PRACTICE PROFILE
Midwest ENT Centre

May 2016 - Vol. 35, No. 04

The practice provides a full spectrum of audiology services, allergy testing and immunotherapy services, office-based IAC, accredited CT imaging, and a wide array of in-office surgical solutions

From left: Robert R. MacDonald, MD; Benjamin M. Conoyer, MD; J. Michael Conoyer, MD; J. Matthew Conoyer, MD; Karen E. Boone, MD; and Martin L. Willman, MD.

From left: Robert R. MacDonald, MD; Benjamin M. Conoyer, MD; J. Michael Conoyer, MD; J. Matthew Conoyer, MD; Karen E. Boone, MD; and Martin L. Willman, MD.

Midwest ENT Centre is a single-specialty group of six physician Members of the Academy, located in St. Peters, MO. An “oto family” connection ties three of the practice’s physicians: J. Michael Conoyer, MD, is the father of J. Matthew Conoyer, MD, and Benjamin M. Conoyer, MD.

“We were not pushed into otolaryngology in any way,” said Dr. Matthew Conoyer, Midwest ENT Centre president. “When I was a kid, I knew my father really liked what he did. He felt challenged by it, thought it was rewarding work, and he wasn’t gone all the time. When you see someone close to you be that fulfilled by his vocation over a period of many years, it certainly attracts you.”

Partnered with the Conoyers are Martin L. Willman, MD, Karen E. Boone, MD, and Robert R. MacDonald, MD. “We’re all at the same practice as one big mostly functional family. Everyone gets along,” said Dr. Conoyer. “We’re blessed with a really good group.”

Midwest ENT Centre is the main provider of otolaryngic care for St. Louis’ largest suburban counties, serving a population of more than 350,000. The practice provides a full spectrum of audiology services, allergy testing and immunotherapy services, office-based IAC, accredited CT imaging, and a wide array of in-office surgical solutions.

“We’re in an area with a large geographic draw, we offer a breadth of in-house services, and we happen to be in a pretty bad allergy and sinus area,” Dr. Conoyer said. “And while I don’t anticipate us being anything but a successful private practice in the future, there are definitely more hoops to jump through just to maintain our level of service.”

Of particular concern to the practice as of late is where they as a group would fall on the so-called “quality-cost” curve. “Our diversification of services raises our perceived cost per patient treated. It has nothing to do with overuse or misuse of billable services,” said Dr. Conoyer.

New Bulletin feature

This month we introduce a new feature that will highlight and profile individual practices that represent otolaryngology today. The diverse nature of otolaryngologists and the clinical situations they practice in create unique needs based on the scope of care provided, practice location, employment status, and physician demographics. The creative solutions utilized by these representative practices will illustrate successful strategies employed by our Members as well as personalize the Academy’s activities on behalf of the membership. We appreciate the willingness of Midwest ENT Centre to be the inaugural subject of our Practice Profile.

Under the model used by Midwest ENT, services are billed using the practice’s tax ID number and are linked to each treating
physician’s NPI number. “It makes our costs for effectively treating some of our more complicated patients seem to exceed those of most of our medical colleagues,” he explained.

The practice remains burdened with PQRS reporting as well. “At present, there is no registry available that an otolaryngology group can join with confidence. While the Academy’s registry remains in development, we are left to join a general practice registry.”

Like many private practitioners, Dr. Conoyer is concerned about the “unfunded reporting and technology mandates from CMS” as it influences the way they spend their business dollars and time. “The rules seem to change on a fairly regular basis. Edits come down from Medicare and they will be very different from what they read two weeks ago. It seems to be a moving target.”

Dr. Conoyer and his partners have to put a lot of their business revenue toward compliance for government programs. “It’s tough because there are only so many dollars to go around. A lot of our energy would usually be used toward offering new services, new products, and learning new procedures. Now that energy is diverted toward compliance issues. This is not why we do what we do; it’s a reality that is forced upon us.”

Midwest ENT prides itself on cohesive and convenient quality patient care. The physicians prepare in advance of patient appointments to make sure procedures and tests are preapproved by insurers and that a patient can get everything he or she needs done in one fell swoop. “The keys are common courtesy and good customer care,” said Dr. Conoyer. “We want to be constantly improving, constantly bringing patients the best technologies at reasonable cost and convenience. Unfortunately, there are a whole lot of impediments to that. Only the Academy has the voice to advocate for the entrepreneurial wing of our specialty that provides patients the true clinical quality they need with the convenience they want.”

According to Dr. Conoyer, one way the Academy can help is on a regulatory level. “One of the biggest challenges to running the business is the always-increasing regulatory burden. A lot of the regulations are written for primary care physicians, not specifically for otolaryngologists. The Academy is able to
go to CMS or to the insurers and say ‘You know, for our physicians this isn’t really
applicable. Let us help identify some metrics so that otolaryngologists don’t have to go outside their scope of practice just to satisfy the requirements.”

He also sees coding and reimbursement as an area for Academy assistance. “The lifeline of this business that employs 37 people is the ability to have the work that we do reimbursed at the appropriate rate,” explained Dr. Conoyer. “There’s always downward pressure on that and always new bundles and edits. Our individual appeals are cumbersome, but if the Academy can identify the patterns of denials and address them with payors, the process gets much more efficient and practices’ cash flow improves.”

Dr. Conoyer and the other Academy Members at Midwest ENT have said that they need the Academy to both advocate for and advise its Members. “Some changes, such as those brought by CMS, can only be addressed by otolaryngologists speaking with one voice,” he emphasized.

Academy attuned to practice needs

Midwest ENT is concerned with many of the same things that bother a great number of our Members including adapting their practice to fall favorably on the “quality-cost” curve, complying with meaningful use of EHR, reporting PQRS and clinical quality measures, providing a full spectrum of audiology services, allergy testing and subsequent immunotherapy services, office-based CT imaging and in office surgical care in an environment of ever-changing regulatory burden.

The unsettling nature of shifting requirements facing all of our Members as they try to do what they chose as a life calling—taking the best care of patients possible—has not been lost on the Academy. We will continue to address these issues as they arise knowing that realistically we cannot completely resolve all of them but can, hopefully, influence a positive progression to relieve at least a portion of the burden faced by our Members.

In addition to our “core” Health Policy Advocacy, including both governmental and private entities, the Academy is well down the path of its most ambitious endeavor of recent times. We have set up a clinical data registry that will empower our participating Members to define what is the “best care” for otolaryngologic diseases and procedures, accurately inform payers as to “individual physician quality” based on actual transparent validated measures and patient outcomes, meet reporting requirements, and participate in MOC activities designed to improve patient-based results. We are just beginning the pilot phase of registry operations and expect to begin full data collection by this fall.

We invite you to take advantage of this exciting opportunity to join our “Members only” registry, RegentSM, and help shape and take some measure of control of your future! We also solicit your thoughts and suggestions on how we can most effectively help you, our Members, take the best care of your patients.