More from June 2013 - Vol. 32 No. 06
Joseph W. Rohrer, MD
San Antonio Uniformed Services
Health Education Consortium
A trip to Rwanda starts with thoughts and images that reflect the country’s painful past. Rwanda is marked by the 1994 genocide. This, as we would discover however, is not what defines the country today. Rwandans are redefining themselves and the face we encountered is beautiful, welcoming, clean, safe, and growing.
Our mission in February was the first time the Face the Future Foundation, founded by Peter A. Adamson, MD, had gone to Africa. The team leader was Houston otolaryngologist Ife Sofola, MD, a native Nigerian with great passion to help Africa grow, develop, and thrive. This group included a powerful surgical team including Dan S. Alam, MD, from the Cleveland Clinic; Jose E. Barrera, MD, from the San Antonio Military Health System; Kofi D. Boahene, MD, from Johns Hopkins; Anthony E. Brissett, MD, from Baylor College of Medicine; Sydney C. Butts, MD, from SUNY Downstate; and residents Joseph W. Rohrer, MD, San Antonio Uniformed Services Health Education Consortium, and Myriam Loyo, MD, Johns Hopkins. Joseph Kuang, MD, Houston, supported our anesthesia needs.
The team worked out of two sites in Kigali, King Faisal Hospital and the Rwanda Military Hospital, which continues to undergo extensive upgrades. Our team arrived to screen 20 patients that Charles Furaha, MD, the only plastic surgeon in Rwanda, had selected. By the end of the week, 39 patients had been evaluated.
Our first day, we were given tours of the operating theaters and met the staff. Everyone was excited and a bit nervous. Smiles were everywhere and around 9 am we started seeing our patients. Many had been waiting for weeks, months, or years hoping that something could be done. The first day we saw 29 complex patients. They presented with a Tessier 4 cleft, midline cleft with encephalocele, and multiple patients with disfiguring, and painful neurofibromatosis. We saw osteoradionecrosis of the zygoma, congenital aplasia cutis of the scalp, noma, and disfiguring ameloblastoma. We also saw previous trauma patients: with ectropion, auricular avulsion, non-protected dura, and a 15-year-old with the loss of both lips from a grenade explosion. As the day and week progressed, patients continued to present with complex facial defects.
The foundation’s mission is to empower the local community to advance their craniofacial management capabilities. Members of the group met with the hospital administrators and the Rwandan Minister of Health to discuss ways to make long-lasting changes. We worked hand-in-hand with the local surgeons and staff. We did revision cases and showed our techniques. They even showed us how to use the non-powered dermatome. Our mission performed a fibula free flap to reconstruct a midface, a radial forearm free flap with bilateral FAMM flaps for an upper lip, and fashioned orbital implants to cover unprotected dura. We did orthognathic surgery, completing molds and model surgery with the local oral maxillofacial surgeons.
We owe a debt of gratitude to Dr. Furaha, who will continue to see our follow-up patients and send updates. Next year there are plans to give didactic lectures to stimulate academic exchange. Some patients for next year have already been identified and plans are set in motion to bring special supplies. This may have been our team’s first mission to Rwanda, but while seeing ourselves on local TV as we boarded the plane for home, I’m confident we made an impact not on just the patients we helped, but also in this country, which is working hard and moving positively towards becoming a jewel of Africa. I speak for the team when I say we have been given so much from this wonderful country and hope to continue this partnership for mutual gain. I would like to thank the AAO-HNSF Humanitarian Efforts Committee and the Alcon Foundation for their support of resident travel to this mission.
TBA in early June
Humanitarian Travel Grant–Apply Today!
International Travel Grant and Scholarships
Resident Leadership Grant–Apply Today!
Young Physician Leadership Grant–Apply Today!
TBA in early June James E. Saunders, MD
Coordinator-elect for International Affairs
Peter W. Alberti, MD’s article outlines the visionary efforts by a group of men and women who fought to bring hearing loss onto the global health stage in the last 20 years. Recognition that worldwide hearing loss is common and can result in social isolation, language delay, poor educational outcomes, and economic hardship led to the creation of many international organizations to address these issues. Among them are Hearing International, Sound Seekers International, World Wide Hearing, the IFOS “Hearing for All” Campaign, and the Coalition for Global Hearing Health.
The recognition gave rise to the World Health Organization (WHO) Office for the Prevention of Deafness and Hearing Impairment. For many years, Andrew W. Smith, MSc, MRCP, who developed many surveys that gave us a more accurate assessment of global hearing loss, staffed this office.
In addition, Dr. Smith created training materials for primary care physicians and healthcare workers around the world that have been translated and adapted in multiple languages. After his mandatory retirement from the WHO, Young- Ah Ku, MD, a Korean otolaryngologist, carried on this work.
In 2010, after withdrawal of external funding for this WHO office, the post was vacant for two years, despite the rising global estimates of people affected by hearing loss. When the AAO-HNSF and IFOS joined an international consortium to provide temporary support to this key office, the WHO appointed Shelly Khanna Chadha, MD, an Indian otolaryngologist, to direct this program. Dr. Chadha has served admirably in this position, developing an intensive work plan that includes:
National hearing health programs in multiple countries;
Promoting Primary Ear and Hearing Care (PEHC) around the globe; and
Provisions to explore affordable technology to low resources areas.
Unfortunately, support for Dr. Chadha’s appointment still relies entirely on external funding and is due to expire December 2013. There is an urgent need to raise awareness within the WHO and its member states about the status of global hearing loss. The WHO General Assembly has not received a hearing loss report since the current WHO Resolution (48.9) was adopted in 1995. Meanwhile, the latest WHO estimates are that 360 million people, five percent of the world population, suffer from disabling hearing loss.
Call to Action
The WHO Executive Board, composed of Health Ministry representatives from 34 member states, determines the WHO General Assembly agenda. We urge colleagues working in these 34 countries (including the U.S.) to contact their Health Ministry representative to the WHO Executive Board, asking for a new progress report on the status of global hearing loss.For the Executive Board representatives or to learn more, please email James E. Saunders, MD, at James.E.Saunders@Hitchcock.org. P.W. Alberti, MBBS, PhD, FRCS
Professor Emeritus, ORL, University of Toronto, and Ex-General Secretary, International Federation of Otolaryngological Societies
In 1974, Sir John Wilson, a charismatic blind British activist, founded the World Health Organization (WHO) Global Prevention of Blindness program. A decade later, he challenged otolaryngology and audiology to do the same for hearing loss (HL). WHO had ignored hearing loss but, under the leadership of Baron Jean E. F. Marquet of Antwerp, Belgium, the International Society of Audiology (ISA) and the International Federation of Otolaryngological Societies (IFOS) conducted intense lobbying.
In 1986, this led WHO to commission an internal report on prevalence of HL. Based on a 1971 U.S. public health survey, the report concluded that 42 million people worldwide suffered from moderate to severe HL. WHO initiated a Prevention of Deafness and Hearing Loss program (PDH), but unfortunately because of low prevalence, it was not funded.
However, the figure of 42 million was greeted with incredulity—the landmark UK audiometric prevalence study by Davis, et al., had found a much higher prevalence. In fact, the WHO study probably had a transcription error, perhaps related to differing definitions of zero dB in the U.S. and ISO standards at that time.
In 1991, PDH was placed in the Prevention of Blindness program under the excellent leadership of its director, Bjorn Thylefors, MD. One of his first actions was to host a weeklong external consultation, at which James B. Snow Jr., MD, played a pivotal role, setting the PDH program to the present time. Spurred by the urgent need to update the prevalence figures, Jun-Ichi Suzuki, MD, seconded from Japan to WHO for a year, developed the underpinnings of later national surveys conducted by and with WHO.
In 1994, after surveying literature from the Liverpool School of Tropical Medicine’s Kenneth W. Newell collection, I produced a conservative estimate of 150 million worldwide. To avoid exaggeration, the WHO unilaterally cut this figure to 120 million worldwide. When presented to the 1995 WHO General Assembly, this figure led to a resolution urging action on HL, because of the apparent increase in prevalence.
Andrew W. Smith, MSc, MRCP, hired from Liverpool and funded by CBM (Christian Blind Mission), initiated many regional and national surveys. With limited resources, however, these surveys were still too few. The Chinese (PRC) national disability survey of the 1980s showed HL complaints of only 1.7 percent, which dragged down the global figures. Only in the 21st century did the PRC undertake a representative audiometric study that shows prevalence about four percent, similar to the rest of the world.
Meanwhile the aging global population grew by more than one billion. WHO undertook an internal study proposing a HL prevalence of 235 million. The global burden of disease (GBD), initially a WHO initiative, was revised and lowered the threshold for disabling hearing loss to >34 dB. WHO then raised the prevalence, at >34 dB, to 500 million, although not yet accepting the changed definition. Even at that threshold, GBD concluded the prevalence was only 235 million. The discrepancy remains unresolved. Sukgi S. Choi, MD
Annual Meeting & OTO EXPOSM Instruction Course Coordinator
AcademyU®, the Foundation’s otolaryngology education source, is pleased to offer yet another online learning opportunity. The two Annual Meeting Clinical Fundamentals courses on the treatment of anaphylaxis and evidence-based medicine are now available as online courses and can be accessed through www.entnet.org/clinicalfundamentals. These courses, topics otolaryngologists should know regardless of their practice focus, are designed for practicing otolaryngology head and neck physicians and surgeons, especially those involved in the Maintenance of Certification® process.
Through an agreement with the American Board of Otolaryngology (ABOto), the Foundation now offers a series of clinical fundamentals courses that replace the majority of clinical fundamentals questions on the ABOto Part III MOC exam. These modules should not be confused with the annually required ABO Part II Self-Assessment modules (SAM).
Treatment of Anaphylaxis, presented by John H. Krouse, MD, PhD, reviews the clinical fundamentals on anaphylaxis, including recognition, diagnosis, pathophysiology, and treatment in the clinical setting.
Evidence-Based Medicine, presented by Michael G. Stewart, MD, MPH, reviews the clinical fundamentals of clinical outcomes measures, evidence-based medicine, and research. Included is a discussion of instrument design, study design, and outcome instrument selection.
Each course is roughly one hour long. These enduring materials are also designated for 1 AMA PRA Category 1 CreditTM each. A minimum score of 70 percent on the post-test is required to receive continuing education credit and satisfy the MOC requirement. Proof of successful completion will be forwarded to ABOto on behalf of the course participant.
A total of 10 clinical fundamentals topics have been identified by the ABOto for inclusion in this series.
All 10 topics will be presented as Instruction Courses at the 2013 Annual Meeting & OTO EXPO in Vancouver. The eight new courses will also be recorded and provided as online courses in January 2014. These will join the nearly 200 self-paced and interactive online courses available through AcademyU.
The online courses are $75 each for AAO-HNS members and $100 each for non-members.
View all of the Academy’s education offerings at www.entnet.org/academyu.
Anesthesia-Related Topics for Otolaryngologists Murali Sivarajan, MD
Clinical Outcome Measures/Evidence Based Medicine Michael G. Stewart, MD, MPH
DVP: How, When, Why in Otolaryngology Amy Clark Hessel, MD
Ethics & Professionalism Roger D. Cole, MD
HIPAA: Updates and What it Means for You Kathleen L. Yaremchuk, MD
Integration of Quality and Safety into Otolaryngology Amy Clark Hessel, MD;Randal S. Weber, MD
Management of the Addicted Surgeon Peter S. Roland, MD
Pain Management in Head and Neck Surgery John Sok, MD, PhD; Christopher L. Oliver, MD
Treatment of Anaphylaxis John H. Krouse, MD, PhD
Universal Precautions for the Otolaryngologist Peggy E. Kelley, MD Every spring, the Medicare Payment Advisory Commission (MedPAC), an independent Congressional agency established to advise the U.S. Congress on issues affecting the Medicare program, issues a March report to the Congress. In the March 2013 report, MedPAC focused on several areas, including payment adequacy; payment for hospital inpatient and outpatient services; and payment in Ambulatory Surgical Centers (ASC). Health Policy staff at the Academy regularly track MedPAC reports, and highlight any recommendations that may affect members of the Academy.
In the 2013 report, MedPAC analyzed growth and spending in Medicare and other factors that affect healthcare spending in the U.S. Additionally, it studied the influence spending and growth will have on Medicare and federal healthcare spending. As in previous reports, MedPAC noted that it is essential to reform Medicare to decrease the growth in spending and create incentives for beneficiaries to seek, and for providers to deliver, high quality services at the lowest possible cost.
In October 2011, MedPAC recommended abandoning the Sustainable Growth Rate (SGR) and replacing it with a 10-year path of statutory fee-schedule updates. This path would be composed of a freeze in current payment levels for primary care and for all other services, annual payment reductions followed by a freeze. MedPAC once again reaffirms this recommendation in its March report. The Academy is presently working with members of Congress on a proposal to replace the SGR, and agrees that the current system is broken but does not agree with MedPAC’s recommendations and signed on to an AMA letter noting concerns. For more details on the Academy’s work to replace the SGR, see the April 2013 issue of the Bulletin.
Payment Adequacy Findings and Recommendations
Another aspect of the March report evaluated payment adequacy for care, services, and equipment and decides whether or not to recommend an increase, maintenance, or a decrease to payments provided to Medicare beneficiaries. In previous reports, MedPAC has called for an equalizing of payment rates for office visits provided in outpatient departments and physician offices. This is based on variations in payments between the sites of service, and the Commission’s belief that Medicare can achieve savings by equalizing payment rates. In the March 2013 report, MedPAC reiterated this recommendation.
MedPAC also evaluated payment levels and the influences they have on beneficiary care and access. In the 2013 report MedPAC recommends increasing payment rates for inpatient and outpatient services in 2014 by one percent, based on an analysis of these factors. The report stipulates ASC payments and access are adequate for beneficiaries, but growth has slowed. MedPAC therefore recommended eliminating an update to payment rates in 2014 until Congress requires ASCs to begin reporting cost data to CMS.
Health Policy staff will continue to attend and monitor MedPAC meetings regularly for any policies or recommendations that affect Academy members. If you have any questions about MedPAC, or its recommendations, email the Health Policy team at firstname.lastname@example.org.
New CPT Assistant: See pages 40-42 in print edition
As many members know, CPT® Assistant is a product developed by the American Medical Association (AMA) and is a fully-searchable newsletter that includes more than 20 years of historical reference materials approved by the AMA CPT® Editorial Panel. Monthly issues are made available to subscribers that provide clarity on coding issues as well as accurate and reliable coding tips and interpretations. In special circumstances, the AMA grants permission to medical specialty societies, such as the AAO-HNS, to reproduce CPT® Assistant articles that are relevant to a specific specialty, or set of sub-specialties. As such, we are reproducing the following CPT® Assistant article on Thyroidectomy and Parathyroidectomy, printed in the December 2012 CPT® Assistant newsletter, to apprise members of appropriate coding for these services. Members with questions about the article should contact us at: email@example.com
CPT® Assistant article on Thyroidectomy and Parathyroidectomy 2013 has proven to be yet another busy year for the Academy’s Health Policy team as we continue to work with federal regulatory agencies, private payers, consumer advocate groups, patients, and providers to ensure Academy members receive the best representation and advocacy for our specialty possible. Here is a snapshot, by the numbers, of how the Academy’s Health Policy department has advocated on behalf of members thus far in 2013.
3: The number of fact sheets created by the Health Policy and Research and Quality Improvement departments to inform members and aid in their participation in the Physician Quality Reporting System (PQRS), Electronic Health Record (EHR) Meaningful Use (MU) Incentive Program and the Electronic Prescribing (eRx) Incentive Program. These sheets and other information can be found on the Academy’s website at www.entnet.org/cmspenalties.
135 (as of May 14): The number of member inquiries the Health Policy department has responded to. Every day, members from across the country contact the Health Policy staff with questions ranging from private payer denials and appeals, questions and requests for resources for Quality Reporting Programs such as PQRS and EHR Incentive Programs http://www.entnet.org/Practice/CMSpenalties.cfm, information on changes to CPT coding requirements or newly developed CPT codes http://www.entnet.org/Practice/CPT-Codes-for-2013.cfm, and tools to aid in the upcoming ICD-10 transitionhttp://www.entnet.org/Practice/International-Classification-of-Diseases-ICD.cfm. Health Policy staff work to assist members on a wide variety of issues by providing up-to-date resources and expert analysis. We urge members to contact us with any health policy inquiries at firstname.lastname@example.org.
16: The number of Bulletin articles developed by the Physician Payment Policy (3P) Workgroup and Health Policy staff from January2013 – May 2013. Articles included summaries of 2013 physician payment rules, CPT coding guidance, and work the Academy is undertaking on current, and future, payment models and trends in otolaryngology.
7: The number of physician leaders serving on the Academy Ad Hoc Payment Model Workgroup which includes members of the Physician Payment Policy work group (3P) and research and quality leaders. This Ad Hoc group reviews the current and future payment trends in otolaryngology-head and neck surgery with the goal of preparing our leaders to be able to respond to new payment models as they are developed by government and commercial insurers. Members of the Ad Hoc workgroup have recently begun reviewing some potential bundled payment and episode of care models.
2: The number of miniseminars 3P and Health Policy staff will be presenting at the 2013 AAO-HNSF Annual Meeting & Oto Expo in Vancouver, BC, Canada from September 29 to October 2, 2013. Two sessions, titled “Alternative Payment Models & Academy Advocacy” and “Pearls on How to Transition to ICD-10 Coding by 2014” will feature advice from Academy and outside experts on the future of healthcare payment and provider transition to the ICD-10 coding system.
16: The number of Academy Position Statements reviewed in Round 2 by Academy clinical committees. Position Statements serve the following functions: a response to payer policies; a way to publicize our position or support a procedure; for use in advocacy efforts with state and federal regulatory bodies, in response to federal policy or law; or to clarify the Academy’s position on certain practices within the specialty. They are reviewed every four years to ensure the statements are up to date and useful for members. The Academy’s position statements can be accessed at: http://www.entnet.org/Practice/Position-Statements.cfm
6: The number of CPT codes surveyed by the Academy in 2013 for the January and April AMA Specialty Society Relative Value Scale Update Committee (RUC) meeting. In January, CPT 69210 removal impacted cerumen and new code CPT 6461XX chemodenervation of the larynx were presented to the RUC. In April, the Nasal/Sinus Endoscopy family of codes (31237-31240) were surveyed and data was presented to the RUC during the April, 2013 RUC meeting. Members are encouraged to keep an eye out for future solicitations for participation in RUC surveys, as they are an important tool used to establish Medicare reimbursement for otolaryngology services. To access more information regarding the RUC survey process, visit: http://www.entnet.org/Practice/Applying-for-CPT-codes-and-Obtaining-RVU.cfm.
7: The number of private payer policies the Academy coordinated review of and submitted comments on. These include United HealthCare and Aetna’s Septoplasty and Rhinoplasty coverage policies, United HealthGroups: Direct-to-Consumers (DTC) hearing aid sales program, and WellPoint/BCBS Sinus Ostial Balloon Dilation Policy. You can access resources to help you with the Academy’s Private Payer Advocacy at http://www.entnet.org/Practice/pmNews.cfm.
2: Number of new or revised CPT for ENT articles distributed and posted on the website for Members. For more information on Academy coding guidance visit: http://www.entnet.org/Practice/cptENT.cfm.
1: Number of in-person meetings the Academy Health Policy and Research, Quality Improvement staff has convened with CMS to discuss clinical quality measures and the need for more specific measures related to our specialty to enable members to meaningfully participate in quality programs such as PQRS and the EHR Incentive program. Twitter Glossary
Twitterverse: The Twitter social networking platform and its users.
Handle: Your twitter name. (e.g., @AAOHNSGovtAffrs or @aao-hns)
Follow: When you “follow” someone, you can see what they have tweeted in real time.
Tag: Mentioning another person by placing an “@” before their Twitter handle.
Feed: There are generally two feeds: one is for tweets you have sent out and the other default feed is the tweets of people you are following.
Tweet: A micro-blog of 140 characters.
Retweet (RT): By retweeting something, it will show up on your feed and will be tweeted to others under your name. It is considered a courtesy to “tag” the author of the tweet in your retweet.
Modified Tweet (MT): A modified tweet is a “retweet” you have edited.
Hashtags (#): Make key terms searchable. When hashtagging, it is common for a phrase or pair of words to become a searchable term. However, this requires removing the space between words. (#SpeakerBoehner)
Trending: Hashtagged terms that are widespread and being used by a large portion of the Twitterverse.
Go to www.twitter.com.
Enter your username (generally your email or twitter handle) and password. If it’s your first time, sign up using the box on the screen.
Two Ways to Find Someone on Twitter
Enter search terms or names of colleagues in the search bar.
Twitter also recommends people you may wish to follow.
How to Tweet
There are two areas you may click to compose a tweet.
Tweets cannot be more than 140 characters, which includes letters, spaces, links, and punctuation, so make every character count!
Tweets are short, so do not get hung up on complex grammar/punctuation rules.
Commonly used phrases are often abbreviated and acronyms are often used. For instance, on personal accounts, you may see LOL (laugh out loud), w/o (without), or b/c (because). And, on the AAO-HNS Government Affairs account, you may see SGR (Sustainable Growth Rate), POTUS (President of the United States), or SCOTUS (Supreme Court).
If you are linking to an article in your tweet, shorten the link using www.bitly.com. This will help keep within the 140 character limit.
Hashtag (#) the key words in your tweet. By hashtagging your key words, your tweet becomes searchable to other people in the twitterverse.
If you want to engage an individual on a topic publicly, simply put an “@” in front of their handle. For instance, here is a response by Artur Gevorgyan to our tweet regarding your ears and air travel. By tagging that individual, it gives feedback to the author of the tweet and lets your followers see your comment. Across the nation, 46 state legislatures convened for their regular sessions this year. By the end of July, only five states will remain in regular session as most have already adjourned for the year. As of June 15, more than 79,000 state-based bills had been introduced in the United States in 2012. The AAO-HNS is monitoring more than 740 bills at the state level, including holdover bills from 2011. Of those, there are 42 state legislative bills that have been identified as being of particular importance to the AAO-HNS and its members. We have provided state otolaryngology leaders with customized tracking reports, notifications, and alerts for these legislative bills of interest.
Scope of Practice
The Academy believes it is appropriate for nonphysician providers to seek updates to statutes and regulations relating to their defined scope of practice to reflect advances in education and training. However, the Academy strongly opposes state legislation that would inappropriately expand the scope of practice for nonphysician providers beyond their skills. Enabling nonphysician providers to independently diagnose, treat, or manage medical disorders could adversely affect the quality of patient care.
This year, the Academy has advocated for modifying and/or defeating several potentially harmful bills that would inappropriately expand the scope of practice of nonphysician professionals. The California legislature is considering a bill that would allow audiologists to become qualified medical examiners for workers’ compensation claims. The Academy continues to strongly oppose this legislation. In West Virginia, the Academy successfully opposed a bill regulating the practice of speech-language pathology and audiology. The bill, as proposed, would have inappropriately expanded their scope of practice to allow speech-language pathologists and audiologists to diagnose, manage, and treat. Unfortunately, state legislatures in Colorado and South Dakota adopted scope-of-practice expansion bills for speech-language pathologists. A carry-over bill in New York sought to permit nonphysician oral and maxillofacial surgeons to perform elective surgeries in the oral and maxillofacial regions if granted hospital privileges, the bill died in the Assembly. The Academy worked with other state and national organizations in a coalition to defeat this legislation.
Truth in Advertising
With the emergence of clinical doctorate programs for nonphysician providers, which has led to many degree holders referring to themselves as “doctors,” there is growing confusion within the patient population about the level of training and education of their healthcare providers. In 2012, truth-in-advertising bills were introduced in Arizona, California, Maryland, Missouri, Nebraska, New York, Utah, and Washington. In Maryland, the legislature passed a bill that requires identification tags and advertisements to show the type of certification the practitioner holds, subject to approval by the state medical board. The Academy, working with other national specialty organizations and the state medical society, developed and advocated for language that closes loopholes, but still works for all Academy members’ board certifications. The Washington legislature considered a bill that would have required advertisements by those who identify themselves as “doctors” to list their license, registration, and/or certifications.
Taxes on Medical Procedures
Each year, there is a re-emergence of proposals to tax medical procedures, and in light of extensive state budget shortfalls, this year has been no exception. The Stop Medical Taxes Coalition—a coalition of national, state, and local organizations, of which the Academy is a member—asserts that the taxation of medical procedures is unfair for patients and is a “slippery slope” toward the taxation of other medical services. In California, the legislature is considering two separate proposals on taxing cosmetic procedures. The Academy and other Coalition members have submitted written testimony to the California legislature in opposition to the proposed taxes. In 2012, New Jersey signed into law legislation that will gradually repeal the six percent tax currently imposed on cosmetic procedures. The tax will be reduced by two percent each year, for three years, ending with a zero percent tax rate.
Hearing Aid Services
The coverage, sale, and dispensing of hearing aids is an issue considered by several states in various forms each year. The Academy successfully opposed legislation in Arizona that would have changed the licensure requirements for hearing aid dispensers by removing the practicum examination. In New York, the Academy worked closely with the Patient Access to Hearing Aids (PAHA) Coalition to advocate for a bill that would expand patient access to hearing aid services by striking an archaic law prohibiting physicians from deriving a profit on hearing aid sales. This year, the PAHA Coalition attained introduction of amended companion bills in both the Senate and Assembly. Massachusetts also had legislation seeking to allow otolaryngologists to dispense hearing aids. In addition, several states considered bills to require insurers to cover the cost of, or expand benefits for, hearing aids and/or cochlear implants, including Connecticut, Georgia, Hawaii, Illinois, Kansas, Maine, Massachusetts, Nebraska, New York, Rhode Island, Tennessee, Utah, Vermont, and Wyoming. Several states also considered bills that would provide a tax credit and/or exemption for hearing aids, including Hawaii, Kansas, Michigan, Missouri, New Jersey, and Oklahoma.
Tobacco Use and Smoking Cessation
The Academy supports legislation and regulations that will help to reduce the use of tobacco products and exposure to secondhand smoke in order to promote healthy environments and lifestyles for the public. This year, bills were introduced in 15 states that sought to strengthen existing smoking ban laws, including California, Iowa, Kansas, Maine, Maryland, Mississippi, Missouri, New Jersey, Oklahoma, Rhode Island, South Carolina, Virginia, and West Virginia. A number of states also considered proposals to mandate insurance coverage and/or benefits for tobacco cessation, including Hawaii, Illinois, Indiana, Massachusetts, New Jersey, New York, and Washington. There are a few states—Alabama, Hawaii, and Illinois—that proposed legislation to exempt certain establishments from a smoking ban, if they pay a fee to become licensed as exempt.
Medical Liability Reform
This year, there are 10 states that considered various tort reform measures, including those related to affidavits of merit, alternative reforms, caps on non-economic damages, defensive medicine issues, expert witnesses, health courts, or pre-trial screening panels. In Connecticut, there was a proposal to weaken the requirements for Certificates of Merit. The Academy and the state society advocated against this change. New Hampshire and New Jersey are considering enacting or modifying caps on non-economic damage awards in medical liability cases. In Rhode Island, the legislature is considering proposed legislation on apology inadmissibility, and Washington considered a comprehensive medical liability reform bill.
For more information about Academy legislative priorities and/or activities, visit the Legislative and Political Affairs website at www.entnet.org/advocacy or email email@example.com for state legislation inquiries. If you would like to receive timely updates regarding Academy legislative priorities and efforts, join the ENT Advocacy Network by emailing firstname.lastname@example.org.