi-institutional Study of Voice Disorders and Voice Therapy Referral: Report from the CHEER Network (July 2016)
    • Medications for Allergic Rhinitis: An Opportunity for Quality Improvement? (August 2016)
    • Nonadherence to Guideline Recommendations for Tympanostomy Tube Insertion in Children Based on Mega-database Claims Analysis (September 2016)

    DEVELOPING QUALITY MEASURES

    Dr. Lisa Ishii with Dr. Martha Somerman, this year’s H. Bryan Neel III, MD, PhD Distinguished Research Lecturer.Dr. Lisa Ishii with Dr. Martha Somerman, this year’s H. Bryan Neel III, MD, PhD Distinguished Research Lecturer.

    In conjunction with the work on Regent, staff and physician leaders have reviewed our measures and have worked on a quality measures development strategy to guide our work and to ensure it is inclusive of all of the disease processes treated by our Members with the goal to ensure the development of meaningful measures addressing the depth and breadth of care provided by our Members.

    Measures development governance:

    • The Academy developed a preliminary measures development strategy built upon the operations of four distinct groups: Regent Executive Committee, Clinical Advisory Committees (CACs), Measure Development Groups (MDGs), and the Measures Task Force (MTF) to develop measures for the specialties of otolaryngology-head and neck surgery.
    • Seven individual CACs were created by the Regent Executive Committee (REC) to address measure development needs of each of the otolaryngology specialties. Clinical Advisory Committees comprise experts from Academy committees, specialty societies, and stakeholder groups and are chaired by the following REC representatives:
      • Facial Plastics – Lisa E. Ishii, MD, MHS, chair
      • General & Sleep – Lauren S. Zaretsky, MD, chair
      • Head & Neck – Michael G. Glenn, MD, chair
      • Hearing & Balance Chair – James C. Denneny III, MD, chair
      • Pediatrics – Jennifer J. Shin, MD, SM, chair
      • Sinus & Allergy – William R. Blythe, MD, chair
      • Voice & Swallowing – Melissa A. Pynnonen, MD, chair
    • Measures Development Groups will be formed to complete the specific task of fully developing quality and performance measures for a specific disease, condition, or procedure.
    • The Measures Task Force is a standing task force comprising various methodological experts, Academy measures staff, and stakeholders who have specialized knowledge or perspectives relevant to the work of MDGs, and will be chaired by Richard M. Rosenfeld, MD, MPH, Senior Advisor on Measures. During the AAO-HNSF Annual Meeting and OTO  EXPO,℠ 31 potential measure topics were identified by the CACs for prioritization.
    • The Academy is collaborating with the ECRI Institute to pilot test its GEM Cutting software using our Allergic Rhinitis and Cerumen Impaction guidelines. The Academy will evaluate whether GEM Cutting allows for expedited translation of guidelines into performance measures and assess the quality of the guidelines-based measures developed.
    • The Academy will also be collaborating with the American Academy of Neurology (AAN) regarding the development of neurotology measures.

    Demonstrate the value of strong research and quality education and granting programs to the specialty.

    GRANT FUNDING

    The AAO-HNSF is pleased to continue its partnership with the American Academy of Otolaryngic Allergy (AAOA), American Head and Neck Society (AHNS), American Rhinologic Society (ARS), American Society of Pediatric Otolaryngology (ASPO), Association of Migraine Disorders (AMD), and American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) as part of the Centralized Otolaryngology Research Efforts (CORE) Grant Program.

    Special thanks to Cook Medical and Xoran Technologies LLC for their continued financial support of resident research.

    The CORE Study Section continues to provide a comprehensive review of all otolaryngology applications and provides scores and written critiques to the leadership of the participating societies to help inform their funding decisions. The 2016 CORE leadership (including the boards and councils of all participating societies) approved a portfolio of 29 grants totaling $495,195.

    MOVING RESEARCH INTO PRACTICE

    Earlier this year, the OREBM committee kicked off a new column in the Bulletin, “Publications That May Change Your Practice: Spotlight from the OREBM Committee.” The goal of the column is to highlight important research and how the new studies may change how one practices. In March 2016, the column compared elective neck dissection (END) to therapeutic neck dissection (TND) in patients with early-stage (T1-2), node-negative oral cavity squamous cell carcinoma (OSCC). In September, the highlighted publications presented data regarding management of uncomplicated acute rhinosinusitis (ARS) and recurrent acute rhinosinusitis (RARS) in adults. The next installment will focus on an endocrine topic.

     

     


    More from Annual Report 2016

    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.
    Annual Report 2016: Advocacy
    Throughout 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. 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. 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. Given 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 PAYER 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/REIMBURSEMENT 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 3P 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) Clinicians 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.