Healthcare’s crushing storm

June 2019 – Vol. 38, No. 5

Healthcare’s crushing storm

Meaningful healthcare reform at the federal level may be on the way. After treading water while the Affordable Care Act has been debated, public intolerance has forced both political parties to address a worsening situation. Unremittingly rising out-of-pocket expenses, “surprise” bills in excess of deductibles, the inexplicable complexity associated with our healthcare system, skyrocketing pharmaceutical and device costs, non-essential administrative burdens, and continued access problems in the face of unsustainable healthcare spending have intersected and created the impetus for action. The de facto rationing of care caused by these conditions is unacceptable to the American public.

James C. Denneny III, MD, AAO-HNS/F EVP/CEO

Both comprehensive and issue-specific proposals have been made. The concept of “Medicare for All” has gained traction and promises of a systemwide reform following the 2020 election cycle has been set forth. Currently, the hot button issue relating to surprise or unexpected billing has risen to the top of legislative priorities for this Congress. There is bipartisan, bicameral support to address this issue. Multiple instances have been reported where five- and six-figure bills were submitted to patients who believed they were receiving in-network services at a participating institution and were cost-protected by their insurance plans. Many medical associations, including the Academy, have been actively lobbying for legislation to protect our patients from situations that they have no control over and that are too complex for most to understand and predict. It is essential that our patients do not get caught in the middle of systemic problems between providers and insurers.

Most of these interactions occur around both emergency and elective hospital services. Patients will engage a physician and hospital system listed as “participating providers” only to find out later that all providers treating them may not be “participating providers.” They subsequently receive multiple large bills they were not planning on. In my opinion, it is inherent upon the hospital system and health insurance companies to offer complete transparency to the patients. If an entity is listed as a “participating provider,” a patient should be able to count on all services they receive from that institution to be covered and paid per contract as participating providers. The health insurance companies need to bear the responsibility for creating adequate networks and promote them in a transparent fashion so patients, who are already under a great deal of stress, can understand the process they will need to follow.

Educational grants

Lee D. Eisenberg, MD, MPH, established Health Policy Educational Grants last year. This year, there were four grants awarded. Dr. Eisenberg has a long history of outstanding service and financial contributions to the Academy and Foundation spanning over 40 years. He has been a member of multiple committees, given many courses and lectures at the Annual Meeting, served as a Coordinator for Socioeconomic Affairs and Development, been a member of the CPT panel, received a Presidential Citation, led the ENT PAC Board of Advisors, and served on the 3P Committee for more than 10 years. As Dr. Eisenberg prepares for retirement, I want to offer my personal thanks, as well as that of the organization, for all he has done and the multiple contributions he has made to our organization.

Specialty societies

The 2019 Bulletin will carry a series of articles submitted by our colleagues representing otolaryngology specialty societies as well as ASCENT (otolaryngology administrators) and SPAO (PAs in otolaryngology). These articles are designed to inform our members of important happenings in each area and provide related education. This month, the American Neurotology Society (ANS) provides us with a snapshot of recent significant happenings in neurotology. I would like to thank ANS for taking the time to inform us about these critical issues.

Kudos

I would also like to congratulate Sheng-Po Hao, MD, and Karl Hoermann, MD, who were chosen as candidates for Chair-Elect of the International Advisory Board.