AAO-HNS Bulletin | Special Edition | January 2021

16 SPECIAL EDITION: 125TH ANNIVERSARY AAO-HNS BULLETIN ENTNET.ORG/BULLETIN Gavin Setzen, MD, AAO-HNS/F Past President and Chair of the AAO-HNS Future of Otolaryngology Task Force T he United States healthcare system is poised for significant change in the coming years as we continue to strive toward the creation of a viable system that truly works for everyone. While the U.S. healthcare system has been moving toward a more consumer-focused experience, progress has been slow and cost-containment efforts have been largely ineffective. For decades, regulatory barriers and competition within the provider community have made it difficult to create a transparent, consumer-friendly, efficient, cost-effective, and physician- friendly healthcare delivery system. Otolaryngology practices (independent, employed, and academic) will, in the absence of change, likely experience continued downward economic pressure in the decades ahead. Declining reimbursement from Medicare and Medicaid have led to softening in operational performance with a pronounced rise in annual expense growth coupled with a slowed rate of commercial payor revenue growth. Other continuing trends include a shift of inpatient services to outpatient settings, “site-neutrality” for facility reimbursement, competition from niche providers (nontraditional competition), and the increasing role of medical consumerism. These factors have contributed to the recent wave of consolidation in healthcare, exacerbated by the novel coronavirus pandemic. Health systems and practitioners, at all levels, are being pushed to either compete as their own integrated (horizontal or vertical) high-value networks, or to be rolled up into a larger organization. This trend has clinicians and executives searching for opportunities to influence their market share and sustainability in the regional, national, and now international healthcare marketplace— in an era of medical consumerism and medical tourism. The recent CVS-Aetna merger, collaboration among Amazon, Berkshire Hathaway, and JP Morgan, and heightened interest shown by Apple, Google, and other tech giants in transforming (and controlling) healthcare are just a few examples of disruptive efforts to harness the potential efficiencies of big data, machine learning, virtual reality (VR), and telemedicine with current practice patterns in order to provide efficient and high-quality care with improved access and patient convenience. Public Policy and Advocacy Healthcare policy and advocacy will continue to be driven by the imperative to lower the cost of healthcare while increasing affordable access to all Americans. There are limited financial resources without major revenue restructuring. There are several other factors complicating this process, including lack of political consensus on direction, physician workforce shortage in otolaryngology, generational workforce changes, new technologies, and future models of care delivery. While healthcare delivery system reforms have been ongoing, there will be an accelerated emphasis on alternative payment models (APMs), flexible accountable care organizations, and progressive affirmation of the value-based payment system. The trend away from traditional fee-for-service (FFS) models toward FFS linked to quality and value is well-suited to otolaryngology given the complexity and subspecialty nature of our field, and the fact that as a specialty we represent a small percentage of the total annual national healthcare spend. The AAO-HNS will advocate for and protect members and the patients we care for in negotiating with health policy makers, payers, consultants, regulators, the public, pharma, medical device companies, hospital systems, and the myriad other entities vying for dominance, control, and relevance in the rapidly changing healthcare arena. CMS and Congress will likely continue surgical devaluation with emphasis on primary care and expansion of scope for allied health providers. Meaningfully addressing cost and healthcare reform will continue to be ineffective until there is a willingness to address costs in a systematic fashion along with nonphysician stakeholders in the healthcare arena (big pharma, insurance industry, medical liability reform, etc.). There will be increased pressure to abandon therapeutic regimens that provide little or no benefit to patients based on outcomes research. Pressure will continue from legislators, payers, and policymakers to de-adopt low-value services. Predictions: Technology will transform healthcare like every other industry where TheNext 125Years inOtolaryngology- Head andNeck Surgery "The AAO-HNS will advocate for and protect members and the patients we care for in negotiating with health policy makers, payers, consultants, regulators, the public, pharma, medical device companies, hospital systems, and the myriad other entities vying for dominance, control, and relevance in the rapidly changing healthcare arena."