Published: October 17, 2013

Coding and Reimbursement Strategies: Using an Unlisted Code for Endoscopic Skull Base Surgery

Kim Pollock, RN, MBA, CPC Mary LeGrand, RN, MA, CCS-P, CPC The American Medical Association’s Current Procedural Terminology® (CPT) codes for reporting medical services and procedures performed by physicians must be used to bill services to third party payers. The contemporary practice of medicine is occasionally ahead of the CPT code system and an accurate code may not always exist for the procedure performed; this is true for reporting most endoscopic/endonasal skull base surgery procedures.Coding Issues Only one CPT code exists for an endoscopic skull base procedure—62165, Neuroendoscopy, intracranial; with excision of a pituitary tumor, transnasal, or trans-sphenoidal approach. Unlike the skull base surgery codes that include separate codes for the approach and definitive procedure, CPT 62165 includes the approach, tumor resection, and closure. Modifier 62 (two surgeons) is appended to 62165 when performed as co-surgery involving the otolaryngologist (ORL) and neurosurgeon (NS) to show that neither surgeon performed the entire procedure code. The existing open (involving a skin incision) skull base surgery CPT codes were introduced to the CPT code system in 1994. Endonasal/endoscopic skull base surgery is relatively new and performed in a limited number of organizations. Therefore, endonasal/endoscopic skull base procedures, except the endoscopic resection of a pituitary tumor (62165), do not have a CPT code. Both the AAO-HNS and the American Association of Neurological Surgeons agree it is not accurate to use the existing skull base surgery CPT codes for endonasal/endoscopic procedures because the existing codes describe an open procedure involving skin incision(s). Current Coding Landscape Many otolaryngology and neurosurgery practices have implemented a successful coding and reimbursement strategy for performing endoscopic skull base surgery procedures together. We have found that many payers fail to recognize, and appropriately reimburse, claims where both surgeons report the same unlisted code with modifier 62 (e.g., 64999-62). Also, CPT guidelines state it is not appropriate to append a modifier to an unlisted code because an unlisted code does not describe a specific procedure. Because each surgeon is performing his or her own separate procedure in endoscopic/endonasal skull base surgery, much like in the use of the existing skull base surgery codes, we recommend each surgeon report his or her own unlisted CPT code (ORL–31299, NS–64999). It is not accurate to report individual component codes (e.g., endoscopic sinus surgery, septoplasty) instead of an unlisted code for endoscopic skull base surgery as this is not in line with CPT coding guidelines. Using an Unlisted Code Each unlisted CPT code is used to describe the actual work by each surgeon. Consider an endoscopic transnasal approach to the anterior cranial fossa, intradural resection of a clival chordoma, with dura repair and septal flap closure. In this scenario, the ORL assists the NS by holding the endoscope and vice versa. The otolaryngologist reports 31299 (Unlisted procedure, accessory sinuses) for his or her portion of the procedure and this code encompasses the ORL’s work of the transnasal approach, entering the skull base, but not the dura, assisting the neurosurgeon during the dural opening and tumor resection, and then performing the closure using a local flap. Use a “base” or similar existing comparison CPT code to determine the ORL’s fee for 31299. For example, the base code might be 61580 (Craniofacial approach to anterior cranial fossa; extradural, including lateral rhinotomy, ethmoidectomy, sphenoidectomy, without maxillectomy or orbital exenteration) for the above example of the clival chordoma endoscopic resection. The ORL fee for 31299 would include his or her assistant surgeon activity (modifier 80 or 82) on the NS’s base code. Repair of the Dura/Closure  Closure of the dura is included in the unlisted procedure code reported just as it is part of the usual skull base surgery definitive procedure codes (e.g., 61601). Do not use codes such as 61618 or 61619 (secondary repair of cerebrospinal fluid (CSF) leak codes) as a comparison or base code for the unlisted code billed. A return to the operating room subsequent to the initial procedure, for repair of a CSF leak, may be separately reported. Additionally, CPT guidelines include surgical wound closure in the open resection/excision definitive procedure skull base code. However, if graft material is harvested through a separate surgical exposure, then a separate graft harvest code may be reported. It is not appropriate to report 15750 (Flap; neurovascular pedicle) for a nasolabial flap. CPT says the following about 15750: “This code includes not only skin, but also a functional motor or sensory nerve(s). The flap serves to reinnervate a damaged portion of the body dependent on touch or movement (e.g., thumb).” The nasolabial flap is created through the same surgical exposure as the primary procedure so it would be included in the primary procedure code.  Postoperative Care There is no defined postoperative global period for an unlisted code; therefore, the fee for the unlisted code may reflect a zero-day postoperative global period. Doing so allows the surgeon to separately report all postoperative follow-up care in the hospital, and in the office, including a sinus debridement (31237) and/or nasal endoscopy (31231). The fee for any comparison or base code(s) include a 90-day global period, therefore, the surgeon may want to decrease his/her fee for the unlisted code. Alternatively, the surgeon may set his/her fee for the unlisted code to reflect a 90-day postoperative global period similar to the open skull base code(s) used as the comparison or base code(s). Reimbursement Issues Many payers do not have a strategy for reimbursing unlisted CPT codes. KarenZupko & Associates, Inc., recommends the following actions to ensure optimal reimbursement for these services. Make sure your managed care contracts include a clause requiring payers to reimburse a specific percentage of your billed charge since unlisted codes do not have an assigned Medicare relative value unit (RVU) or payment amount. Make an appointment for both specialty surgeon(s) to meet with the medical directors and provider relations representatives (together at the same meeting) of your major payers and present a professional PowerPoint talk with a couple of patient case studies. Also, show how performing the procedure endoscopically results in lower cost and higher quality of care. Use the letter that follows as one of the following tools: 1) a written prior authorization letter as part of the approval process prior to surgery, 2) a cover letter with the ORL claim submission, or 3) as an appeal letter for a claim denial. Customize the letter to meet your specific need and patient case. It is beneficial to bill and collect for both specialties out of a separate, combined billing area or provider listing in the practice management system when both specialties are in the same practice. This allows separation of these combined specialty cases resulting in easier data analysis. For example, while Medicare may not provide significant additional payment for an unlisted code, we have found that other payers do. One can easily calculate the average payment per case if these services are billed from a separate billing area or provider listing. The funds can also be more easily divided in a manner equitable to both specialties if desired. Conclusion Advancements in technology and clinical care are crucial in medicine, although the associated billing and reimbursement practicalities may be challenging. A strategy for accurate coding and optimal reimbursement is critical for otolaryngologists and neurosurgeons who perform endoscopic skull base surgery. Kim Pollock and Mary LeGrand are consultants with KarenZupko & Associates, Inc., a Chicago-based physician practice management consulting company. Both are instructors for the AAO-HNSF/KZA coding and reimbursement workshops.

Kim Pollock, RN, MBA, CPC
Mary LeGrand, RN, MA, CCS-P, CPC

The American Medical Association’s Current Procedural Terminology® (CPT) codes for reporting medical services and procedures performed by physicians must be used to bill services to third party payers. The contemporary practice of medicine is occasionally ahead of the CPT code system and an accurate code may not always exist for the procedure performed; this is true for reporting most endoscopic/endonasal skull base surgery procedures.Coding Issues
Only one CPT code exists for an endoscopic skull base procedure—62165, Neuroendoscopy, intracranial; with excision of a pituitary tumor, transnasal, or trans-sphenoidal approach. Unlike the skull base surgery codes that include separate codes for the approach and definitive procedure, CPT 62165 includes the approach, tumor resection, and closure. Modifier 62 (two surgeons) is appended to 62165 when performed as co-surgery involving the otolaryngologist (ORL) and neurosurgeon (NS) to show that neither surgeon performed the entire procedure code.

The existing open (involving a skin incision) skull base surgery CPT codes were introduced to the CPT code system in 1994. Endonasal/endoscopic skull base surgery is relatively new and performed in a limited number of organizations. Therefore, endonasal/endoscopic skull base procedures, except the endoscopic resection of a pituitary tumor (62165), do not have a CPT code. Both the AAO-HNS and the American Association of Neurological Surgeons agree it is not accurate to use the existing skull base surgery CPT codes for endonasal/endoscopic procedures because the existing codes describe an open procedure involving skin incision(s).

Current Coding Landscape
Many otolaryngology and neurosurgery practices have implemented a successful coding and reimbursement strategy for performing endoscopic skull base surgery procedures together. We have found that many payers fail to recognize, and appropriately reimburse, claims where both surgeons report the same unlisted code with modifier 62 (e.g., 64999-62). Also, CPT guidelines state it is not appropriate to append a modifier to an unlisted code because an unlisted code does not describe a specific procedure.

Because each surgeon is performing his or her own separate procedure in endoscopic/endonasal skull base surgery, much like in the use of the existing skull base surgery codes, we recommend each surgeon report his or her own unlisted CPT code (ORL–31299, NS–64999). It is not accurate to report individual component codes (e.g., endoscopic sinus surgery, septoplasty) instead of an unlisted code for endoscopic skull base surgery as this is not in line with CPT coding guidelines.

Using an Unlisted Code
Each unlisted CPT code is used to describe the actual work by each surgeon. Consider an endoscopic transnasal approach to the anterior cranial fossa, intradural resection of a clival chordoma, with dura repair and septal flap closure. In this scenario, the ORL assists the NS by holding the endoscope and vice versa.

The otolaryngologist reports 31299 (Unlisted procedure, accessory sinuses) for his or her portion of the procedure and this code encompasses the ORL’s work of the transnasal approach, entering the skull base, but not the dura, assisting the neurosurgeon during the dural opening and tumor resection, and then performing the closure using a local flap.

Use a “base” or similar existing comparison CPT code to determine the ORL’s fee for 31299. For example, the base code might be 61580 (Craniofacial approach to anterior cranial fossa; extradural, including lateral rhinotomy, ethmoidectomy, sphenoidectomy, without maxillectomy or orbital exenteration) for the above example of the clival chordoma endoscopic resection. The ORL fee for 31299 would include his or her assistant surgeon activity (modifier 80 or 82) on the NS’s base code.

Repair of the Dura/Closure 
Closure of the dura is included in the unlisted procedure code reported just as it is part of the usual skull base surgery definitive procedure codes (e.g., 61601). Do not use codes such as 61618 or 61619 (secondary repair of cerebrospinal fluid (CSF) leak codes) as a comparison or base code for the unlisted code billed. A return to the operating room subsequent to the initial procedure, for repair of a CSF leak, may be separately reported.

Additionally, CPT guidelines include surgical wound closure in the open resection/excision definitive procedure skull base code. However, if graft material is harvested through a separate surgical exposure, then a separate graft harvest code may be reported.

It is not appropriate to report 15750 (Flap; neurovascular pedicle) for a nasolabial flap. CPT says the following about 15750: “This code includes not only skin, but also a functional motor or sensory nerve(s). The flap serves to reinnervate a damaged portion of the body dependent on touch or movement (e.g., thumb).” The nasolabial flap is created through the same surgical exposure as the primary procedure so it would be included in the primary procedure code. 

Postoperative Care
There is no defined postoperative global period for an unlisted code; therefore, the fee for the unlisted code may reflect a zero-day postoperative global period. Doing so allows the surgeon to separately report all postoperative follow-up care in the hospital, and in the office, including a sinus debridement (31237) and/or nasal endoscopy (31231). The fee for any comparison or base code(s) include a 90-day global period, therefore, the surgeon may want to decrease his/her fee for the unlisted code. Alternatively, the surgeon may set his/her fee for the unlisted code to reflect a 90-day postoperative global period similar to the open skull base code(s) used as the comparison or base code(s).

Reimbursement Issues
Many payers do not have a strategy for reimbursing unlisted CPT codes. KarenZupko & Associates, Inc., recommends the following actions to ensure optimal reimbursement for these services.

  • Make sure your managed care contracts include a clause requiring payers to reimburse a specific percentage of your billed charge since unlisted codes do not have an assigned Medicare relative value unit (RVU) or payment amount.
  • Make an appointment for both specialty surgeon(s) to meet with the medical directors and provider relations representatives (together at the same meeting) of your major payers and present a professional PowerPoint talk with a couple of patient case studies. Also, show how performing the procedure endoscopically results in lower cost and higher quality of care.
  • Use the letter that follows as one of the following tools: 1) a written prior authorization letter as part of the approval process prior to surgery, 2) a cover letter with the ORL claim submission, or 3) as an appeal letter for a claim denial. Customize the letter to meet your specific need and patient case.
  • It is beneficial to bill and collect for both specialties out of a separate, combined billing area or provider listing in the practice management system when both specialties are in the same practice. This allows separation of these combined specialty cases resulting in easier data analysis. For example, while Medicare may not provide significant additional payment for an unlisted code, we have found that other payers do. One can easily calculate the average payment per case if these services are billed from a separate billing area or provider listing. The funds can also be more easily divided in a manner equitable to both specialties if desired.

Conclusion
Advancements in technology and clinical care are crucial in medicine, although the associated billing and reimbursement practicalities may be challenging. A strategy for accurate coding and optimal reimbursement is critical for otolaryngologists and neurosurgeons who perform endoscopic skull base surgery.

Kim Pollock and Mary LeGrand are consultants with KarenZupko & Associates, Inc., a Chicago-based physician practice management consulting company. Both are instructors for the AAO-HNSF/KZA coding and reimbursement workshops.

More from April 2013 - Vol. 32 No. 04
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Dates to Remember
April 15: International Travel Grant application deadline. Email international@entnet.org. April 16: World Voice Day www.entnet.org/bulletin and www.entnet.org/HealthInformation/worldVoiceDay.cfm April 14-20: Oral Head and Neck Cancer Awareness Week May 1: International Visiting Scholars application deadline. Email international@entnet.org. May 15: Otolaryngology Historical Society submissions deadline. Email museum@entnet.org. June: Early June International Travel Grant notifications sent. June: Early June Otolaryngology Historical Society paper acceptance notifications sent. June: Mid June International Visiting Scholars grant notifications sent.
Mark Your Calendar: May Is Better Hearing and Speech Month
May is Better Hearing and Speech Month (BHSM)! This annual event provides opportunities to raise awareness about communication disorders and to promote treatment that can improve the quality of life for those who experience problems with speaking, understanding, or hearing. During this month there is a major push to screen people for hearing loss and speech habilitation, some participating organizations team up to offer free or reduced price hearing tests and assistance in obtaining hearing aids. May is the best time of the month to remind patients to have a hearing test. If you do not do hearing testing in your office, you may want to direct patients to screening sites in your area via Academy ENTlink website: www.entnet.org. The number of Americans with a hearing loss seems to have doubled during the past 30 years. Data from Federal surveys illustrate the following trend of prevalence of hearing loss for individuals aged three years or older: 13.2 million (1971), 14.2 million (1977), 20.3 million (1991), and 24.2 million (1993). An independent researcher estimates that 28.6 million Americans had an auditory disorder in 2000.” The National Institute on Deafness and Other Communication Disorders (NIDCD) provide helpful statistics on voice, speech and language: Approximately 7.5 million people in the United States have trouble using their voices. The prevalence of speech sound disorders in young children is eight to nine percent. By the first grade, roughly five percent of children have noticeable speech disorders; the majority of these speech disorders have no known cause. Between six and eight million people in the United States have some form of language impairment. Anyone can acquire aphasia (a loss of the ability to use or understand language), but most people who have aphasia are in their middle to late years. Men and women are equally affected. It is estimated that approximately 80,000 individuals acquire aphasia each year. About one million persons in the United States currently have aphasia. The Media and Public Relations Committee will observe BHSM in May. Please visit the Academy’s website in April at http://www.entnet.org/AboutUs/publicCampaigns.cfm for helpful tips and resources that you can share with your patients and the public. For more information on ASHA, visit http://www.asha.org/.
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Last Chance to Book for Dr. K.J. Lee’s 2013 China Tour
May 1 is the deadline to book for Dr. K.J. Lee’s tour of China, June 5-16. It starts following the IFOS World Congress in Seoul, South Korea, and ends at the World Chinese ENT Academy Congress in Hong Kong. Exchange ideas with Chinese otolaryngology leaders and enjoy Chinese cultural heritage, with these famous sights: The Great Wall, Beijing’s Summer Palace, Tiananmen Square, and Forbidden City Peking Opera and Peking duck banquet Xi’an’s terra cotta warriors and the World Heritage Site, Fujian Tulou Hong Kong To reserve today, call Donna Dalnekoff at 1-203-772-0060 or 1-800-243-1806, or email Donna.Dalnekoff@ATPI.com to do your booking. Questions? Contact Dr. K.J. Lee: 1-203-777-4005 or kjleemd@aol.com
4th International Coalition for Global Hearing Health Conference Set
For a fourth consecutive year, multiple disciplines worldwide will confer on global concerns about hearing healthcare at the 4th Coalition for Global Hearing Health Conference, which will take place May 3-4 at Vanderbilt University in Nashville, TN. Past conferences have been hosted by such world-recognized facilities as EduPlex, South Africa (2012); House Ear Institute, Los Angeles (2011); and the American Academy of Otolaryngology—Head and Neck Surgery, Washington, DC (2010). The purpose of each annual conference is to provide an opportunity for otolaryngologists, audiologists, deaf educators, speech pathologists, policy makers, philanthropic leaders, deaf and hard-of-hearing individuals and families to work together to raise awareness of vital issues relative to hearing health in the developing world. Presentation topics will focus on: advocacy and media; education of professionals in underserved regions; empowering families and communities; harnessing technology; and ensuring best practices. Conference co-organizers, James E. Saunders, MD, of Dartmouth Hitchcock Medical, and Jackie L. Clark, PhD, of the University of Texas at Dallas, have long-established roots on the international arenas as Humanitarian Committee chairs within their professional organizations, the American Academy of Otolaryngology-Head Neck Surgery Foundation and the International Society of Audiology, respectively. To learn more about upcoming or past conferences, visit http://coalitionforglobalhearinghealth.org.
Travel to Canada
Will you be one of the convention attendees traveling from the U.S. or internationally into Canada? If so, you should know that thousands of people visit Canada to attend conferences every year. We invite you to visit the following link to the Citizenship and Immigration Canada website (www.cic.gc.ca) to key important information for event attendees. We recommend that you bookmark this website and refer to it often as a resource to help you avoid problems that can affect your travel plans. The CIC website will help you to: Determine your Eligibility—Find out if you qualify as a business visitor. Apply—Before you plan your visit, you should find out if you need a visa to enter Canada. If you do not need a visa to enter Canada, you will still need to meet some specific requirements. If you do need a visa, find out how to apply. Check Processing Times—Most applications for visitor visas (temporary resident visas) are processed within a few weeks or less. Processing times vary depending on the visa office. After You Apply: Get Next Steps—Find out what you should do after you apply for a visitor visa. Prepare for Arrival—Be prepared and know what to expect when you arrive in Canada. Extend your Visa—To extend your stay in Canada, you should apply 30 days before your status expires. Bring a Guest to Canada—You can avoid problems or delays when you bring your foreign business guests to Canada by following certain guidelines. Final Preparation for Your Trip to Vancouver Before catching your flight to Canada, contact your local cell phone carrier to learn about special pricing plans for calls, text messaging, and Internet usage outside your home country. If you use a smartphone, ask your carrier about certain settings such as “airplane mode” that may help you save money on usage. Take Note: Roaming charges and data plan fees for cell phones (especially smart phones like the iPhone or the Android) and tablets like the iPad can be costly, with prices spiking as high as several dollars per minute. Below are links to some popular carriers’ international coverage plans: Verizon Wireless–www.verizon.com AT&T–www.att.com Sprint–www.sprint.com T-Mobile–www.t-mobile.com Boost Mobile–www.boostmobile.com Virgin Mobile–www.virgin.com
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Experience Vancouver, BC, Canada
Think of Vancouver, and you’re likely to think of Mounties, hockey, skiing, the 2010 Winter Olympics, and the awe-inspiring natural beauty of Grouse Mountain. Beyond those impressive attractions, Vancouver is one of the world’s premier meeting and convention destinations. As you’ll soon learn when you attend the AAO-HNSF 2013 Annual Meeting & OTO EXPOSM, Vancouver has an endless supply of things to see and do. It doesn’t matter what time of day or what time of year, whether you want to be indoors or out, active or a spectator, spend a lot of money or none at all—Vancouver has it all! Vancouver offers a winning combination of world-class hotels, meeting venues, and restaurants in a setting of spectacular beauty. Few convention cities can offer such a wide range of cosmopolitan amenities in a downtown core that is safe, clean, pedestrian-friendly, and stunning in its backdrop of mountains and ocean. When you join us in Vancouver, not only will you be part of the world’s best gathering of otolaryngologists, have access to hundreds of instruction courses presented by the world’s leading experts, attend intriguing and thought-provoking miniseminars presided over by a panel of experts—but you can take part in the scientific program where you’ll see and hear the latest evidence-based research and explore the world’s largest collection of otolaryngology products and services in the OTO EXPO. This value is heightened by the intrinsic beauty of the surrounding landscape and wonder and vibe throughout spectacular Vancouver. In planning your trip to Vancouver this September, consider these options: Outdoor Activities Outside is where you’ll find the heart and soul of the West Coast. Breathtaking scenery. Untouched wilderness. Wide open spaces. Fresh air and crystal water. Take part in Vancouver outdoor activities such as: Golfing Hiking on Vancouver’s North Shore Ocean kayaking River rafting Salmon fishing Walk through rainforests Shopping As a cosmopolitan, coastal city, Vancouver’s style ranges from haute couture to cozy flannels and fleece. Shopping in Vancouver offers this same diverse range with high fashion boutiques, designer labels, accessory and jewelry stores, and extensive shop-’til-you-drop malls. There are distinctive areas all around Vancouver for clothing, art, ceramics, furniture, and much more waiting for you to discover. For some great shopping areas in Vancouver, visit: Burnaby—Metropolis at Metrotown Chinatown Commercial Drive Downtown and Gastown Granville Street Granville Island Market Robson Street Yaletown First Nations Heritage Vancouver is also rich with native heritage and there are many opportunities to learn about this unique and inspiring culture. A few outstanding First Nations’ activities, tours, and culinary options include: Sweat lodge Heritage Tour (atop Grouse Mountain) First Nations nature tour Listel Hotel—Native Art/Museum Museum of Anthropology at UBC Native food catering, Major the Gourmet Native canoe, Takaya Tours Executives without ties (Squamish Tribe) Pre- and Post-Conference Tours Enhance your Vancouver meeting and convention experience by taking advantage of the incredible pre- and post-opportunities Vancouver and British Columbia have to offer. A few suggestions for outstanding pre- and post-travel options: Whistler Victoria and Vancouver Island Nanaimo Vancouver—Alaska cruise (check out website www.entnet.org/annual_meeting for AAO-HNSF attendees special promotional discounts) Okanagan Valley Rocky Mountains Stay tuned for next month’s issue of the  Bulletin, which will contain the 2013 Annual Meeting & OTO EXPO Preliminary Program featuring the entire instruction course and miniseminar program. We invite you to come to the AAO-HNSF 2013 Annual Meeting & OTO EXPO in Vancouver, BC, to experience everything the annual meeting and Vancouver have to offer you. Registration and housing will open in May 2013.
Professional Development Gap Analysis and Needs Assessment Initiative Under Way
Sonya Malekzadeh, MD  AAO-HNSF Coordinator for Education The AAO-HNS/F Board of Directors’ 2013 Strategic Plan calls for a robust system to evaluate the activities and processes of the AAO-HNS Foundation’s lifelong learning and continuing professional development program. The Foundation unit has embarked on a yearlong initiative to seek input from stakeholders on member education and performance improvement gaps and needs. Education committee members, the BOG, and AAO-HNS members will be queried through surveys, SWOT analyses, and focus groups. Current program evaluations, quality and safety data, and literature reviews will also be included in this systematic and multifaceted process. This critical feedback will be used to direct decisions on types of activities, determine interventions, and guide program development. The needs assessment and gap analysis process must be constant and not episodic. This initiative is intended to provide a foundation and planning framework for frequent evaluation of members’ professional development needs. Building on the principles of lifelong learning while also mindful of opportunities for improvement, we will strive to maintain consistency and quality in the evaluation and implementation of education processes and outcomes. The Initiative includes seven phases: Phase 1: Education Committee Member Survey and SWOT Analysis A comprehensive survey and SWOT analysis has been distributed to the eight specialty education committees. Each member is engaged in education planning and development, and thus has an intimate knowledge of the education processes and programs. As education leaders, these individuals are uniquely positioned to examine the internal education-related strengths and weaknesses as well as the external education-related opportunities and threats facing the Foundation. Phase 2: Analyze Existing Data Data on member participation, specific product usage, and evaluation of current education activities will be collected. Performance gaps will be identified through the Foundation’s research and quality data, a review of pertinent scientific literature, national registry data, and other health assessment resources. Phase 3: Education Product Survey Foundation staff will survey individuals who currently participate in Foundation education activities. These include the Home Study Course and Patient Management Perspectives subscribers, online course participants, and Coding Workshop attendees. This survey will assess their opinions on the positive and negative aspects of each activity and determine venues by which the Foundation can improve upon these resources. Phase 4: Membership Education Survey The entire Academy membership will be queried to assess perceived practice gaps and education needs. This broad survey will examine the Foundation education activities on numerous levels and serve to engage members in lifelong learning. Phase 5: Focus Groups  Focus groups will be assembled to assess the specific learning needs of each of our target audiences. A Board of Governors focus group meeting is scheduled for spring 2013. Phase 6: Analysis and Reporting AAO-HNSF staff and education leadership will work together on analysis and interpretation of the data. A summary report of the yearlong initiative will be prepared and presented to the Board of Directors at the 2013 Annual Meeting & OTO EXPOSM in Vancouver, BC, Canada. Phase 7: Planning and Implementation Gathering appropriate data will support the allocation of funds and resources toward planning feasible and effective programs. Education activities will be prioritized, developed, and implemented with the specific intent of closing practice gaps and meeting the learning needs of our members. The gap analysis and needs assessment initiative will provide the Foundation with critical information and data to monitor, evaluate, and plan education activities. I urge you to participate in the forthcoming surveys and focus groups designed to measure the impact and effectiveness of our learning activities and processes. Your opinions will be used to modify current activities, enhance learning experiences, and develop outcomes measures that contribute to the professional development of otolaryngologists and quality patient care. Please take advantage of this unique opportunity to shape and direct the future of our specialty’s education programming.
CPT Code Changes: Implantation of Biologic Implant +15777
For CY 2013, the Current Procedural Terminology® (CPT) Editorial Panel has modified the descriptor for add-on code +15777 and has limited this code’s use to biologic implants placed into breast and/or trunk sites only. The new text is highlighted and underlined, and the new descriptor and corresponding parentheticals are noted in the following box. The highlighted text notes changes that directly affect otolaryngology-head and neck surgeons. Providers implanting biologic implants for soft tissue reinforcement in areas such as the head or neck (such as implantation of Alloderm® into a parotidectomy wound bed) are now instructed to use the unlisted code CPT 17999 to report these procedures. Members should keep in mind that the unlisted code is not an add-on code, as is +15777, which was previously reported. This means reimbursement for the unlisted code (17999) may be subject to a multiple procedure payment reduction. As a reminder, unlisted codes do not have specific Medicare payment associated with them and are subject to the approval of local Medicare Administrator Contractors (MAC). Members should work directly with their local MAC and third party payers to determine what reimbursement, if any, will be assigned to unlisted codes when supported with the necessary medical and diagnostic documentation. Members seeking more information should email the Academy health policy team at healthpolicy@entnet.org. +15777 Implantation of biologic implant (e.g., acellular dermal matrix) for soft tissue reinforcement (i.e., breast, trunk) (List separately in addition to code for primary procedure.) (For implantation of biologic implants for soft tissue reinforcement in tissues other than breast and trunk, use 17999) (For bilateral breast procedure, report 15777 with modifier 50.) (The supply of biologic implant should be reported separately in conjunction with 15777.)
Sample Prior Authorization, Cover Letter, or Appeal Letter for the Otolaryngologist’s Use of an Unlisted CPT Code for Endoscopic/Endonasal Skull Base Surgery
To Whom It May Concern: Attached is a copy of Dr. _____’s operative note and CMS 1500 claim form to support the use of an unlisted Current Procedural Terminology® (CPT) code for the procedure(s) performed. There are no CPT codes for endoscopic skull base surgery; therefore, I used CPT 31299 (unlisted procedure, nervous system) for my endoscopic definitive procedure of the skull base tumor resection and closure. The CPT guidelines instruct physicians not to select a CPT code that merely approximates the service provided. Additionally, CPT guidelines state if no such procedure or service exists, then the appropriate unlisted procedure or service code is reported. We are following CPT guidelines by reporting an unlisted CPT code, 31299, because the current skull base CPT codes do not describe an endoscopic/endonasal procedure. The following table, below left, shows the procedures performed and represented by the CPT code billed and the surgeon’s fee using the appropriate unlisted code. The table below on the right shows a comparison to the current “open” skull base surgery CPT code and our associated fee so you will understand how we derived our charge for this patient’s procedure. [Add the following statement if the fee reflects a zero-day postoperative global period: Please note that there is no postoperative global period assigned to unlisted CPT codes; therefore, I will be separately reporting all necessary follow-up care including hospital care (9923x), office visits (9921x), endoscopic sinus debridements (31237), and nasal endoscopy (31231).] [Add the following statement if the fee reflects a 90-day postoperative global period: Please note that I have included in the fee all postoperative care for 90 days as is included in the comparative base open CPT code(s) listed above. This includes at least three hospital days and two office visits with endoscopic sinus debridements performed bilaterally (31237-50).] Procedure Performed/Unlisted CPT Code/Our Fee Comparative Base Open CPT Code(s)/Our Fee CPT 31299 Unlisted procedure, nervous system (List name of endoscopic procedure here as written by the physician on the operative note) Fee: $ CPT (list the codes, descriptions, and fees for the codes used in comparison) Fee: $ Thank you in advance for kindly processing this claim in an expeditious and appropriate manner. Sincerely, Dr. Otolaryngologist
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Medicare Quality Penalties: A Wizard Can Help
Rahul K. Shah, MD George Washington University School of Medicine Children’s National Medical Center, Washington, DC This column has afforded a unique opportunity during the past five years to help escalate patient safety and quality improvement issues that are highlighted in the media, within our Academy, and anecdotally from our practices. Rarely do we delve into politically sensitive or potentially explosive issues. However, the recent data on the Physician Quality Reporting System (PQRS) has some a bit concerned about the readiness of our Academy members to proactively engage in reporting. Fortunately, the Academy has been ahead of the game for PQRS reporting and has even partnered to provide our membership an extremely easy portal/method to track and report the requisite metrics called PQRIwizard (https://aaohns.pqriwizard.com/). Our Academy staff members, Jean Brereton and Peter Robertson, have been monitoring the national landscape vis-à-vis PQRS and have made efforts to let our membership know about this program. PQRS is a program from the Centers for Medicare & Medicaid Services (CMS) that began in 2007 and initially purported to be a voluntary program that provided financial incentives for reporting on specific quality measures. Recent data demonstrates that for individual physicians the incentive payments are around $2,000, and for practices it is about $20,000.1 I stress the word “initially” in the above statement as now it is clear that the time for incentives is passing. CMS has stated that in 2015, there will be payment adjustments—read: penalties—for not properly reporting the mandatory quality metrics. The time has now come! The 1.5 percent noncompliance penalty will not be put in place until 2015. However, CMS is basing this penalty on data collected in 2013! Therefore, Academy members must start reporting the PQRS metrics to CMS now if they do not want to be penalized in 2015. To this end, the Academy is an excellent resource for helping the membership learn about, collect, and report the pertinent PQRS metrics.2 The tool, PQRIwizard, helps accomplish the tedious part of the data collection and reporting for practitioners and practices. It is no surprise that to encourage compliance, CMS raises the payment adjustment to two percent in 2016. CMS has been consistent in following the stated plan to provide support and incentives in the beginning so that practitioners and practices could take a few years to integrate reporting into their practice flow. CMS has always noted that in the future the reporting of PQRS metrics would be mandatory with payment adjustments for noncompliance. Some of our Academy members do not have a large proportion of Medicare patients in their patient panels and hence are not being aggressive in putting in place hard-wired pathways to ensure proper data collection. That may suffice for now, but many of us fear that this is just the beginning. If there is proof-of-principle that the payment adjustments markedly increase reporting on quality metrics, then I am sure all insurers will be forced to collect similar data with similar adjustments. Our Academy has tremendous resources for the PQRS program and has tools available to help. I strongly encourage our membership to spend a bit of time on these items to understand what is being asked of us, and what we will potentially be penalized for not reporting. Furthermore, for those practitioners and physicians attempting to avert the 2015 payment adjustment, it is imperative to begin reporting and collecting the data this year—in 2013—for this is the year that the 2015 adjustments will be based upon. We encourage members to write us with any topic of interest and we will try to research and discuss the issue. Members’ names are published only after they have been contacted directly by Academy staff and have given consent to the use of their names. Please email the Academy at qualityimprovement@entnet.org to engage us in a patient safety and quality discussion that is pertinent to your practice. References Most doctors headed for penalty over Medicare quality reporting. http://www.ama-assn.org/amednews/2012/05/28/gvl10528.htm, accessed 1/30/13. http://www.entnet.org/pqrs.
CMS Quality Reporting Initiatives Fact Sheets
This is a pivotal year for physicians as the Centers for Medicare & Medicaid Services (CMS) now begins to apply penalties across three of its quality initiatives. In 2015, physicians will be subject to financial penalties, known as payment adjustments, for the first time for the Electronic Health Record (EHR) Meaningful Use Incentive Program and Physician Quality Reporting System (PQRS). The 2015 EHR and PQRS penalties are based on participation and reporting in 2013. Penalties also increase for failing to participate and meet the e-Prescribing (eRx) Incentive Program reporting criteria in 2013. In order to help you understand the reporting requirements for these quality initiatives, the Academy has created one-page fact sheets for each of the CMS initiatives. These fact sheets include a brief overview of the program; provide information on how you and your practice can successfully meet the reporting criteria, earn incentives, avoid payment reductions; and direct you to additional resources to help you in 2013. For information on all of these programs, visit the Academy’s CMS Quality Initiatives webpage at www.entnet.org/cmspenalties.
Figure 1. Physician Use of EHRs and their Capabilities. Source: http://www.cdc.gov/nchs/data/databriefs/db111.htm
3P Update: EHR Cloning and Provider Responsibility
The Physician Payment Policy Workgroup (3P), co-chaired by James C. Denneny III, MD, and Michael Setzen, MD, is the senior advisory body to Academy leadership and staff on issues related to socioeconomic advocacy, regulatory activity, coding or reimbursement, and practice services or management. 3P wants members to take note that 2013 represents a shift in the use of Electronic Health Records (EHR) as the program administered by the Centers for Medicare & Medicaid Services (CMS) incorporate penalties for unsuccessful participants for the first time. Reporting in 2013 will be used to determine whether or not an eligible professional will be subjected to a one percent Medicare payment reduction in 2015. These penalties increase annually as the program advances. Penalties and incentives are determined on an annual basis, meaning if a physician attests or fails to successfully attest in 2013, it only applies to the incentive payment in 2014, or the penalty assessed in 2015. It is important to note that you must continue to successfully report on an annual basis to avoid penalties and earn incentive payments. How Are Your Colleagues Doing? In the last few years, the Health Policy department has seen an increase in the number of physicians and eligible professionals utilizing EHRs in their practice. According to a December 2012 Centers for Disease Control and Prevention (CDC) report, 72 percent of office-based physicians used an EHR system in 2012, up from 48 percent in 2009. Forty percent of all office-based physicians said their system met the basic Office of the National Coordinator of Health Technology (ONC) and CMS certification criteria. This is an increase of 18 percent since 2009. The same report stated that 66 percent of office-based physicians reported that they planned to apply, or already had applied, for “meaningful use” incentives. Finally, 27 percent of office-based physicians who planned to apply or already had applied for meaningful use incentives had computerized systems with capabilities to support 13 of the “Stage 1 Core Set” objectives for meaningful use. See Figure 1. The Academy supports the continued integration of EHRs into the practices of otolaryngologist-head and neck surgeons and is working to continue to provide resources to members to best allow them to use EHRs and successfully participate in the CMS Medicare and Medicaid EHR Incentive Program. As this integration continues and increases in the coming years, physicians and their staff should be aware of the responsibilities they face with the implementation or continued use of an EHR in their practice and actively protect themselves and their practices. This article, while not designed to scare you or deter you from utilizing an EHR system, hopes instead to make you aware of potential issues so you can most effectively use your EHR to improve your practice while remaining vigilant to potential issues that can arise with the incorporation of an EHR system. CMS Audits Last summer, CMS began to send out letters to physicians notifying them they were chosen to be audited for their EHR Meaningful Use Stage 1 Incentive Payment. According to Jim Tate of the website HITECHAnswers, letters from the accounting firm Figliozzi and Company, the contractor chosen to administer the EHR Audit program, asked physicians to provide “proof of possession of a certified EHR technology system…documentation that proves that 50 percent or more of patient encounters during the reporting period were entered into a Certified EHR Technology system,” and “for both the Core and Menu Set Objectives/Measures: supporting documentation used during the attestation.” According to the law firm of Ober Kaler, these audits are not specifically targeting physicians, but appear to be sweeping audits to investigate incentive payments and possibly serve as the basis for future audit programs to maintain program integrity. It is important to remember several points as you use your EHR system in your practice in case you are chosen for an audit of your EHR Incentive Program payment. Key Point # 1: Keep sufficient documentation of your patient encounters, including the supporting documentation for the criteria you choose to report as part of the attestation process and any other records that could be used to prove the encounter took place during the reporting period. An EHR “does not think” and it is important to add additional relevant information regarding the patient’s problem during the visit in order to support what is being done. It is also helpful to keep records of any conversations you have with official resources like the EHR Incentive Program Information Center concerning questions about attestation. Proper Coding and Cloning: Another important point a physician and his/her office should remember refers to the billing associated with EHR systems. Many systems provide suggested CPT and associated ICD 9 codes to assist with the billing process. However, it is important to remember that these are suggestions, not hard facts. The responsibility for proper coding rests with the physician and his office, not the EHR or the vendor that developed the system. “Upcoding” and “cloning” are two terms that have quickly become associated with issues surrounding EHR coding and present challenges to physicians when it comes to protecting themselves. Cloning refers to an EHR system automatically copying and pasting notes from a previous patient encounter into a new documentation of examination, and when coupled with new information input into the note, could lead to the EHR suggesting a higher level of E/M exam. In any case, the physician, working with his staff, is ultimately responsible for ensuring correct coding and need to code based on 1995 or 1997 E/M coding guidelines. One way to help ensure correct coding is to work with the vendor to allow the prior information to be seen, but not “counted” as part of the visit. Speak with your vendor to see if your EHR system has this capability. Key Point #2: As the physician, you must ensure that you review the information included in a note and the suggested associated E/M code and confirm the proper codes are reported.  You can review your contract with your vendor, but in many cases, vendors explicitly state they are not responsible for any coding submitted by a physician and it is the responsibility of the physician to make sure they are coding correctly. Potential Liability Issues: Along with potential audits associated with the use of an EHR, physicians must also assess the potential personal and medical liability issues associated with the use of an EHR. Sensitive patient data is stored and transmitted via an EHR and it is essential you work to ensure this information is protected. Many EHRs meet the specified security criteria set by ONC, but it is important that you check with your vendor to verify your system meets the necessary security criteria and is up to date to protect against threats. According to The Doctors Company, another issue physicians must be aware of is “alert fatigue.” Many EHRs have the capability to alert the physician of different warnings including drug-drug interactions, drug allergies, or other designated alters. “Because of ‘alert fatigue,’ there is a danger that doctors may ignore, override, or disable alerts, warnings, reminders, and embedded practice guidelines. If it can be shown that following an alert or a guideline would have prevented an adverse patient event, the doctor may be found liable for failing to follow it.” Key Point #3: Work with your vendor and your attorney to understand your rights and responsibilities when it comes to potential medical and personal liability risks when using an EHR in your practice.  Resources to Help: The Academy does have resources designed to help you navigate the world of Meaningful Use and the policies that govern the program, which can be found on the Academy’s EHR webpage at http://www.entnet.org/Practice/ONC.cfm. Here you can find the Academy’s comment letters and summaries, as well as details on the specific objectives and measures in meaningful use. The Academy continues to comment on current and future regulations based upon our members’ needs and experiences. If you have specific questions regarding your system or your potential liability, the Academy recommends contacting your vendor, consultant, or an attorney that can best help you with your specific and unique case. However, the Academy can direct you to several resources designed to help navigate the world of electronic health records and your practice. Government Agency Resources The Agency for Healthcare Research and Quality (AHRQ) has developed a guide to reducing unintended consequences when using an EHR. http://www.ucguide.org/index.html. The CMS EHR Incentive Program Information Center is a toll free hotline that helps answer all physician questions regarding EHRs. (888) 734-6433, TTY (888) 734-6563. CMS EHR Incentive Program criteria and information. http://cms.gov/ehrincentiveprograms. Additional Resources  Karen Zupko and the AAO-HNS provide workshops that can help you learn how to code properly and help protect against audits. http://www.entnet.org/ConferencesAndEvents/codingworkshops.cfm. The Doctors Company, the largest medical malpractice insurer, has a useful page full of resources to navigate physician liability when it comes to EHRs. http://www.thedoctors.com/KnowledgeCenter/EHRandTelemedicine/index.htm. For additional questions about electronic health records or meaningful use criteria, email Joe Cody, MA, health policy analyst at healthpolicy@entnet.org.
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Fighting an Antiquated Law: Hearing Aid Dispensing in New York
In New York State, under current law, few physicians offer hearing aid services within their practices, as it is not economically feasible to do so. The result is limited patient choice and reduced access to quality hearing healthcare for patients. The Patient Access to Hearing Aids (PAHA) coalition, comprised of state and national medical and specialty organizations, was formed to educate New York legislators, patients, and otolaryngologists about an archaic law in New York prohibiting physicians from dispensing hearing aids for a profit and to advocate for change. Building on our momentum from previous years, the coalition is at a critical juncture to change this outdated law and make a difference in New York. Earlier this year, Assemblyman Jeffrey Dinowitz and Sen. Betty Little reintroduced A. 655/S. 3055. If adopted, these bills would expand patient access to treatment services by enabling physician offices to dispense hearing aids for a profit. There are several advantages to patients being able to attain hearing aids in a physician’s office, including continuity of medical care and convenience for the consumer. The ability to treat both a patient’s medical and audiological needs at the same office location often results in better patient care. Patients can receive a medical determination on the cause of their hearing loss and have their treatment overseen by a medical doctor. This reduces the need for multiple visits to different providers, which can cost a patient in both time and resources, and would allow patients to receive the full spectrum of treatment in one location. In addition, the passage of A. 655/S. 3055 would allow patients the freedom to choose their provider. Because this prohibition exists in New York, many otolaryngologists and other physicians—despite being fully qualified to dispense hearing aids—have had to tailor their practices to transfer a whole segment of their patients to hearing aid dispensers and independent audiologists, who can (and do) profit from the sale of hearing instruments. Thus, the patient’s freedom to choose the best provider for their needs is eliminated. Many patients prefer to have their hearing aids fitted by their otolaryngologist or an audiologist employed by their physician. This is especially true for patients with complicated or severe otological needs. Also, due to basic market principles of supply and demand, the improved choice for consumers and increased competition among providers would help lower the cost of hearing aids for patients. Unlike some other dispensers, physicians have little profit motive for one method of treatment over the other, and will focus on the right treatment for the problem—whether it be medical, surgical, or through the dispensing of hearing aids. Now is the time to act to repeal this antiquated practice in New York. This month, the New York State Society of Otolaryngology-Head and Neck Surgery (NYSSO), will conduct its annual State Lobby Day in conjunction with the New York Coalition of Specialty Care Physicians on Tuesday, April 23, in Albany. Efforts to advance A. 655/S. 3055 will be a key item on the agenda. A good turnout is critical to effectively advocate for patients and the profession, so all New York otolaryngologists are urged to participate in Albany on April 23. For additional details and a registration form, please contact the NYSSO office at 1-518-439-2020 or nyssohns@aol.com. For more information on the PAHA Coalition and its legislative efforts, visit the PAHA Coalition website at http://www.entnet.org/Practice/members/PAHA.cfm (AAO-HNS member log-in required). With questions, contact the AAO-HNS Government Affairs team at legstate@entnet.org. *The PAHA Coalition includes the AAO-HNS and the New York State Society of Otolaryngology-Head and Neck Surgery (NYSSO), along with the Medical Society of the State of New York (MSSNY), the American Medical Association (AMA), the American Osteopathic Association, the American Osteopathic Colleges of Ophthalmology and Otolaryngology-Head and Neck Surgery, the American Otological Society, American Academy of Pediatrics, District II, Association of Otolaryngology Administrators, Ear Professionals International Corporation, New York Coalition of Specialty Care Physicians, and the New York State Osteopathic Medical Society.
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ENT PAC
ENT PAC, the political action committee of the AAO-HNS, financially supports federal Congressional candidates and incumbents who advance the issues important to otolaryngology–head and neck surgery. ENT PAC is a nonpartisan, issue-driven entity that serves as your collective voice on Capitol Hill and helps to increase the visibility of the specialty with key policymakers. To learn more about ENT PAC, visit our new PAC website at www.entpac.org (log-in with your AAO-HNS ID and password).
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Follow AAO-HNS Government Affairs on Twitter
To provide AAO-HNS members with quick and timely updates, the Government Affair’s Twitter account will now be used as a primary method for distributing breaking news. Follow us @AAOHNSGovtAffrs today!
Overview: 2013 State Legislative Priorities
Each year, the AAO-HNS reviews thousands of bills introduced in legislatures across the nation to determine relevancy to the specialty. Of those bills, the AAO-HNS actively tracks hundreds of pieces of legislation at any given time. The following is a brief summary of some of the Academy’s state legislative priorities for 2013. For a more detailed listing of the issues/bills being monitored by the AAO-HNS, visit www.entnet.org/Practice/members/stateAdvocacy.cfm. Scope of Practice The AAO-HNS believes it is appropriate for non-physician providers to seek updates to statutes and regulations relating to their defined scope of practice to reflect advances in education and training. However, the AAO-HNS strongly opposes state legislation that would inappropriately expand the scope of practice of non-physician providers beyond their education and training. Enabling non-physician providers to independently diagnose, treat, or manage medical disorders could adversely affect the quality of patient care. Hearing Aid Services The coverage of, sale, and dispensing of hearing aids is an issue considered by several states in various forms each legislative year. The AAO-HNS tracks a number of bills that address the scope of practice of dispensing hearing aids, state insurance mandates for hearing aids, and the tax credits and/or exemptions for hearing aids. Taxes on Medical Procedures Each year, there is a re-emergence of proposals to tax medical procedures. In light of continuing state budget shortfalls, 2013 will likely be no exception. The Stop Medical Taxes Coalition, of which the AAO-HNS is a member, asserts that the taxation of medical procedures is unfair for patients, violates patient privacy, requires physicians to be tax collectors, and is a “slippery slope” toward the taxation of other medical services. Truth in Advertising With the emergence of clinical doctorate programs for non-physician 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. The AAO-HNS continues to advocate for increased transparency and clarity in patient communications and interactions to help avoid confusion in the healthcare delivery system. Tobacco Use and Smoking Cessation The AAO-HNS 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. The AAO-HNS tracks legislation that seeks to strengthen or weaken smoking ban laws, as well as proposals to mandate insurance coverage and/or benefits for tobacco cessation. Medical Liability Reform Each year, numerous states consider various tort reform measures, including those related to affidavits of merit, alternative reforms, caps on non-economic damages, defensive medicine costs, expert witnesses, health courts, and/or pre-trial screening panels. The AAO-HNS strongly supports comprehensive medical liability reforms to stabilize and reduce professional liability premiums, ensure continued access to care by patients, and eliminate frivolous lawsuits. For more information on state legislative issues or specific measures, contact legstate@entnet.org or 1-703-535-3794. *Priorities are subject to change as the year continues. Check back on the Government Affairs webpage (www.entnet.org/advocacy) for updates.
Overview: 2013 Federal Legislative Priorities
The American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) is committed to the enactment of legislation that will strengthen the delivery of, and access to, quality healthcare. To that end, the AAO-HNS urges Congress to take the following actions in 2013: Permanently Repeal the Sustainable Growth Rate (SGR) Formula The volatility and instability of the Medicare payment system is threatening beneficiaries’ access to healthcare. Continued payment cuts, rising practice costs, and a lack of certainty going forward make it difficult, if not impossible, for already financially challenged physician practices to continue to treat Medicare patients. During the past decade, the AAO-HNS and others in the physician community have repeatedly advocated for the reform and redesign of the unstable and unsustainable Medicare physician payment formula. However, Congress’ failure to enact permanent reform has created an instability and uncertainty that undermines the ability of physicians to plan for the future, to provide for their employees, and to make investments to help improve the quality and efficiency of the care they provide. No true success in the healthcare reform and/or deficit reduction arenas can be achieved without the concurrent repeal of the SGR formula and development of a new Medicare physician payment model. Members of Congress are urged to support the permanent repeal of the flawed SGR formula. Protect Patient Safety Within the Medicare Program The AAO-HNS strongly believes a physician-led hearing healthcare team with coordination of services is the best approach for providing the highest quality care to patients. In past years, some in the audiology community have pursued unlimited direct access to Medicare patients without a physician referral, and the AAO-HNS has repeatedly opposed such legislative efforts due to significant patient safety concerns. In addition, some audiologists now seek to amend Title XVIII (18) of the Social Security Act to achieve a “limited license physician” status within the Medicare program. Hearing and balance disorders are medical conditions that require a full patient history and physical examination by a Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO). While audiologists play a critical role in providing quality-hearing healthcare, their desire to independently diagnose hearing disorders transcends their level of training and expertise. Members of Congress are urged to oppose “direct access” to audiologists without a physician referral and proposed Title XVIII expansions to ensure patient safety is preserved. Repeal the Independent Payment Advisory Board (IPAB)  The IPAB, an unaccountable body of individuals appointed by the President and charged with creating Medicare payment policy, usurps the rightful authority of our elected Congressional officials to create and shape Medicare policy. By limiting Congressional authority, the IPAB essentially eliminates the transparency of hearings, debate, and the meaningful opportunity of stakeholder input. In fact, fewer than half of the IPAB members can be healthcare providers, and none are permitted to be practicing physicians or be otherwise employed. Members of Congress are encouraged to support the introduction and passage of legislation to repeal the Independent Payment Advisory Board. Enact Comprehensive Medical Liability Reforms The nation’s current medical liability system places patients in jeopardy of losing their access to vital healthcare services. With affordable and adequate medical liability insurance becoming difficult to find, physicians are retiring early, limiting their practices, or moving to states with less costly premiums. This disturbing trend is leaving entire communities without access to critical healthcare services. As a specialty, in an effort to reduce and learn from instances of medical error, we have committed substantial resources to and engaged our members in proactive quality improvement initiatives. However, further statutory changes are necessary to address flaws in our current tort system and enact proven reforms to reduce frivolous lawsuits. Members of Congress are urged to explore innovative solutions to alleviate the burdens associated with the current medical liability system. Support Clarity and Transparency in Healthcare Advertisements Currently, there is little “transparency” associated with the most fundamental and important component of healthcare delivery—the many health professionals who interact with patients every day. Recent studies confirm America’s patients prefer a physician-led approach to healthcare and are often confused about the level of training and education of their healthcare providers. Because of this uncertainty, patient autonomy and decision-making have been compromised. America’s patients deserve to be fully informed and able to easily identify in healthcare advertisements their providers’ credentials, licenses, and training when seeking treatment. Members of Congress are urged to support legislation designed to require ALL healthcare providers to provide critical credentialing/training information in healthcare advertisements and during patient interactions. For more information on AAO-HNS federal legislative priorities, contact the Government Affairs team at legfederal@entnet.org. *Priorities are subject to change as the year continues. Check back on the Government Affairs webpage (www.entnet.org/advocacy) for updates.
Stay Informed: Bookmark the AAO-HNS Legislative and Political Affairs Webpage
Do you want to be one of the first to know the status of healthcare bills moving through Congress or your state? Bookmark the Legislative and Political Affairs webpage today! By visiting the webpage, you can learn more about the issues affecting the specialty, including the flawed Sustainable Growth Rate (SGR) formula, medical liability reform, scope-of-practice battles, Graduate Medical Education (GME) funding, truth-in-advertising initiatives, and efforts to repeal the Independent Payment Advisory Board (IPAB). Visit www.entnet.org/advocacy.
Alphabet Soup: Acronyms Advocates Need to Know
CBO: Congressional Budget Office. CBO produces independent analyses of budgetary and economic issues to support the Congressional budget process. CBO “scores” proposed bills to help lawmakers understand the cost or savings associated with a legislative package. CHHC: Congressional Hearing Health Caucus. CHHC is a bipartisan caucus of members from the U.S. House and Senate committed to supporting the U.S. needs of people with hearing loss and other auditory disorders. The AAO-HNS is a member of the Friends of the CHHC. CMS: Centers for Medicare & Medicaid Services. CMS is a federal agency within the U.S. Department of Health and Human Services. It is responsible for administering the Medicare program and working with states on administering their Medicaid programs. DHHA: Deaf and Hard of Hearing Alliance. DHHA is a coalition that seeks changes to federal public policy to help improve the quality of life for people who are deaf, hard of hearing, or have hearing loss. The AAO-HNS is a member of DHHA. HCLA: Health Coalition on Liability and Access. HCLA is a national advocacy coalition working to advance medical liability reform at the federal level. The AAO-HNS serves on the HCLA Board. HIT: Health Information Technology. Software and computer systems can now make medical records electronic, reducing paperwork and redundant forms. Federal and state governments are exploring numerous proposals to encourage the adoption of HIT while promoting quality initiatives and protecting patient privacy. IPAB: Independent Payment Advisory Board. The IPAB is an unelected government body established under the Patient Protection and Affordable Care Act. It is responsible for reducing the rate of growth in Medicare without affecting its coverage or quality. The Board is scheduled to implement its first proposal in 2015, although this is likely to be delayed. The AAO-HNS supports repeal of the IPAB. MedPAC: Medicare Payment Advisory Commission. MedPAC is an independent federal body established by the Balanced Budget Act of 1997. It is responsible for advising Congress on topics within the Medicare program, and more specifically, on issues dealing with payments to private health plans participating in Medicare and health providers that serve Medicare beneficiaries. MLR: Medical Liability Reform. MLR is a critical healthcare reform issue in the U.S. and a legislative priority for the AAO-HNS. Proponents of MLR are working to implement or amend legislation to lessen/cap excessive liability insurance costs for physicians while ensuring fair compensation for patients injured by negligent actions. PAC: Political Action Committee. PACs allow individuals with shared interests the opportunity to pool their voluntary donations to make contributions to federal candidates on behalf of the entire group. PACs represent a legal and ethical way to participate in the election process. ENT PAC (www.entpac.org) is the political action committee of the AAO-HNS. SGR: Sustainable Growth Rate. The SGR formula is a flawed expenditure target against which healthcare costs are compared. Generally, if annual healthcare costs fall below the target, Medicare reimbursement rates are increased. Conversely, if annual healthcare costs exceed the target, Medicare payment rates are decreased to reduce costs. Since healthcare costs tend to grow faster than the rate of inflation, the flawed formula has historically triggered annual Medicare physician payment cuts, which have typically been averted by Congressional action. The AAO-HNS supports repeal of the SGR formula. TIA: Truth in Advertising. The AAO-HNS and others in the physician community support state and federal efforts to implement TIA legislation requiring all healthcare providers to inform patients of their credentials and/or level of training in patient communications and marketing materials. Truth in advertising is an important component of providing patients with the best possible care. – See more at: http://aaobulletin.365.staging2.ascendmedia.com/Highlight.aspx?p=463&id=5937#sthash.44T2rmia.dpuf
Home Is Where the Votes Are: In-District Grassroots Outreach (I-GO)
The AAO-HNS is continually advocating on behalf of its members and the specialty by monitoring legislation, writing comment letters to state and federal legislators, and by supporting pro-otolaryngology candidates for federal office through ENT PAC, the Academy’s political action committee. However, when dealing with elected officials, the most effective way to “lobby” on legislative issues is through you, our members, who are viewed as voters and constituents by legislators. Each year, a group of our dedicated members comes to Washington, DC, during the OTO Advocacy Summit and meets with their Members of Congress. These meetings are always professional and informative to the representatives and their staffs. However, after the meetings conclude, these officials often do not hear from our members for another 364 days. In order to amplify the voice of the specialty, and to be heard for more than just one day, the Academy is launching its In-district Grassroots Outreach (I-GO) program. The main goal of I-GO is to engage members with their state and federal officials at home in their legislative districts. This helps Academy members to have their voices heard more frequently without the need to travel to Washington, DC, and it provides representatives with a helpful resource at home. How Do I Get Involved? Town Halls and Office Visits By far, the most effective method of advocating on behalf of otolaryngology–head and neck surgery is meeting face-to-face with policymakers. Legislators make this possible through periodically holding town halls or by hosting open office hours in their district offices, so their constituents can meet with them directly. The best way to learn about these events is to read your local paper or by reaching out to your official’s office. Or, simply email AAO-HNS Government Affairs at govtaffairs@entnet.org, and we can assist in your outreach. Fundraisers One constant in politics is the need to raise money. Whether it is federal or state politics, all politicians must hold fundraisers to get the resources they need to make their case to voters. Generally, fundraisers are small gatherings, which means they are great opportunities to get “face time” with candidates. Also, due to the nature of the event, you are considered a friendly person they can listen to for counsel on the issues. If you are a current ENT PAC investor, email entpac@entnet.org, and your donation to attend a fundraising event may be covered. Host a Legislator at Your Practice  You will often see elected officials visiting small or new businesses in your area on “site visits.” These visits provide an opportunity for the official to hear directly from stakeholders and voters on certain legislation or regulations. They also provide a nice photo-op for any media that accompanies them to the location. Many physicians are more comfortable talking about healthcare issues on their own turf. Consider inviting a legislator to your office—a truly memorable and effective hands-on experience. The Pen Is Mightier… The majority of people who contact their elected officials write a letter or send an email. Legislators are well aware of this and monitor closely the issues being highlighted in their inboxes and mailboxes. A benefit of this method of communication is it is less time intensive than some of the other options. Here are some tips for effective letter writing: Share personal stories about your practice or training; Make a strong “ask” about what their position is/should be; Always keep a positive tone with no insults; and Make sure they know you are a physician/otolaryngologist/constituent/voter/business owner. Write a Letter to the Editor Everyone knows they need a physician; however, not everyone knows what a physician needs. Write a letter to your local paper, telling them about an issue that is being considered in Congress or your state legislature. Often, people are unaware of pending physician-related issues that could affect them, as patients, and the care they receive from their physicians. Also, since all public officials monitor their local media to see what is being discussed, it could help inform legislators as well. Where Do I Begin? First, if you are not a member of the ENT Advocacy Network (a free, yet rewarding, AAO-HNS member benefit) sign up today by emailing govtaffairs@entnet.org. Members of the Network are the first people to hear about public events in their area and are considered the “front line” for AAO-HNS Government Affairs efforts. Second, visit the Legislative Grassroots at www.entnet.org/advocacy. This resource features updated state and federal talking points, guides on talking to elected officials, writing samples, and links to current grassroots programs. The grassroots page is a great guide to help you when interacting with public officials in certain situations and a great way to keep informed about our issues and talking points. Finally, make sure to use the Government Affairs team as your resource. If you do not feel comfortable reaching out to a legislator’s office or have questions about a topic, simply email govtaffairs@entnet.org or call 1-703-535-3795. The team stands ready to help you make a difference!
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Ready to Make a Difference This Spring?
Join Us in Washington, DC Register NOW: www.entnet.org/bog&summit Feeling a bit overwhelmed by all the recent changes in healthcare? Would you, your practice, and your patients benefit from hearing “insider” information on the new reforms associated with the Affordable Care Act (ACA)? Curious how your colleagues are handling these changes? Tired of legislators making decisions for you? Are you ready to make a difference? If you answered “yes” to any of the above questions, we have the answer. The AAO-HNS is excited to host the 2013 BOG Spring Meeting & OTO Advocacy Summit (May 5-7) in Alexandria, VA, and Washington, DC. This year’s combined meeting will provide a great opportunity for attendees to hear from experienced policymakers, participate in committee meetings, attend networking events, and meet with your legislators on Capitol Hill. Even better—this event is free for AAO-HNS members! BOG Spring Meeting The Board of Governors (BOG) Spring Meeting offers attendees the opportunity to learn more about the grassroots arm of the Academy, network, and engage in peer-to-peer interactions with eminent members in the field. Information sharing and presentations from a variety of dynamic speakers and subject-matter experts will be featured throughout the BOG portion of the combined meeting. Attendees will also benefit from a comprehensive review of important issues affecting otolaryngology practices in today’s rapidly changing healthcare environment, as society representatives from across the nation gather to discuss national, state, and local issues of importance. On the morning of Sunday, May 5, the meeting begins with an icebreaker event followed by the first of our BOG committee meetings. For Sunday’s luncheon, the BOG Executive Committee has invited Wendy B. Stern, MD, chair of the Media and Public Relations Committee and BOG secretary. Dr. Stern will present a panel discussion on how social media in academic and private practice settings can be a great benefit, and ways to avoid unnecessary risks to physicians, their practice, and/or academic setting. The day will continue with committee meetings highlighting hot topics, including an overview of the current legislative environment at the state and federal levels, a discussion of how to reenergize our BOG societies, and pediatric subcertification. Issues of reimbursement, specialty unity, health system reform, and the shrinking otolaryngology workforce will figure prominently in these committee discussions. Immediately following the Sunday sessions, you are invited to a Professional Education Focus Group. Tell us what you think about the Foundation’s professional education efforts. We are looking for a representative sample of members to talk about how to enhance and improve upon current education offerings and to better serve the education needs of our members. Look for more information about the focus groups with BOG Spring Meeting information. On Sunday evening, ENT PAC, the political action committee of the AAO-HNS, will host a reception open to all 2013 ENT PAC Leadership Club donors. Reception attendees will be treated to a scenic evening boat cruise on the Potomac River while mingling with colleagues and enjoying heavy hors d’oeuvres and refreshments. Don’t miss this opportunity to see Washington, DC, from a perspective most visitors would envy. On Monday, May 6, the meeting begins with a “society information sharing” session where BOG committee chairs will provide updates about their committee activities since the last annual meeting and plans for the upcoming meeting in Vancouver. Shortly thereafter, the BOG General Assembly will feature the always lively president-elect “Candidates Forum,” which offers attendees the opportunity to question the candidates for AAO-HNS/F president-elect. The BOG portion of the combined meeting will conclude with a luncheon featuring keynote speaker, Wendy Kroll, JD, who will present on the legal implications of the Affordable Care Act on an ENT practice. OTO Advocacy Summit Following the BOG luncheon on Monday, May 6, the Summit will officially begin by transitioning into an in-depth advocacy briefing conducted by members of the AAO-HNS Government Affairs team. Legislative priorities will be highlighted, including “truth in advertising,” Medicare physician payment reform, repeal of the Independent Payment Advisory Board, and scope of practice. AAO-HNS members also will be equipped with key talking points to fully brief Members of Congress and/or Congressional staff on the legislative issues important to the specialty. Immediately following the advocacy briefing, Summit attendees will hear presentations by Congressional and Administration speakers who will offer an “insider’s” view into the policymaking process and the current proposals being debated in Washington, DC. Ample time will be provided to ensure a robust Q&A session between our guest speakers and Summit attendees. On Tuesday, the Summit will culminate with a full day of meetings with Members of Congress and/or their staffs. After an early morning final briefing, Summit attendees will be transported from Alexandria to the AAO-HNS Washington, DC, office on Capitol Hill. Following a quick group photo on the steps of the U.S. Capitol, AAO-HNS members will participate in pre-scheduled meetings with their House and Senate legislators. This unique and invigorating opportunity will enable Summit participants to showcase their insight and expertise in patient care, while communicating the key legislative priorities for the specialty. Attendees are invited back to the AAO-HNS Capitol Hill office in between or after their Hill visits to provide feedback to Academy staff on their meetings. Lunch and refreshments will be provided for all members. To ensure sufficient time to attend all your Hill meetings, attendees are requested to plan their flight departures after 4 pm. Sign Me Up! Interested in attending? Academy members can register online for the BOG Spring Meeting & OTO Advocacy Summit by visiting www.entnet.org/BOG&Summit. Other important information can also be found on this site, including tentative agendas, resident leadership travel grant applications, and directions on ways to book your hotel reservation at the meeting’s host hotel, the Embassy Suites Alexandria Hotel. Don’t delay: Act now to participate. The 2013 BOG Spring Meeting & OTO Advocacy Summit is a unique way for members to learn more about the Academy and influence federal legislation affecting the specialty, your patients, and your practice. Make sure to take advantage of this free member benefit and register today. We hope to see you in May!
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If History Still Lives for You, Attend Our Otolaryngology Historical Society Meeting
Marc D. Eisen, MD, PhD The Otolaryngology Historical Society (OHS) provides a forum for the discussion, presentation, and preservation of the history of all aspects of otolaryngology. The society welcomes otolaryngologists from around the world and from all stages of training and practice, as well as individuals in related fields. OHS Annual Meeting To keep life easy, we conduct our annual event in conjunction with the AAO-HNSF Annual Meeting & OTO EXPOSM. This event offers an informal social gathering for all members, guests, and those interested in medical history. There is no shortage of conversation, owing to the rich nature of this area and how history literally lives in our daily practice. The program format includes select presentations on historical topics. Recent topics presented included the history of cochlear implantation, tonsillectomy, and the Eustachian tube; contributions of Avicenna, Julius Lempert, and Max Brödel; and otolaryngology in Byzantium. As you can see from the list, our range of interest is vast. Submit an Abstract The society strongly encourages submitting a history-related otolaryngology abstract as a possible presentation for the OHS meeting. Abstracts should be no longer than 300 words. Presentations are 20 minutes long, which includes five minutes for a lively exchange of questions and comments. The Society’s review panel will select the best abstracts for presentation based on originality, applicability, and historical content. As an incentive to join the society, preference will be given to those OHS members who submit abstracts. Joining the OHS Is Easy To join the OHS as a member or renew your OHS dues, check the box on your member dues invoice or email memberservices@entnet.org. Annual dues are $50, which includes the OHS annual meeting and reception. To learn more about the OHS or send an abstract, email Catherine R. Lincoln, CAE, MA (Oxon), staff liaison, History and Archives Committee, at museum@entnet.org or call 1-703-535-3738.
(left to right); Peter W. Alberti, MD (AAO-HNS), Alessandro Martini, MD (conference host), Robert J. Ruben, MD (AAO-HNS), Albert Mudry, MD (Switzerland), guest, Neil Weir, FRCS (UK), guest, Wolfgang Pirsig, MD (Germany), guest, Mrs. Sue Weir (UK), and Mrs. Elizabeth Alberti (Canada)
International Historical Society’s Meeting in Padua
Robert J. Ruben, MD Last August, the International Society of the History of Otolaryngology conducted its sixth working meeting in the historic medical school of Padua University, 20 miles west of Venice, Italy. The host was Alessandro Martini, MD. The wide-ranging program attended by 30 participants included historical aspects of anatomy, research, global hearing health, and giants in the specialty, with speakers from Canada, Germany, Italy, Switzerland, the United Kingdom, and United States. It addressed such famous historical figures as Kaiser Frederick III, the composer Giacomo Puccini, and the discoverer of ancient Troy, Heinrich Schliemann. The meeting opened with a tribute to our departed colleague, Dafydd “Dai” Stephens, PhD, professor of audiological medicine, Sussex University, UK. The meeting continued with the following presentations: Bonaventura Angeli and His Description of Ménière’s Symptoms in “De Vertigine et Scotomia,” by Alessandro Martini, et al; Symbols of Medicine in the Seal of the Padua Medical School, by Giorgio Zanchin; Historico-medical Research in Otology: Pitfalls, Doubts, and Successes, by Albert Mudry and Wolfgang Pirsig; Who First Described and Depicted the Foramen in the Anterior External Bony Auditory Meatus, Mostly Termed Foramen of Huschke?, by Wolfgang Pirsig and Albert Mudry; Three Knights of King’s—Sir Victor Negus, by Neil Weir; Analysis of a Letter from Felix Semon to Count Herbert von Bismarck, Secretary of State of Prussia, Concerning Frederick III of Prussia, Dated July 12, 1888, by Robert J. Ruben and Wolfgang Pirsig; Forty to 300 Million with Disabling Hearing Loss, 1985-2005: How the WHO Changed its Mind, by Peter W. Alberti; A Brief History of Mastoidectomy and the Role of Hermann Schwartze, by Stefan K. Plontke, et al; The Last Journey of Heinrich Schliemann, by R. Ragona Marchese, I. Mylionakis, and Alessandro Martini; Role to Define: Medicine and Deafness in Nineteenth-century France, by Sabine Arnaud; The Unfinished Turandot and Puccini’s Laryngeal Cancer, by R. Ragona Marchese and Alessandro Martini: Wenzel Leopold Gruber and His Ligament at an Anthropological Edge, by Herwig Swoboda; and Liaisons Heureuses—Medicine Between Padua, Trieste, and Vienna, by Herwig Swoboda. In addition to this fascinating and thought-provoking program, we visited Padua’s Anatomical Theater, established by the pioneering anatomist Girolamo ab Aquapendente; the Hortus Simplicius, the first botanical garden devoted to the teaching and study of plants of medical interest; and the Museum of the History of Medicine and Health (Museo di Storia della Medicina e della Salute). The society’s next meeting will be in Vienna, Austria, September 13-14. To learn more, email Albert Mudry at albert@oreillemudry.ch, or Wolfgang Pirsig at wolfgang.pirsig@extern.uni-ulm.de or museum@entnet.org.
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Lunch and Learn to be Social: A Media and Public Relations Event
Wendy B. Stern, MD BOG Secretary Chair, Media and Public Relations Committee What is more social than a social media luncheon? The BOG has invited the Academy’s Media and Public Relations Committee to present a discussion on various aspects of social media in the academic and private practice settings. This luncheon will take place on Sunday, May 5, as part of the BOG Spring Meeting & OTO Advocacy Summit. The knowledgeable luncheon speakers are sure to generate interest and discussion. Spencer C. Payne, MD, is an associate professor and director of rhinology at the University of Virginia, department of otolaryngology. Familiar with technology and creating an online presence since the early 1990s, he has helped bring his department to social media using the basics of Facebook and Twitter within university policy. He will discuss the basics of social media, establishing a presence, and taking steps to prevent unnecessary medico-legal exposure and risk as they apply to the academic physician. Christopher Y. Chang, MD, is a solo private practice otolaryngologist in northern Virginia who has been active in social media since 2005. Being an early adopter, he has throughout the years developed techniques of effectively using social media to develop one’s practice while simultaneously being time efficient in this important marketing activity. Although he is in solo private practice and lacks brand-name recognition, he has successfully developed a well-recognized social media and Internet presence with thousands of followers and hundreds of millions of views. For this presentation, he will convey tips and strategies that others can incorporate when developing their own social media presence not only effectively, but also efficiently when considering how precious time has become. The BOG is committed to providing a variety of lectures that will enhance your practice of otolaryngology. Please join us.
Academy Advantage Premier Partner The Doctors Company: Best Practices for Creating an ACO
The U.S. healthcare system is moving toward Accountable Care Organizations (ACOs), groups of healthcare providers who agree to be accountable for the quality, cost, and overall care of Medicare patients. According to the Future of Health Care Survey conducted by The Doctors Company, the nation’s largest medical malpractice insurer, 57 percent of doctors are either undecided or need more information on ACO participation. In the YouTube video, Principles for ACO Success: Health Care and Clinical Integration, found at www.youtube.com/doctorscompany, healthcare industry thought leaders recommend the following best practices when forming ACOs: Create a readiness checklist. “A readiness checklist…involves things like patient-centered medical homes and the attributes that primary care physicians have,” said Robert J. Jackson, MD, MMM, president and medical director, Accountable Healthcare Alliance in Michigan. “It talks about, ‘How well do we deal with data? Do we have patient registries? Do we have patient care plans? Do we have transition of care issues developed?’” Meet patients’ specific needs. “The key is designing the care management tools, resources, people, and interventions to manage the specific needs of that patient,” said Laura P. Jacobs, MPH, executive vice president, The Camden Group in California. Develop clinical integration. “Make sure all the providers are engaged in real-time information sharing so a care plan can be developed within a very quick period of time and all the providers know their roles and the timelines in which they have to perform their services,” said Michael H. James, JD, president and CEO of Genesys PHO, a pioneer ACO, and Genesys Integrated Group Practice in Michigan. Engage the community. “The community has to…support programs that improve health and improve the way patients live because healthcare goes beyond just acute care,” James said. “It involves the patients’ safety, whether they have enough to eat, their transportation, education, business opportunities or employment opportunities.” Select the right board members. “A pioneer ACO requirement is to expand the board with a patient and a community advocate,” James said. “Genesys…selected the leader of their volunteer group. He is 72 years old and is very engaged and involved in community studies on how to improve access to care. The community advocate is the executive director of a group of nursing homes.” Contributed by The Doctors Company. For more risk tips, patient safety tips, and physician practice tips, visit www.thedoctors.com.
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ENTLINK App: The Best Way for Patients to Find You
One of the most visited online Academy sites, “Find an ENT,” is now available as a mobile app, ENTLINK! This app helps patients locate an ENT quickly and easily, and allows you to find colleagues in order to refer patients. You can search by location, proximity, name, and subspecialty. All AAO-HNS members are automatically included in the Academy’s online directory. Be sure to update your AAO-HNS profile at www.entnet.org/profile or, email memberservices@entnet.org, so colleagues and patients can find you quickly. The ENTLINK App is free and available for download in iTunes and Android stores.
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Academy Advantage Partner EYEMAGINATIONS: Why Patient Education Is Important
According to a recent University of Minnesota study, patients retain only 50 percent of the information provided by healthcare providers, with half of that information recalled incorrectly.1 So why might this breakdown in communication exist? Well, it could be inconsistent patient education. When considering implementation of a formal patient education program, here are a few thoughts to consider: Do Your Patients Fully Understand Their Conditions and Prescribed Treatment Options? The better you can educate a patient, the more they will trust you and make the best decisions about their medical care. Simply, better-educated patients make better decisions, therefore ensuring that your existing client base keeps coming back for follow-up visits. Is Your Patient Education Messaging Consistent across All Staff Levels? Streamlining your patient education program ensures that the same information is received no matter whom patients speak to in your practice. This makes educating patients the responsibility of your entire staff, saving you valuable time in the exam room. Does Your Website Match Your Practice Messaging? A recent Pew Internet Project report indicated that 80 percent of all Internet users look online for health information specifically.2 The way that you are represented online should always be consistent with how you are represented during an office visit. In summary, a dedicated patient education program can save you time and reinforce what your patients learn during the office visit. Eyemaginations helps to improve patient understanding and informational recall through a suite of tools to help practices simplify complex topics and reinforce clinical messaging. Here are a few ways that better patient information can help: Increase conversion rates by educating patients in the waiting room on your offerings. Save 10 minutes of your time per patient by showing condition development and point-of-view perspectives quickly and efficiently to patients in the exam room via iPad or PC. Increase traffic and improve patient retention by integrating animations onto your website to reinforce messaging, so patients can review your recommendations at any time. As an AAO-HNS Advantage Partner, Eyemaginations remains committed to helping you achieve your patient education goals. For more information, we invite you to call us directly at 1-877-321-5481, email entinfo@eyemaginations.com, or visit us online at www.eyemaginations.com. References Margolis, Robert H. Informational Counseling in Health Professions: What do Patients Remember? Retrieved from http://audiologyincorporated.com/?s=what+do+patients+remember&submit.x=0&submit.y=0&submit=Search. Fox, Susannah. Pew Internet: Health. Retrieved from http://pewinternet.org/Commentary/2011/November/Pew-Internet-Health.aspx.
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In Memoriam: Charles J. Krause, MD, Past AAO-HNS/F President
Charles J. (Chuck) Krause, MD, who served as AAO-HNS/F president from 1996 to 1997, died on February 7, in Naples, FL. Dr. Krause was the former chair of the department of otolaryngology-head and neck surgery at the University of Michigan. Academy President James L. Netterville, MD, said upon hearing the news, “It was with heartfelt sadness and a sense of professional loss that I note the death of one of the specialty’s most dedicated leaders—that of Charles Krause, MD.” During his career, Dr. Krause also served as president of the American Society of Head and Neck Surgery, the American Board of Otolaryngology, and the American Academy of Facial Plastic and Reconstructive Surgery. Originally from Iowa, Dr. Krause earned both his BA (1959) and his MD (1962) degrees from what was then known as the State University of Iowa, now known as the University of Iowa. He interned at Philadelphia General Hospital from 1962 to 1963, and served at the USAF Hospital at Randolph Air Force Base from 1963 to 1965. He returned to the University of Iowa and undertook residency training there from 1965 to 1969. From 1969 to 1977, Dr. Krause served as a faculty member in the department of otolaryngology and maxillofacial surgery at the University of Iowa. In 1977, Dr. Krause was recruited to join the faculty at the University of Michigan as a professor of otolaryngology and served as chair of the department until 1992. He served in leadership positions in various hospitals and health centers in the Michigan area, including dean for clinical affairs at the medical school and chief of clinical affairs at the University of Michigan Hospitals. He was appointed senior associate dean for clinical affairs at the medical school in 1992. He served as senior associate hospital director for medical affairs from 1995 to 1996 and returned to clinical practice in the department of otolaryngology in 1996. He remained active on the faculty until 2000. Dr. Krause served with distinction as a clinician, faculty member, senior hospital administrator, and as a world-renowned speaker. In addition to his clinical work, he was extremely active in the humanitarian outreach. Prior to his retirement, he established the Barbara and Charles Krause Lectureship in Humanities in Medicine in the department of otolaryngology-head and neck surgery at the University of Michigan Medical School. In recognition for his support and contributions to the promotion of cultural diversity with his establishment of the first departmental diversity committee, he was awarded the Harold R. Johnson Diversity Service Award in 1999. In November 2012, he and his wife Barbara attended the first installation of the Charles J. Krause, MD, Collegiate Professorship in Otolaryngology, an honor given to Carol Bradford, MD, chair of otolaryngology. David R. Nielsen, MD, Academy EVP/CEO, remembered Dr. Krause as a wonderful role model, “Dr. Krause had the rare quality of inspiring immediate confidence from everyone who met him. He seemed like a mentor and friend even to those who knew him only moderately well. I was certainly the beneficiary of his kind compliments and counsel on many occasions. His positive influence will continue in the next generation of leaders.” Neil O. Ward, MD, MALS, then AAO-HNSF President, remembers, Chuck Krause served as the Academy’s president-elect during the AAO-HNS 1996 Centennial Year. “It was my pleasure to get to know him well during that year,” he said, “and subsequently he and I shared the privilege of offering the membership a dues reduction during our tenure.” Dr. Krause’s AAO-HNS presidential term began in September 1996 at the annual meeting in Washington, DC, when the Academy was celebrating its centennial year. In addition to his term as president, his service to the AAO-HNS included many leadership positions. During the late 1980s, he served on the Building Committee, which had oversight of the AAO-HNS purchase of the new Academy headquarters building at One Prince Street. He chaired several committees, including the Ethics Committee, the Nominating Committee, the Bylaws Committee, and the Humanitarian Efforts Committee. He served on the Editorial Board of the journal and was active on several committees throughout his involvement with the Academy. In 2003, he received both an Honor Award and the Distinguished Service Award. Dr. Krause is survived by his beloved wife of 50 years, Barbara, his daughters Sharon and Ann, and his son John, and their families. The former AAO-HNS Executive Vice President, Jerome C. Goldstein, MD, greatly valued his association with Dr. Krause, “Chuck Krause and I were friends for more than 30 years… I was president of Council of Medical Specialty Societies in 1995 and he was the Academy delegate to that organization, and I counted on his support. He was president of the Academy in 1987, and I was senior EVP so we had a chance to work together again. Chuck’s management style was to lead by building consensus. He brought different people together who had ideas that could be disruptive and by fostering discussions led them through compromise. . . He was a master at this. Chuck was a calm and thoughtful visionary and contributed much to our specialty.”
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What Is the BOG and What Can It Do for Me?
Sujana S. Chandrasekhar, MD Immediate Past Chair, BOG This is the 31st year of the Board of Governors (BOG), but many of the 12,000-plus members of our Academy don’t understand what it is, what it does, or how they can interact with it and benefit from it. So, here’s a primer. WHO: The Board of Governors represents each member of the AAO-HNS. Its mission is to function as the representative of member otolaryngologists’ grassroots and socioeconomic concerns, and to bring those concerns to the Board of Directors (BOD) of the Academy. As such, the interface between the BOG and Academy activities occurs at committee meetings and in the development of educational offerings; at task forces (TF) such as the Guidelines Task Force and TFs that select coordinators and journal editors for the Academy; and directly at the Executive Committee (EC) and BOD of the Academy. HOW: Your concerns are represented at the BOG. There are local, state, regional, and/or national and international ENT society members of the BOG. These include the state otolaryngology societies, the national subspecialty societies, and either region-based or subspecialty-based societies. There are currently more than 60 local/state/regional societies, 17 national societies, two sections, two committees, and 54 International Corresponding Societies (ISC) that belong to the BOG. Each member society has three representatives to the BOG. There is a governor, a legislative representative, and a public relations representative. These individuals are appointed by their societies, and are expected to attend the BOG Spring Meeting in Alexandria, VA, the Fall BOG meeting the Saturday before the start of the Annual Meeting & OTO EXPO, and the BOG General Assembly (GA) the Monday afternoon of the annual meeting. All Academy members are welcome to attend the GA, but only a member society’s governor may vote. If the governor cannot attend the GA, then one of the other two representatives may vote. WHAT: The structure of the BOG is as follows. Every year, there is a new chair-elect, who is elected at the Fall GA meeting. Every other year, there is a new secretary and a new member-at-large, whose elections are staggered, and who serve two-year terms. Their candidate statements are published in the Bulletin, and you can get to know them at the BOG Spring Meeting and during committee meetings. There are three major BOG committees: the Legislative Representatives Committee; the Socioeconomic and Grassroots Committee; and the Rules and Regulations Committee. Any member of the Academy in good standing can apply for membership to any of these committees through the normal Academy committee process, which ends every February. There is also a Nominating Committee, chaired by the immediate past chair of the BOG (me, this year) and has members elected at the GA. When needed, BOG task forces with a shorter shelf life are created. An example of a successful TF was the BOG Development TF, which helped launch the Millennium Society and has been folded into the Foundation’s Development Committee. The Executive Committee of the BOG consists of the chair, chair-elect, immediate past chair, secretary, member-at-large, and committee chairs and vice chairs. The BOG Executive Committee meets regularly to deliberate on matters of importance to practicing otolaryngologists in all types of work environments. We are an excellent first-line access point for practice and legislative matters that need to get to the attention of the Academy leadership and staff. The chair and chair-elect of the BOG sit on the Academy’s Executive Committee, with the chair having a voting position. The chair, chair-elect, and immediate past chair are all voting members of the Academy’s BOD. There is BOG representation on all Academy taskforces. WHEN: Plan to attend the BOG Spring Meeting & OTO Advocacy Summit May 5-7, 2013, in Alexandria, VA, and plan to storm Capitol Hill and meet with your legislators on May 7. This is a free member benefit open to all Academy members, and it is a lot of fun. Please try to bring a resident or two with you so they can be mentored as well. Arrive in Vancouver a day early this year and attend the BOG committee meetings on Saturday, September 28, 2013. You will love the camaraderie, the give-and-take, and the opportunity to make your perspective heard. Monday, September 30, plan to attend the BOG General Assembly beginning at 5 pm. Encourage your society’s representatives to attend and vote. Also be sure to attend the BOG-sponsored miniseminar, “Hot Topics in ENT.” You’ll be amazed at what you’ll learn about your own practice. WHY: The BOG is a remarkable group within our Academy that offers every otolaryngologist an opportunity to have his or her voice heard. It is a wonderful place to learn more about the practice and legislative aspects of ENT, and to learn and build your own leadership skills. As the healthcare landscape changes, we can’t keep our heads buried in the sand or hidden in the ivory tower. It is up to us, the otolaryngologists, to guide our citizens and legislators on the right path, and the BOG affords us that ability. You can always reach the BOG at bog@entnet.org, or contact any of us on the Executive Committee directly. I look forward to seeing you at future BOG events.
David R. Nielsen, MDAAO-HNS/F EVP/CEO
Advocacy Is a Team Sport
While advocacy is always a prominent topic in the Bulletin, this month has additional focus on the efforts the Academy makes on behalf of its members, and by extension, their patients. You have recently read much about how the elected and appointed leaders of the Academy have successfully intervened, contributed to, and positively influenced healthcare policy on our behalf—sometimes in concert with other societies with shared issues, and sometimes specifically and exclusively regarding otolaryngology. Examples of the former include our comments on the Patient Protection and Sunshine Act (PPSA); support of the Council of Medical Specialty Societies’ “Code for Interactions with Companies;” or our many comment letters on proposed rules for a host of elements of healthcare reform legislation. The latter category is illustrated by our response to the FDA on the issue of blackbox warnings for the use of codeine for pain relief in children post-tonsillectomy; our participation in the Choosing Wisely® campaign; and our World Voice Day activities, among many others. How This Happens We have just completed the update of strategies, actions, and work plans for the next 12 to 18 months of Academy and Foundation initiatives and the extensive review and approval of our boards of directors, executive committees, finance and investment sub-committee (FISC), and our budgeting process. The manner in which the extensive scope of Academy activity is identified, prioritized, developed, and implemented is complex, but very effective. Considering our budget and resources, I believe we “accomplish more with less” than just about any other major medical society, in large part because of the tremendous spirit of volunteerism and the culture of contributing to the profession that characterizes otolaryngology-head and neck surgery. On many levels the Academy’s structure and governance requires teamwork and collaboration, mentoring and development, and the leveraging of assets to accomplish so much. While some of this is cultural and consistent with the personal attitudes and behaviors of our members and staff, a great deal occurs intentionally through training and skill-building of staff, management, board, and membership. Each year the Executive Leadership Team (ELT) of the Academy/Foundation engages in ongoing leadership and skills training to expand our abilities. Part of this year’s training included a discussion on “high performing teams” and taking action on specific elements of improvement. After a review of the expansive literature and the publications of the many experts on teamwork, we culled and focused on a collection of principles that we believe embody the most essential elements of highly functioning teams. We combined these principles into four categories: 1) superior communications and related learning environment; 2) alignment around a common purpose and supported leadership; 3) effective planning and work processes that lead to measurable solutions; and 4) a foundation of trusting relationships and environment. Communications: After several years of staff surveys with successful actions to address needed change, we note that “communications” always seems to be an issue raised in an organization committed to improvement. It is our experience that the need for improved communications is either a significant part of any problem, or a key to the solution. Alignment: Alignment is highly related to communications. We believe that the single most important element necessary for success is clarity and a compelling vision around a specific purpose or goal. The ability of all members of a team to articulate the desired outcome and to champion the cause is directly related to the degree of success of the team. The more team members there are who just “go with the flow,” the greater the likelihood of failure or stagnation. Effective processes: Processes include the identifying, prioritizing, and planning processes; as well as the work flow processes and measures of completion. There has to be a balance between those team members who excel at the planning and envisioning of the results and the pragmatic and realistic workers who implement and carry out the actions. People are rarely great at both, and mutual respect for the absolute necessity of each focus is essential. Trust: An environment of trust is built both on competence and character. While it is tempting to believe that trust is based only on honesty and integrity, being “able” is the key to being “accountable.” Failing to deliver on an agreed upon expectation can undermine trust as rapidly as being disingenuous or insincere. In fact, part of being truly honest requires us to accurately assess what we can accomplish and then to make good on our commitments. Your elected leaders and all the professional staff here in Alexandria, VA, and Washington, DC, commit to continuously improving our teamwork as we advocate with you to empower us to provide the best possible patient care.
James L. Netterville, MD AAO-HNS/F President
Face to Face Patient Care
My friends, with six months of my presidential year behind me now, I can really say, as time goes by, it goes by more quickly. So, I feel some urgency to make the most of each chance given me to further our Academy strategy this year. Therefore, on May 5 and continuing through May 7, I hope to join some of you in Washington, DC, to advocate personally for quality patient centered otolaryngic care. With each new Congress, we have the opportunity to advance the targeted legislative issues your Board and other AAO-HNS/F leaders have picked as those where our advocacy can best exercise influence for the good of our patients’ care. The road maps for these efforts, our federal and state issue platforms, are outlined on pages 26 and 27 in this issue. To prepare you for your Capitol Hill visits and this opportunity, our own BOG member-volunteers connect with issue experts to present practical workshops and “backgrounders” that will help us carry the specialty messages to our elected leaders. One of these events, and the most exciting for me, will be the BOG-hosted Presidential Forum that allows our president-elect candidates to address attendees directly on those questions outlined for them by our excellent Nominating Committee. The Hill Visits These member-to-member meetings lead up to the face-to-face meetings with legislators and congressional staff that present the best chance we each have to influence history—the moment each of us can personalize what patient care should be. In these sometimes small yet important offices, our legislators can clearly see in each of us how much we care about our patients. You will be the face of otolaryngologic care for each person you talk to that day. Face to Face with Patients More often than ever the issues we will discuss with these legislators and among ourselves at home involve the integration of care—diagnosis and treatment, outcomes and performance, safety and quality, knowledge and transparency—all of a piece. This coming together of disciplines is changing how we practice medicine. For instance, we often mention the importance of guideline development and a guideline’s “translation to practice” as steps to that integration. When guidelines are introduced, it is the optimal time to think not just of how we will incorporate these new recommendations into our care, but also how we will make new recommendations available to patients. Keeping patients engaged in healthcare decisions is part of what we must do now more than ever when costs are so high and options for care more confusing. To encourage these conversations, last month this organization announced its list of five procedures that physicians and patients should discuss to assess quality care and safety in treatment options. These conversations will involve data and decision-making in a way that is focused and involving for both patients and physicians. Informational materials that can be made available to patients to revisit will be more helpful than ever to the process. In a blog post on the ABIM Foundation Choosing Wisely® website, Executive Vice President Daniel Wolfson, MHSA, wished (from his own patient experience) for the following physician/patient competencies: “Provide me with the clinical evidence about the options for surgery, professional opinions on the best course for my situation, and help me to make the best decision for myself. . . As a patient I want to feel we are in conversation about my health and that he [the physician] is fully present with me.” Our clinical committees are working harder than ever to update the Academy patient information materials in concert with guideline development, product relevancy efforts, and such initiatives as those of the Choosing Wisely® campaign. Join me then in May to personalize care. Come to DC to see your legislators, and at home, take advantage of the tools available like those for Better Hearing and Speech month to help your patients to talk about options. Use the “bonus” patient information leaflet in this Bulletin to help (and see page 46). For more special community outreach materials, login to www.entnet.org/Community/outreach.cfm. Source: The “Other” Physician and Patient Competencies—What’s all the Fuss?; Daniel Wolfson, September 4, 2012. Accessed from http://blog.abimfoundation.org/the-%e2%80%9cother%e2%80%9d-physician-and-patient-competencies%e2%80%94what%e2%80%99s-all-the-fuss.