Published: October 20, 2013

Global ENT Outreach Mission Trip: Phnom Penh, Cambodia

Anthony G. Del Signore, MD, Mount Sinai School of Medicine, Resident Travel Grantee Ian M. Humphreys, DO, Michigan State University/Detroit Medical Center, Resident Travel Grantee In July, we joined a medical missions trip led by Global ENT Outreach to Phnom Penh, Cambodia. This was the largest volunteer group to date for our host organization and included the following team members: Shaheen M. Counts, MD; Anthony G. Del Signore, MD; Ian M. Humphreys, DO; Marta Sandoval, MD; Richard Wagner, MD; and Charles Z. Weingarten, MD. We feel the experiences afforded to us by the AAO-HNSF Humanitarian Travel Grant were truly remarkable. After nearly 20 hours of travel we reached the Cambodian capital of Phnom Penh. Our team of surgeons, nurses, medical students, and public health educators met for the first time in a tiny hotel. Our nationalities, ethnicities, and languages were diverse, but we shared a unified vision of providing otologic care and training to these people in need. Only 30 years prior, an act of unspeakable genocide targeted the educated and professionals in this area; an entire generation of physicians, health educators, and nurses were eradicated. Today, a fractured healthcare system with poor infrastructure, limited resources, and inexperienced health professionals exists. Rehabilitative efforts, including a nascent otolaryngology residency-training program at the National Hospital Preah Ang Duong, are underway. However, otologic care in particular is poorly understood and under delivered. The week began with a dedicated otologic clinic to further evaluate patients initially screened by Cambodian otolaryngologists. Many patients traveled great distances from the surrounding countryside to obtain long awaited care. In total, 120 patients were evaluated using either a teaching microscope or video endoscope. Forty-five surgeries were scheduled subsequently for the remainder of the week. We saw a diverse spectrum of pathology, and patients including congenital malformations, chronic otorrhea, tympanic membrane perforations, cholesteatoma, and otosclerosis. Accordingly, surgical interventions focused on the management of chronic ear disease, with tympanoplasty and tympanomastoidectomy being the most frequent surgical procedures. One goal reigned supreme: to create a dry, safe ear. Given the lack of readily available inhalational anesthesia, the majority of the procedures were performed under local anesthesia and intravenous sedation. All patients were admitted for overnight observation and subsequently discharged home with follow-up care to be provided by the Cambodian otolaryngologists. Both in the clinic and operating room we had frequent opportunities to teach evaluative and diagnostic strategies, as well as surgical techniques. Despite obvious cultural and language barriers, we focused our collective efforts to achieve our mission. In the end, we provided high quality demonstrative surgery and instruction that serves as a model for continued development of the Cambodian otolaryngology training program. Not only did we gain an appreciation for the difficulty of providing otologic care in a relatively impoverished part of the world with limited resources and a fractured health system, we also experienced the role of surgeon educator. In the end, our cultural awareness and sense of humanistic professionalism flourished throughout our Cambodian experience. We are completely indebted to the support provided by the AAO-HNSF Humanitarian Efforts Committee and the Alcon Foundation for this wonderful experience and are confident that it has solidified our commitment to future mission endeavors.

Anthony G. Del Signore, MD, Mount Sinai School of Medicine, Resident Travel Grantee
Ian M. Humphreys, DO, Michigan State University/Detroit Medical Center, Resident Travel Grantee

Anthony Del Signore, MD, examines a patient’s ear during the screening clinic.Anthony Del Signore, MD, examines a patient’s ear during the screening clinic.

In July, we joined a medical missions trip led by Global ENT Outreach to Phnom Penh, Cambodia. This was the largest volunteer group to date for our host organization and included the following team members: Shaheen M. Counts, MD; Anthony G. Del Signore, MD; Ian M. Humphreys, DO; Marta Sandoval, MD; Richard Wagner, MD; and Charles Z. Weingarten, MD. We feel the experiences afforded to us by the AAO-HNSF Humanitarian Travel Grant were truly remarkable.

After nearly 20 hours of travel we reached the Cambodian capital of Phnom Penh. Our team of surgeons, nurses, medical students, and public health educators met for the first time in a tiny hotel. Our nationalities, ethnicities, and languages were diverse, but we shared a unified vision of providing otologic care and training to these people in need.

Only 30 years prior, an act of unspeakable genocide targeted the educated and professionals in this area; an entire generation of physicians, health educators, and nurses were eradicated. Today, a fractured healthcare system with poor infrastructure, limited resources, and inexperienced health professionals exists. Rehabilitative efforts, including a nascent otolaryngology residency-training program at the National Hospital Preah Ang Duong, are underway. However, otologic care in particular is poorly understood and under delivered.

The week began with a dedicated otologic clinic to further evaluate patients initially screened by Cambodian otolaryngologists. Many patients traveled great distances from the surrounding countryside to obtain long awaited care. In total, 120 patients were evaluated using either a teaching microscope or video endoscope. Forty-five surgeries were scheduled subsequently for the remainder of the week.

We saw a diverse spectrum of pathology, and patients including congenital malformations, chronic otorrhea, tympanic membrane perforations, cholesteatoma, and otosclerosis. Accordingly, surgical interventions focused on the management of chronic ear disease, with tympanoplasty and tympanomastoidectomy being the most frequent surgical procedures.

Ian Humphreys, DO, with a post-operative patient.Ian Humphreys, DO, with a post-operative patient.

One goal reigned supreme: to create a dry, safe ear. Given the lack of readily available inhalational anesthesia, the majority of the procedures were performed under local anesthesia and intravenous sedation. All patients were admitted for overnight observation and subsequently discharged home with follow-up care to be provided by the Cambodian otolaryngologists.

Both in the clinic and operating room we had frequent opportunities to teach evaluative and diagnostic strategies, as well as surgical techniques. Despite obvious cultural and language barriers, we focused our collective efforts to achieve our mission. In the end, we provided high quality demonstrative surgery and instruction that serves as a model for continued development of the Cambodian otolaryngology training program.

Not only did we gain an appreciation for the difficulty of providing otologic care in a relatively impoverished part of the world with limited resources and a fractured health system, we also experienced the role of surgeon educator. In the end, our cultural awareness and sense of humanistic professionalism flourished throughout our Cambodian experience.

We are completely indebted to the support provided by the AAO-HNSF Humanitarian Efforts Committee and the Alcon Foundation for this wonderful experience and are confident that it has solidified our commitment to future mission endeavors.

More from December 2012 - Vol. 31 No. 12
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201212_04_olympus
Olympus
201212_02_sinu_science
SinuScience Network
Clementine Paddleford, journalist and cookbook author. Photographs courtesy of Special Collections, Hale Library, Kansas State University.
From Cancer to Cookbooks: The Story of Clementine Paddleford*
Andrew G. Shuman, MD, Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY The story of Clementine Paddleford, a laryngeal cancer survivor, who thereafter became the most famous culinary journalist of her time, would be remarkable in any era. The fact that she accomplished this feat 80 years ago makes it simply extraordinary. Through archival research, the oft-forgotten tale of Clementine Paddleford may be shared with a new generation. An aspiring journalist from Kansas, Paddleford developed hoarseness shortly after arriving in New York in 1931; subsequent workup confirmed laryngeal cancer. Perhaps no individual better encapsulates the potential consequences of head and neck cancer than does a food writer; speech and swallowing are truly indispensable. In an era when vocal rehabilitation after total laryngectomy was severely limited and conservation laryngeal procedures were still being developed, Paddleford and her surgeon at New York Hospital agreed to proceed with partial laryngectomy. Thereafter, she persevered, never accepting that she was disabled. Her permanent metal tracheotomy tube morphed into a fashion statement, and her distinctive dysphonia became her calling card. Paddleford penned a column with a weekly readership measured in the millions, and served as the food editor for a major newspaper in Manhattan during a decades-long tenure. She would pilot an airplane across the country, writing about regional cuisine decades before the topic became popular. Paddleford’s success reminds us that cancer survivorship is not only measured in months or years. Even in modern surgical oncology’s infancy, functional outcomes were carefully considered, and quality of life was prized. As a testament to individual willpower and the ability of doctors and patients to forge partnerships with common goals, Paddleford’s legacy lives on. *Based on Dr Shuman’s presentation at the Otolaryngology Historical Society’s 2012 meeting at the Cosmos Club, Washington, DC, September 10, 2012. For a fuller description, please see the October issue of Otolaryngology–Head and Neck Surgery.
Otolaryngology in Eretz-Israel: 1911-1948 book cover.
Otolaryngology in Eretz-Israel: 1911-1948
Avishay Golz, MD, Rambam, Health Care Campus and Bruce Rappaport Faculty of Medicine The Technion Department of Otolaryngology-Head and Neck Surgery, Haifa, Israel Until 1911, there was no Ear Nose and Throat (ENT) specialist in Eretz-Israel. Moshe Sherman, MD, an ENT specialist, disembarked at the port of Jaffa on August 4, 1911. He acquired his medical education in Odessa and Berlin, graduated from the University of Dorpat (now Tartu), Estonia, and pursued postgraduate studies in otolaryngology in Moscow, Russia. Dr. Sherman was the first otolaryngologist in the country and remained the sole specialist for almost one year. He lived and worked in Jaffa and every six months he went to Jerusalem for two weeks to examine patients and perform small operations. In January 1912, Dr. Sherman, together with five other physicians, laid the foundation for the first doctors’ organization in Israel—the Israel Medical Association of today. Between 1911 and 1948, when the State of Israel was established, more than 100 otolaryngologists arrived in Israel and were dispersed throughout the country. Karl Berenfeld, MD, opened the country’s first ENT department in 1925 at Bikur Holim Hospital in Jerusalem. Dr. Berenfeld studied medicine in Vienna, and practiced otolaryngology, also in Vienna, under the famous professors Markus Hajek, Gustav Alexander, and Heinrich Neumann. Dr. Sherman and Dr. Berenfeld, together with other otolaryngologists, brought modern and advanced European medicine to Israel. Many left their imprint on the development of ENT medicine in the country, laying the foundation of today’s otolaryngologic services, both in clinical and academic spheres. ENT medicine, like the other fields of medicine, evolved following the establishment of the State of Israel in 1948. Many departments were opened and equipped with the best modern instruments and technology.  Department heads are the pupils of our pioneer physicians. The book Otolaryngology in Eretz-Israel: 1911-1948 is dedicated to the memory of these pioneer physicians, to their work and their achievements. They should be remembered and cherished by their successors and all physicians in Israel. The book (in Hebrew) can be purchased through the publisher Itay Bahur: www.bahurbooks.com or contact: itay@bahurbooks.com Otolaryngology Historical Society Many thanks to Professor Golz, who donated a copy of Otolaryngology in Eretz-Israel: 1911-1948 to the AAO-HNS Foundation’s historical collection, managed by the History Factory, Chantilly, VA. For inquiries, email info@historyfactory.com or call 1-703-631-0500.Reminder: If you have not yet renewed your OHS membership this year, email museum@entnet.org or call 1-703-535-3738. Not yet a member? Visit http://www.entnet.org/HealthInformation/otolaryngologyHistoricalSociety.cfm.
CPT Changes for 2013: What ENTs Need to Know
As the medical community has come to expect, part of the annual rulemaking process conducted by the Centers for Medicare and Medicaid Services (CMS) includes the annual issuance of new and modified CPT codes, developed by the American Medical Association’s (AMA) Current Procedural Terminology (CPT) Editorial Panel, for the coming year. In addition, CMS includes new, or updated, values—also known as relative value units (RVUs)—for medical services, which have undergone review by the American Medical Association’s Relative Update Committee (AMA RUC). CMS has the discretion to accept the RUC’s RVU recommendations for physician work, and their recommendations for direct practice expense inputs, or they may exercise their administrative authority and elect to assign a different value, or practice expense inputs, for medical procedures paid for by Medicare. The final value, as determined by CMS, is then publicly released in the final Medicare Physician Fee Schedule (MPFS) rule for the following calendar year. The Academy is an active participant in both the AMA RUC valuation of otolaryngology-head and neck services, and the CMS annual rulemaking processes. As part of those efforts, we want to ensure members are informed and prepared for key changes to CPT codes and valuations related to otolaryngology-head and neck surgery serviced for CY 2013. The following outlines a list of coding changes, including new and revised CPT codes, and codes that were reviewed by the AMA RUC and could have modified Medicare reimbursement values for 2013: New Codes In CY 2013, several new CPT codes will be introduced, including: Two new codes to report pediatric polysomnography for children under the age of six. These services will be reported using new CPT codes 95782 and 95783. Two new codes to report intraoperative neurophysiology monitoring in the operating room. This also includes new introductory language in that section of the CPT book. These services will be reported using new CPT codes 95940 and 95941. Codes Reviewed by the AMA RUC  The AMA RUC reviewed several codes relating to otolaryngology and their RUC-approved values were submitted to CMS for final determination for the CY 2013 final rule. Members should be prepared for modified relative value units for some, or all, of these procedures in CY 2013. It is critical to note that once the final MPFS is issued by CMS, typically on or about November 1 of each year. Academy health policy staff will summarize the final rule and alert members to any critical changes in reimbursement for any of the following medical procedures. Services that were reviewed include: 31231 Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure) 40490 Biopsy of lip 69200 Removal foreign body from external auditory canal; without general anesthesia 69433 Tympanostomy (requiring insertion of ventilating tube), local or topical anesthesia 13132 Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 2.6 cm to 7.5 cm 13151 Repair, complex, eyelids, nose, ears and/or lips; 1.1 cm to 2.5 cm 13152 Repair, complex, eyelids, nose, ears and/or lips; 2.6 cm to 7.5 cm New codes for pediatric polysomnogoraphy 95782 younger than six years, sleep staging with four or more additional parameters of sleep, attended by a technologist 95783 younger than six years, sleep staging with four or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bi-level ventilation, attended by a technologist New add-on codes for intraoperative neurophysiology monitoring +95940 Continuous intraoperative neurophysiology monitoring in the operating room, one on one monitoring requiring personal attendance, each 15 minutes (List separately in addition to code for primary procedure.) +95941 Continuous intraoperative neurophysiology monitoring, from outside the operating room (remote or nearby) or for monitoring of more than one case while in the operating room, per hour (List separately in addition to code for primary procedure.) As noted above, health policy staff will provide members with a detailed summary of CMS approved values for the above services once they are issued in the 2013 final MPFS. Should members have any questions regarding the above information in the meantime, email healthpolicy@entnet.org.
By the Numbers: How the Academy’s Health Policy Team Helps You
As an AAO-HNS member, you receive a multitude of benefits. One of these benefits is a Health Policy team dedicated to advocating on your behalf, representing otolaryngologists nationally and supporting state and local efforts. During the past year, the Academy’s Health Policy department has been busier than ever, expanding its capabilities and advocating for members with regard to both private payer and federal regulatory policies. Here is a snapshot, by the numbers, of how the Academy’s Health Policy department has helped members in 2012. $12,000-$15,000  The return on your $840 dues as calculated by BOG Chairman Michael D. Seidman, MD, in 2011. For “card-carrying” members of the AAO-HNS, your $840 dues had a calculable return on investment of about $12,000 to $15,000 secured by coding changes and other efforts made by your leadership and staff at the AAO-HNS. The Academy continues to advocate on your behalf and your dues help to fund our efforts. For more information on these savings, access the June 2011 Bulletin article at http://bulletin.entnet.org/highlight.aspx?id=3096&p=284. 294 As of October 3, 2012, the number of member questions the Health Policy department has responded to. Every day, members from across the country contact the Health Policy staff with questions, ranging from assistance with private payer denials and appeals to information and resources on how to achieve Meaningful Use in the EHR Incentive Program. Health Policy staff work to help members on many issues by providing up-to-date resources and expert analysis. For questions or more information, contact the Health Policy department at healthpolicy@entnet.org. 105 The average number of coding questions the AAO-HNS Coding Hotline answers each month for members. Members often have complex coding questions and as part of your membership dues, the Academy provides access to members to an AAO-HNS Coding Hotline that can answer your questions. Since January 2012, the coding hotline has answered 945 coding questions from members and their staff (through August 2012). You can reach the Coding Hotline from 9:00 am to 6:00 pm EST, at 1-800-584-7773, to have your coding questions answered within one to two business days. More complex questions and review of operative notes or Evaluation and Management encounters will be answered in three to five business days and not to exceed 10 business days. 9 The number of updated Clinical Indicators the Academy released in 2012. In May, the Academy completed a review of outdated Clinical Indicators and released nine updated documents designed to help members by defining a basis of medical necessity for a range of procedures. Indicators include definitions; procedures and CPT codes; indications, including history, physical examination, and tests; postoperative observations (if applicable); outcome reviews; associated ICD-9 diagnostic codes; and patient information. They can be accessed at http://www.entnet.org/Practice/clinicalIndicators.cfm. 39 The number of CPT for ENT articles available to help members. Academy coding experts have drafted numerous CPT for ENT articles designed to help members with complex coding issues. Article topics include stereotactic computer-assisted navigation, nasal sinus endoscopy, and Modifier-59. CPT for ENT articles can be found at http://www.entnet.org/Practice/cptENT.cfm. 8 The number of Appeal Template letters the Academy has produced to help members with denials. Appeal Template letters are designed by Academy socioeconomic experts and are offered as a resource for members to assist in the appeal process for specific procedures you feel were inappropriately denied. Letters include balloon dilation, septoplasty, and image guidance templates and can be accessed with other private payer advocacy resources at http://www.entnet.org/Practice/pmNews.cfm. 9 The number of private payer policies the Academy has commented on in 2012. Private Payers such as BlueCross BlueShield, WellPoint, and UnitedHealthcare often send drafts of national policies to the Academy for review. With the input of expert Academy clinical committees, the Academy provides comments to these payers on the appropriateness of the policies and their contents. The Academy has been successful in working with payers to ensure their policies allow physicians to make necessary medical decisions to provide the highest quality of treatment for their patients, and to obtain appropriate reimbursement for their care. Notable efforts in 2012 include Academy-led advocacy for increased local coverage for balloon dilation procedures, which have resulted in coverage of balloon dilation-only procedures for roughly 194 million people nationwide. 20 The number of CPT codes the Academy successfully surveyed and presented to the AMA Relative Update Committee (RUC) during 2012. The Academy anticipates the high level of work in this area to continue into 2013. This is in large part due to the change in policy requiring families of codes to be surveyed, rather than individual CPT codes, when a code is identified by CMS as requiring review. Members should expect 2013 surveys to include nasal/sinus endoscopy codes, removal of cerumen, and chemodenervation for spasmodic dysphonia, among others. 6 The Academy submitted six Code Change Proposals (CCPs) in 2012 to the AMA CPT Editorial Panel and commented on two CCPs. This included proposals to clarify and expand on correct coding guidance for the large family of soft tissue codes, removal of cerumen, and dilation of the esophagus, as well as the development of new codes for rigid, transoral, and transnasal esophagoscopy and chemodenervation for spasmodic dysphonia; and the deletion of one complex wound repair code. Find out more about filling out surveys and participating in the CPT process athttp://www.entnet.org/Practice/Applying-for-CPT-codes-and-Obtaining-RVU.cfm. 29 The number of Policy Statements under review by Academy clinical committees. Policy Statements serve the following functions: as a response to payer policies; a way to publicize our position or support a procedure; for use in advocacy efforts with state and federal regulatory bodies, or in response to federal policy or law; or to clarify the Academy’s position on certain practices within the specialty. They are reviewed every three years to ensure the statements are current and useful for members. The Academy’s policy statements can be accessed at http://www.entnet.org/Practice/policystatements.cfm 1 The number of members it takes to influence policies affecting otolaryngologists-head and neck surgeons. The Academy is dedicated to the pursuit of the best interests of otolaryngologists and works tirelessly on behalf of members, but the best advocate for the specialty is you. There is nothing more powerful than the voice of the physician who operates on and cares for patients, so we appreciate your efforts in getting involved in Academy advocacy and health policy efforts, including taking RUC surveys, reviewing private payer coverage policies, and reviewing AAO-HNS Clinical Indicators and Policy Statements to keep them updated. For more information on how you can help, read the weekly News, quarterly HP Updates, or contact the Health Policy staff at HealthPolicy@entnet.org.
cms-incentives-penalties
How to Avoid CMS Quality Initiative Payment Penalties
Next year is a pivotal year in the development of numerous quality initiatives currently underway by the Centers for Medicare and Medicaid Services (CMS). These include the Electronic Prescribing (eRx) Incentive Program, Medicare and Medicaid’s Electronic Health Records (EHR) Incentive Program, and the Physician Quality Reporting System (PQRS). This article is designed to serve as a primer for each of these programs and provide you with the information you need to take advantage of available incentives and avoid payment penalties by becoming compliant. Information on all of these programs can be found on the Academy’s new webpage at www.entnet.org/cmspenalties. Starting next year, CMS will be collecting reporting data from physicians for each of these programs that will be used to calculate payment penalties, which could add up to nearly five percent in payment reductions for non-participating physicians in 2015 (see Table 1). It is essential that members take the necessary steps and begin participating in these programs as soon as possible. Incentive payments are available for physicians who begin participating in PQRS and EHR Meaningful Use to help offset the cost of implementing these systems in practice. Electronic Prescribing (eRx) Incentive Program The eRx Incentive program is designed to facilitate the transition to electronic prescribing software through incentive payments and penalties. E-prescribing can be achieved through stand alone software or through Electronic Health Records that have an e-prescribing capability. 2012 was the first year of the program with both incentive payments and payment adjustments (penalties). 2013 is the last year incentive payments are available for successful e-prescribers. Those who successfully report in 2013 are eligible for a .5 percent bonus for all of their reimbursed Medicare Part B claims. In 2013, physicians must report the eRx measure for at least 25 unique electronic prescribing events in which the measure is reportable by the eligible professional during 2012 in order to be eligible for the .5 percent incentive payment. If a physician fails to report at least 25 prescribing events, or to report the G8553 code via claims for at least 10 unique denominator-eligible eRx events for services provided January 1, 2013, through June 30, 2013, they will be subject to a two percent payment penalty for all Medicare payments in 2014. Physicians who successfully reported in 2011 are exempt from 2013 payment penalties. It is important to note that each year physicians do not meet the criteria for successful electronic prescribing, payment penalties increase. For example, in 2013, physicians will be subject to a 1.5 percent penalty, based on 2012 reporting and in 2014 this increases to a two percent payment penalty, based on 2013 reporting. For more information on the eRx Incentive Program, see the Academy’s information page at http://www.entnet.org/Practice/MedicareERxFactSheet.cfm. Medicare and Medicaid’s Electronic Health Records (EHR) Incentive Program The Electronic Health Records Incentive Program is an initiative from CMS designed to facilitate the use of EHRs in clinical settings. Eligible professionals (EPs), hospitals, and critical access hospitals (CAHs) that demonstrate meaningful use of EHRs are eligible for incentive payments. For EPs, incentive payments can accumulate to up to $44,000 by 2015 if they began to successfully participate in 2012. It is important to note that physicians cannot participate in the eRx Incentive Program and the EHR Medicare Incentive Program simultaneously. The EHR Incentive Program is structured in three stages, with a possible fourth stage starting as early as 2018. In order to successfully demonstrate meaningful use in Stage 1, which began in 2011, EPs must meet 20 objectives out of 25 possible. There are 15 required core objectives while the remaining five objectives may be chosen from the list of 10 menu set objectives. EPs must also report on six total clinical quality measures (CQMs): three required core measures (substituting alternate core measures where necessary) and three additional measures (selected from a set of 38 clinical quality measures). The criteria for meaningful use for Stage 2, which is scheduled to begin in 2014, increases as physicians are required to report higher thresholds and more CQMs. In Stage 2, eligible professionals will have to report all 17 core objectives, which include several consolidated core and menu objectives from Stage 1, and three of six menu objectives. EPs will have two options for reporting CQMs in Stage 2 including reporting nine out of 64 measure choices or successfully reporting Physician Quality Reporting System (PQRS) CQMs through the PQRS EHR reporting option. Just as in the eRx program, there are future penalties for professionals who do not begin participating in the EHR Incentive Program. Beginning in 2015, EPs, hospitals, and CAHs that do not successfully demonstrate meaningful use of EHRs will be subject to a one percent penalty that increases annually up to five percent by 2020. It is important to note that these penalties will be based on reporting submitted two years prior, meaning 2015 payments will be based on 2013 reporting. For more information on the EHR Incentive Program including information on Stage 1 and Stage 2 criteria, see the Academy’s information page at http://www.entnet.org/Practice/ONC.cfm. Physician Quality Reporting System (PQRS) The Physician Quality Reporting System is currently a voluntary reporting program that provides an incentive payment to physicians or groups that report data on quality measures. In 2013, physicians who successfully report data on quality measures are eligible for .5 percent bonus payment on all Medicare claims. Individual eligible professionals may choose to report information on individual physician quality reporting quality measures, or measures groups, to CMS on their Medicare Part B claims, to a qualified Physician Quality Reporting registry, or to CMS via a qualified EHR product, or to a qualified Physician Quality Reporting data submission vendor. Participating physicians are eligible for an additional .5 percent bonus payment for working with a Maintenance of Certification entity and successfully reporting data, participating in, and completing a certified Maintenance of Certification Program practice assessment. The Academy currently offers an online tool called the PQRIwizard to help members collect and report quality measure data for the PQRS program in 2013. The PQRIwizard offers automatic data validation, minimized data entry time, and retrospective or prospective data submission. Information for the PQRIwizard can be found at http://www.entnet.org/Practice/PQRS.cfm. Beginning in 2015, CMS will adopt a payment penalty as part of the PQRS program similar to the eRx and EHR programs. Eligible professionals who do not satisfactorily submit PQRS quality measure data will incur a 1.5 percent payment penalty. This penalty rises to two percent in 2016. To avoid the 2015 payment penalty, an eligible professional must satisfactorily report PQRS quality measure data during the 2013 reporting period (January 1, 2013-December 31, 2013). For more information on PQRS, see the Academy’s information page at: http://www.entnet.org/Practice/cmsPQRIBonus.cfm. There are several reasons for physicians to begin to adopt the technology and initiatives detailed above. There are incentives currently in place for practices and groups like yours to make the transition and adopt new technologies. Physicians are able to participate in several of these programs at the same time, and when combined with other initiatives’ bonuses, there is the potential for increased revenue for practices. Along with these incentives, however, there are potential pitfalls along the way. The Academy encourages members to do their due diligence when investigating which programs and systems are right for their practice. Most importantly however, physicians and groups will begin to see financial penalties for failure to adopt new technologies and initiatives, which could potentially cost their practices up to a 10 percent reduction of all Medicare payments. For any questions or information about these programs, please contact the Health Policy unit at healthpolicy@entnet.org, or visit the Academy’s CMS Quality Initiative webpage at www.entnet.org/cmspenalties.
Academy Works with WellPoint to Revise WellPoint’s Policy on Tonsillectomy for Children
On October 16 the Academy submitted a letter to WellPoint regarding the WellPoint policy on Tonsillectomy in Children that inappropriately incorporated some statements from the AAO-HNS’s Clinical Practice Guideline (CPG). On November 5, a conference call took place with WellPoint physician executives, Academy Research and Health Policy leaders and staff, to further discuss these concerns. The conversation was very collegial and the WellPoint executive leaders attentively listened to comments made by the Academy leaders. The Academy’s comments from the call and the October 16 letter were reviewed by the Medical Policy and Technology Assessment Committee (MPTAC) during their November 7-8 meeting. On November 12, WellPoint revised the policy on Tonsillectomy for Children, incorporating many of the Academy’s comments. This change will affect all of the WellPoint affiliated plans–Anthem BCBS of CT, NH, ME, VA, OH, KY, IN, WI, MO, CO, NV, Anthem Blue Cross (CA), Empire BCBS (NY), BCBS of Georgia, and Unicare. Please see an outline of the changes and a link to the full policy at http://www.entnet.org/content/news-and-updates-private-payers
Systematic Review Training
2013 Cochrane Colloquium, Quebec City, Canada September 19-23, 2013 2013 Cochrane Scholars The AAO-HNS/F leadership and SAGE, publisher of Otolaryngology–Head and Neck Surgery, have identified a need to train otolaryngologists in the conduct and publication of systematic literature reviews. Systematic reviews have a high citation impact, and serve as the foundation for evidence-based practice guidelines, clinical performance measures, and maintenance of specialty certification. Four travel grants of up to $2,500 will be offered for the 2013 Colloquium in Quebec City, Canada, September 19-23, 2013. The Colloquium features a full scientific program and nearly 60 training and discussion workshops related to systematic review. In return for a travel grant to attend the meeting, grant recipients must agree to initiate and submit a systematic review to Otolaryngology–Head and Neck Surgery for publication consideration within 12 months (by September 23, 2014). Attendees will be introduced to the Cochrane Collaboration, the world leader in evidence summaries of healthcare interventions, and will learn state-of-the-art techniques for producing systematic reviews and meta-analyses. The AAO-HNS/F has partnered with the staff and editors of the Cochrane ENT Disorders Group to create this unique educational opportunity.* Apply by January 1, 2013 To learn more about how to apply, visit http://www.entnet.org/EducationAndResearch/Cochrane.cfm. Questions? Contact Caitlin Murray at cmurray@entnet.org or 703-535-3748. *Residents and previous G-I-N or Cochrane Scholar recipients are not eligible to apply
Jenna Kappel, MPH, MA
Imaging Committee Health Policy, Quality, and Education Update
Gavin Setzen, MD, Chair Jenna Kappel, MPH, MA, Director, Health Policy and Staff Liaison, Imaging Committee Imaging Committee: Dual Charge The Academy’s Imaging Committee continues to educate members on CT imaging policy and regulation and will now also assume a more proactive role in ultrasound imaging in the head and neck region as this modality has become an integral part of contemporary management of patients with a variety of head and neck conditions. The Committee serves the members in a dual role: advocating for appropriate government regulations and fair insurance policies related to imaging services, and identifying educational needs and CME activities for CT imaging accreditation in otolaryngology practice. The Clinical Consensus Statement: Appropriate Use of Computed Tomography for Paranasal Sinus Disease was released in November, 2012, and the committee is ready to assist members with any follow-up issues related to health policy matters. With the focus of the December Bulletin on Education, we wanted to take this opportunity to share with members some of the efforts of the Imaging Committee on the behalf of members, including developing a joint survey with the American Rhinologic Society on CT imaging, participating in the American College of Radiology (ACR) workgroups on Appropriateness Criteria to provide the Otolaryngology perspective, and providing members with resources to help meet accreditation, which is a requirement of the Centers for Medicare and Medicaid Services (CMS) to receive reimbursement for providing advanced imaging services to Medicare patients. AAO-HNS/ARS CT Imaging Survey The Academy’s Imaging Committee joined with the American Rhinologic Society (ARS) to develop a questionnaire to jointly survey Academy and ARS members, including residents and fellows in training, regarding practice patterns and other aspects of CT imaging in patients with paranasal sinus disease. The Imaging Committee and the ARS will be able to analyze these data to assess potential areas to improve care provision, safety and quality, as well as address potential issues relating to knowledge gaps and educational opportunities as well. These data, together with the Clinical Consensus Statement on Appropriate Use of Computed Tomographyfor Paranasal Sinus Disease will be helpful to members and possibly payers and policy makers as well. Academy Resources for Continuing Education Credit With the adoption of in-office CT technologies, there continues to be an emphasis on quality and safety.  Standardization through accreditation is an integral part of the quality initiative and is also required for reimbursement by CMS and many third party payers. Formalized standards for medical practices choosing to use in-office CT imaging have been established by the Intersocietal Accreditation Commission. The Academy offers resources that meet both ACCME standards and IAC standards. If you are a member, you can obtain the CME credit necessary to meet IAC requirements, via member benefits by: Attending the Annual Meeting CT-related Miniseminars or Instructional courses. There are nearly 100 courses related to CT imaging, with many courses specific to CT, at the Annual Meeting & OTO Expo. Participation in any/all of these courses can provide credit toward the CME requirement for accreditation. A list of CT-related Miniseminars and Instruction courses that can be used towards your accreditation requirements can be found here.Recordings of these courses are available for purchase through the 2012 AAO-HNSF Annual Meeting & OTO EXPO webpage. However, CME credit is not available for these recordings. Taking Academy U CT-related courses from ANY year. The Academy is currently working to flag all online courses available that are appropriate for this purpose. Check the Imaging Services webpage for future updates. Otolaryngology-Head and Neck Surgery Journal. CT-relevant articles are published each year in the Academy’s monthly journal. Online access to the journal can be found here. While journal CME credit is currently not available, these articles could be of value to your practice. IAC- Recommended CME Resources. As a service to CT professionals looking for CT-related CE/CME, the IAC maintains a list of resources for CE/CME. To access this list of courses click here. Contact Audrey Shively at ashively@entnet.org with any questions regarding education related to CT imaging and the accreditation process. Contact Jenna Kappel with any questions regarding health policy or payment issues related to CT imaging. For specifics on regulatory and socioeconomic advocacy efforts, visit the Academy webpage on Imaging Services. The Committee will continue its policy, advocacy and educational efforts to meet IAC accreditation requirements and assist members in providing optimal imaging care to their patients. If you are interested in joining the Imaging Committee, please contact Gavin Setzen, MD at gavinsetzenmd@albanyentandallergy.com.
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 page, 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.
Physicians Unite to Declare Independence from the SGR Formula
During the AAO-HNSF 2012 Annual Meeting & OTO EXPO, the Academy debuted a petition titled the “Declaration of Independence from the SGR Formula,” calling for the repeal of the flawed Sustainable Growth Rate (SGR) formula. This innovative idea was shared with other national physician groups, and as a result, a collaborative grassroots effort spearheaded by the AAO-HNS emerged. The petition was signed by more than a thousand physicians from all 50 states and included the names of more than 500 AAO-HNS members. In November, the Declaration was delivered to Members of Congress on Capitol Hill for consideration during this year’s lame-duck session. A cover letter accompanied the petition explaining how physicians need stability in the Medicare system for their practices and their patients. To view the final petition, visit www.entnet.org/advocacy.
Save the Date for the 2013 BOG Spring Meeting & OTO Advocacy Summit
Mark your calendar for the 2013 BOG Spring Meeting & OTO Advocacy Summit—May 5-7, 2013—in Alexandria, VA, and Washington, DC. Next year’s BOG Spring Meeting and Summit will provide a great opportunity for attendees to hear from experienced policymakers, participate in committee meetings, receive “insider” briefings, and take advantage of pre-scheduled visits with Members of Congress and/or their staffs on Capitol Hill. There will also be ample networking events and an exclusive ENT PAC fundraiser. Registration for both the BOG Spring Meeting and the OTO Advocacy Summit will open in February 2013. Additional information is available at www.entnet.org/BOG&Summit. Mark your calendar today, and we look forward to seeing you in May!
2012 State Legislative Wrap-Up
In 2012, the AAO–HNS reviewed thousands of bills introduced across the country to determine relevancy to the specialty. Of those bills, the Academy actively tracked nearly 800 state bills, including many held over from the 2011 sessions. More than 50 key bills were identified in 31 states, resulting in the Academy providing strategy, advocacy resources, and coalition engagement to state otolaryngology societies, as needed. Members can view a full listing of these bills through the State Advocacy website, www.entnet.org/Practice/members/stateAdvocacy.cfm, which provides real-time access to active state legislation and relevant information. The following is a brief summary of some of the Academy’s 2012 priority state bills and other highlights from the year. 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. This year, the AAO–HNS advocated to modify and/or defeat several potentially harmful bills that would have inappropriately expanded the scope of practice of non-physician professionals. In West Virginia, the AAO–HNS successfully opposed a bill that would have inappropriately expanded the scope of practice for speech-language pathology and audiology to include medical diagnosis, management, and treatment. Both Colorado and South Dakota passed legislation that essentially expands the scope of practice of speech-language pathologists. The AAO-HNS submitted letters of opposition to both state legislatures and will continue to monitor as the legislation is implemented. A carry-over bill in New York sought to permit non-physician oral and maxillofacial surgeons to perform elective surgeries in the oral and maxillofacial regions if granted hospital privileges. The AAO–HNS worked as part of a coalition to defeat this legislation. The California legislature passed a bill to allow audiologists to become qualified medical examiners to make determinations on workers’ compensation claims, an effort strongly opposed by the AAO–HNS. The governor ultimately vetoed the legislation. Taxes on Medical Procedures Each year, there is a re-emergence of proposals to tax medical procedures, and in light of extensive state budget shortfalls, this year has been no exception. The Stop Medical Taxes Coalition, of which the AAO–HNS is a member, asserts that the taxation of medical procedures is unfair for patients and is a “slippery slope” toward the taxation of other medical services. In California, there were two legislative proposals opposed by the AAO–HNS and the Coalition that would result in a tax on elective cosmetic procedures. Both proposals never progressed beyond committee. The New Jersey legislature passed a proposal supported by the AAO–HNS and the Coalition that was signed into law by the governor in early 2012. The law provides for a gradual repeal of the 6 percent tax currently imposed on cosmetic procedures. The tax will be reduced by 2 percent each year, for three years, ending with a 0 percent tax rate. Hearing Aid Services The coverage, sale, and dispensing of hearing aids is an issue considered by several states in various forms each year, and 2012 was no different. Arizona considered legislation that would have changed the requirements for hearing aid dispensing licensure. The bill, which was successfully opposed by the Academy and the state society, would have removed the current practicum exam and replaced it with a requirement of 160 hours of supervised work that would have included the identification of medical conditions. In New York, the Academy continued its work with the Patient Access to Hearing Aids (PAHA) Coalition on legislation to expand patients’ access to hearing aid services by amending an archaic law prohibiting physician practices from deriving a profit on hearing aid sales. In 2012, the PAHA Coalition attained introduction of both a Senate and Assembly amended bill. Massachusetts considered legislation for the first time to allow otolaryngologists to dispense hearing aids in the state, which is currently prohibited. The legislation did not progress in the 2012 session, but the Academy will continue to work with the state society for the passage of this legislation in 2013. Several states considered bills to require insurers to cover the cost of or expand benefits for hearing aids and/or cochlear implants, including Connecticut, Georgia, Hawaii, Illinois, Kansas, Maine, Massachusetts, Nebraska, New York, Rhode Island, Tennessee, Utah, Vermont, and Wyoming. A number of states also considered bills that would provide a tax credit and/or exemption for hearing aids, including Hawaii, Kansas, Michigan, Missouri, New Jersey, and Oklahoma. 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. In 2012, there were 11 truth-in-advertising bills introduced in the states. Legislation passed in Maryland, Mississippi, and Utah. In Maryland, the legislature passed a bill to require identification tags and advertisements to show the type of certification the practitioner holds subject to approval by the state medical board. The Academy worked with other national specialty organizations and the state medical society to develop and advocate for language that closes loopholes, but applies to all AAO-HNS members’ board certifications. The Washington legislature considered a bill that would have required advertisements by those who identify themselves as “doctors” to list their license, registration, and/or certifications. Tobacco Use and Smoking Cessation The Academy supports legislation and regulations that help reduce the use of tobacco products and exposure to secondhand smoke in order to promote healthy environments and lifestyles for the public. This year, bills were introduced in 15 states that sought to strengthen existing smoking ban laws, including California, Iowa, Kansas, Maine, Maryland, Mississippi, Missouri, New Jersey, Oklahoma, Rhode Island, South Carolina, Virginia, and West Virginia. A number of states considered proposals to mandate insurance coverage and/or benefits for tobacco cessation, including Hawaii, Illinois, Indiana, Massachusetts, New Jersey, New York, and Washington. Alabama, Hawaii, and Illinois proposed legislation to exempt certain establishments from a smoking ban if they paid to become licensed as exempt. Medical Liability Reform In 2012, there were 10 state legislatures that considered various tort reform measures, including those related to affidavits of merit, alternative reforms, caps on non-economic damages, defensive medicine issues, expert witnesses, health courts, or pre-trial screening panels. New Hampshire and New Jersey considered enacting or modifying caps on non-economic damage awards in medical liability cases, while Rhode Island considered proposed legislation on apology inadmissibility. A comprehensive medical liability reform bill was considered in Washington. In Connecticut, the Academy, with the state specialty society and state medical society, successfully opposed legislation that would have weakened the current standards for certificates of merit. In addition, across the nation, there were a number of legal challenges relating to medical liability actions, specifically a number of states that reviewed the constitutionality of caps on damages. In 2013, the Academy will continue to track and advocate on these important issues and others as they may arise. Many of these issues will continue into 2013 and beyond, as states look to adjust to the ever-changing healthcare environment. The Academy will continue to actively engage with specialty societies and state medical societies on these important issues to strengthen our voice in the state legislatures. For more information on state legislative issues or specific measures, contact AAO–HNS State Legislative Affairs at legstate@entnet.org or 1-703-535-3794.
A “Status Quo” Election
What We Know In what turned out to be a not-so-close electoral race, President Barack Obama returns to the White House with an opportunity to solidify the implementation of his cornerstone achievement, the Affordable Care Act (ACA). The first thing this year’s election results made clear was that the ACA is here to stay, and efforts to fully repeal the law are unlikely. However, attempts to fine-tune provisions of the ACA are possible since this year’s electorate also returned a divided Congress. As the Election Day dust continues to settle, the make-up of the 113th Congress has become clearer. In the U.S. House of Representatives, Republicans retained their majority with a total of 233 seats (218 needed), slightly less than their majority in the 112th Congress. As of November 13, 2012, seven House races remained too close to call. Conversely, Democrats in the U.S. Senate succeeded in building upon their existing majority to garner a total of 53 seats. See the accompanying chart for a full U.S. House/Senate Election Day breakdown. What We Don’t Know Everything else. Even though this year’s elections returned the same political paradigm to Washington, DC, it doesn’t necessarily mean overwhelming partisan warfare will continue to reign. While Republicans retained control of the U.S. House, their diminished majority could spur a heightened perspective about what it will take to remain in the majority. In addition, Democrats must be cognizant of the fact that many now view the Democrat-controlled Senate as a place where legislation goes to die. An optimistic view of this year’s election results points toward both parties finally realizing that they can’t effectively legislate from the far right or far left. A negative view dictates another “do-nothing” attitude in which no meaningful legislating occurs. What Happens Now? Members of the 112th Congress returned to Washington, DC, to convene a lame-duck session on November 13, 2012. The legislative activity or inactivity of the lame duck will drive much of the initial agenda for the 113th Congress. Before the end of this year, Congress must address (at least in concept): expiring tax provisions; looming across-the-board spending cuts due to sequestration; a pending debt ceiling increase; and avoiding the 26.5 percent cut in Medicare physician payments slated for January 1, 2013. Conclusion Perhaps the most important thing to remember about the 2012 elections is that the results may be viewed as deceptive. While the electoral vote results returned the President to the White House by a clear margin, there was only a two percentage point difference in the popular vote. Much talk is given to the ideological divide and partisanship that exists on Capitol Hill. However, this year’s election results indicate that the same ideological divide is alive and well within the overall population of the United States. Elected leaders from both parties will be best-served to recognize that no clear power mandate has been deemed by Election Day and movement toward more “give-and-take” legislating will yield the most positive results (and improved approval ratings). The ongoing nature of healthcare reform is a perfect example of a critical issue that requires meaningful input and effort from both parties. As previously stated, the ACA is here to stay, and Congress must now work in earnest to find middle ground to move forward. However, only time will tell. Election Day Breakdown* U.S. House of Representatives U.S. Senate Republicans Republicans 233 Total Seats 45 Total Seats +18 seats, -21 seats = net loss of -3 seats +1 seat, -3 seats = net loss of -2 seats Democrats Democrats 195 Total Seats 53 Total Seats +26 seats, -17 seats = net gain of +9 seats +3 seats, -1 seat = net gain of +2 seats Independents 2 Total Seats
Call for 2013 AAO-HNS Election Candidates
The Nominating Committee of the Academy is calling for recommendations of individuals to be considered for an AAO-HNS elective office. The Academy member(s) you recommend must be in good standing, someone with proven leadership ability, is active in the Academy, is familiar with the strategic direction of the Academy, and can dedicate the necessary time to serve. Please direct your email to any member of the Nominating Committee and include the nominee’s full name, contact information (business and cell phone numbers, email address, etc.) along with a short letter as to why you believe this person to be qualified to serve in an AAO-HNS elected leadership role. Deadline for nominee recommendations is December 9, 2012. For more information and for a list of the members of the Nominating Committee visit http://www.entnet.org/AboutUs/2012Elections.cfm.
Dates to Remember
At AAO-HNS/F December 5 AAO-HNS Road Show at the Nassau Surgical Society, Inc. (Clinic Day) NSSSec1@ad.com December 9 Deadline for AAO-HNS/F nominee.recommendations: http://www.entnet.org/aboutus/2012elections.cfm. December 31 Membership renewals deadline: www.entnet.org/renew. January 1, 2013 Bulletin feature: Oral Head and Neck Cancer Awareness; Summary of Guideline on Guidelines; read it online too at www.entnet.org. January 21, 2013 Annual Meeting & OTO EXPO Call for Papers Deadlines for Scientific Oral & Poster: Jan 21-Feb 18, 2013 at www.entannualmeeting.org. January 30, 2013 Nomination forms for the 2013 Jerome C. Goldstein Public Service Award due. www.entnet.org/community/Goldstein-Award.cfm. February 1, 2013 2013 Committee Application Opens on November 15 and closes  on February 1. www.entnet.org/committees. In Otolaryngology Details at http://www.entnet.org/conferencesandevents. January 13-14, 2013 AACE Advances in Thyroid Cancer Diagnosis and Therapy http://www.entnet.org/calendar/calendardetail.cfm. January 15-18, 2013 10th GCC Otorhinolaryngology HNS Conference January 18-19, 2013 AACE Advances in Thyroid Cancer Diagnosis and Therapy
Top row, L-R: David Darrow, MD, DDS; Babak Givi, MD; Matthew Brigger, MD, MPH; Stephen C. Maturo, MD; Jack Jiang, MD, PhD. Bottom row, L-R: M. Boyd Gillespie, MD; Richard M. Rosenfeld, MD, MPH; Michael Friedman, MD; Helene J. Krouse; PhD. Missing: Edward D. McCoul, MD, MPH; Maureen T. Hannley, PhD
Star Reviewers and the Journal
The Academy journal, Otolaryngology–Head and Neck Surgery, has recognized its star performers since 2006. This award is a pathway to the journal’s editorial board and associate editor positions, bringing recipients greater responsibility and recognizing achievement. The journal welcomes reviewers from all areas of expertise and stages of career, including residents. By reviewing for the journal, you can earn up to 15 Continuing Medical Education (CME) credits per year and improve patient care and public health by providing thoughtful, timely reviews of journal articles. Reviewers who complete four or more reviews a year are listed in the journal’s January issue every year. The criteria for becoming a star reviewer are posted on the journal’s website, http://www.otojournal.org. Many of our star performers, depending on their areas of expertise and interest, go on to be appointed to the journal’s editorial board and may then serve as associate editors. Star Reviewer recipients receive: One honor point A ribbon to wear at the annual meeting identifying them as a top reviewer Numerous mentions in Academy print and digital media, including the Bulletin, the Meeting Daily, and the official program issue of the journal. Otolaryngology–Head and Neck Surgery encourages anyone who has an interest in becoming a reviewer to sign up today. Our website features a page specifically designed for reviewers, with free content including: The journal’s first ever videocast, a discussion among two associate editors and the editor-in-chief, providing tips on what makes a great reviewer Access to the full text of the article “How to Review Journal Manuscripts,” written by the journal’s editor-in-chief and published in the April 2010 issue of the journal Suggestions from 2011 and 2012 top reviewers An example of a highly rated review A reviewer application form, which can be downloaded and emailed or faxed to the journal’s editorial office The 2012 Star Reviewers were recognized at the journal’s editorial board meeting in Washington. DC, and Michael Friedman, MD, received a plaque for being named as a star performer for the fourth year. Matthew T. Brigger, MD, MPH (second year) David H. Darrow, MD, DDS (third year) Michael Friedman, MD (fourth year) M. Boyd Gillespie, MD (second year) Babak Givi, MD (resident) Maureen T. Hannley, PhD Jack J. Jiang, MD, PhD (second year) Helene J. Krouse, PhD (second year) Stephen C. Maturo, MD (second year) Edward D. McCoul, MD, MPH
Call for 2013 Jerome C. Goldstein Public Service Award Nominees
The Jerome C. Goldstein Public Service Award is given annually to recognize an outstanding member for his/her commitment and achievement in service, either to the public or to other organizations, when such service promises to improve patient welfare. Any Academy member in good standing is eligible to be nominated—or to nominate another member—for this prestigious award. The finalist will be selected on February 12, 2013, by the Executive Committee of the Board of Directors. The recipient will receive a certificate and honorarium in recognition of his/her achievements during the 2013 Annual Meeting & OTO EXPO Opening Ceremony in Vancouver, BC, Canada. Deadline for submission of nominee forms is January 30, 2013. Please visit http://www.entnet.org/Community/Goldstein-Award.cfm for more information on the award criteria and nomination form.
A Silent and Imminent Threat
Richard A. Chole, MD, PhD and Michael J. McKenna, MD, Task Force Co-chairs On September 12, 2012, during this year’s AAO-HNSF Annual Meeting & OTO EXPO in Washington, DC, an Otopathology Task Force was convened to address a serious and imminent threat to our specialty. This Task Force was organized because of an initiative by Michael M. Paparella, MD. It was chaired by Richard A. Chole, MD, PhD, and sanctioned by the American Academy of Otolaryngology—Head and Neck Surgery. Present were some of the preeminent leaders in our field. There was no debate regarding the gravity or seriousness of the problem at hand. The specialty of otolaryngology is on the verge of losing its ability to examine the pathology of the human ear. If this were to occur, we would no longer be able to characterize the pathology of a host of problems that we see and treat on a daily basis. It will stifle our ability to develop new and effective treatments and to evaluate the results of our clinical interventions. Without this fundamental discipline, our specialty will justifiably lose all credibility with our medical and surgical colleagues and our patients. To better understand the scope of the problem, it is essential to review how we got here in the first place. The study of human otopathology is unlike all other pathologic endeavors. It requires a specialized laboratory and unique and intricate processing techniques that take years to master. These techniques cannot be learned from a book or instructional video, but rather take years of mentorship and practice. Similarly, the expertise required to examine and evaluate pathologic specimens takes years of dedicated study and is not a component of the formal educational process in either pathology or otolaryngology training programs. Historically, the great majority of otopathologists have been otolaryngologists. In 1980, there were 32 active temporal bone laboratories throughout the world with 25 located in the United States. The field was thriving with a critical mass of investigators. The work performed within these facilities is largely responsible for the pathologic characterization of many of the diseases we treat on a frequent basis, including otosclerosis, Meniere’s disease, chronic otitis media and many others. Today, there are three remaining labs in the world, all located within the United States. Insufficient operating funds threaten two of these labs, which are on the verge of closing.  This abrupt decline resulted from a significant reduction in research funding for human otopathology and departmental discretionary funds used to support these labs. Most alarming is the near extinction of the technical and pathological expertise. Despite this, there remains a multitude of otologic disorders for which the pathology has not been well characterized with poor treatment options for our patients. Several years ago, a group of concerned leaders in the field approached the National Institute on Deafness and Other Communication Disorders (NIDCD) with their concerns. These discussions led to the formation of a human temporal bone registry and a research network, resulting in the acquisition of pathologic specimens and for funding of a limited number of labs. This funding is specifically for hypothesis driven research and does not support the ongoing processing and evaluations of new pathologic specimens that only become available when a patient with a well documented otologic problem dies. It has been this slow and steady process of investigation that has led to the greatest advancements in our understanding of human otopathology and without which our field will almost certainly begin to stagnate. The solution to this impending problem is not entirely clear. It will likely require both financial and institutional support. To this end, Michael Paparella, MD, has personally pledged more than $500,000 during the next 14 years and established an annual lectureship in human otopathology to be given at the AAO-HNSF meeting. Joseph Nadol, Jr., MD, gave the inaugural lecture at this year’s annual meeting where he eloquently highlighted the importance of human otopathology to the clinical practice of otology and reviewed the dilemma outlined above. The purpose of this communication is to educate the AAO-HNS membership. The task force will continue to actively explore all options to circumvent this potential disaster. There will come a time in the near future when we will call upon the AAO-HNS membership for support. This is a problem that will certainly affect the future of our specialty and will require a unified response.
The Board of Governors and You: Sign Up and Speak Up for Your Region
Wendy R. Stern, MD BOG Secretary The Board of Governors (BOG) is the grassroots arm of the Academy. It serves as a conduit for all of us and our Academy through state/local representation. The BOG meets twice a year. Every otolaryngology society in the country elects a governor and two representatives who serve on the BOG. The governor of each society is a voting member on the BOG. During the biannual meetings, the governors and representatives are invited to participate in the BOG Legislative Committee and the BOG Socioeconomic and Grassroots Committee meetings as members or guests. Issues include pending bills, current legislation, scope of practice, carrier relations, and access to care, among others. The BOG Legislative Committee conducts an annual conference call with society representatives, governors, and committee members to help monitor legislative activity around the country. This information aids our Academy’s Government Affairs division to maintain its vigilance and advocacy. This committee keeps our membership informed and invites activism through emailed action alerts. The BOG Socioeconomic and Grassroots Committee is forming a network of regional representation so issues affecting the practice of medicine nationwide will have direct and timely access to the committee. These forums are venues for the critical exchange of information. They present an invaluable opportunity for the BOG to learn about pressing issues facing Academy members, and conversely, for the governors and representatives to relay information to their society members of events happening in other locations that might affect their practice. The spring meeting takes place in the Washington area near the Academy headquarters. This meeting is open to anyone who wants to be more involved with the BOG. There are often workshops, leadership training sessions, and an ENT PAC (political action committee) event. This past spring, attendees participated in workshops on media, entrepreneurship, and the nuts and bolts of meaningful use. This meeting is also an excellent opportunity to network and meet colleagues from around the country. Following the meeting, the BOG promotes advocacy through participation in the OTO Advocacy Summit, which offers political guest speakers, advocacy workshops, and meetings with Members of Congress. The fall meeting, which dovetails with the AAO-HNSF Annual Meeting & OTO EXPO, is more focused on the committees’ agendas. The BOG General Assembly meeting occurs during the annual meeting. Governors are formally given reports by the BOG leadership and committee chairs as well as the opportunity to vote on referendums that will be presented to the Academy’s Board of Directors. The BOG also sponsors a miniseminar that takes place during the annual meeting. This past meeting the BOG Executive Committee was proud to present, “Hot Topics in Otolaryngology: 2012.” This was a successful seminar that delved into the changing relationship between the physician and the hospital. Pressures to produce a more integrated relationship are increasing partially due to healthcare reform laws and in response to Medicare, Medicaid, and Congressionally-directed efforts to reduce healthcare costs and the deficit. Darlene Burgess, vice president of corporate government affairs for the Henry Ford Health System spoke to us about her experience with one of the nation’s leading and largest integrated healthcare systems. Raymund C. King, MD, JD, an otolaryngologist and now healthcare and corporate attorney, described laws such as Stark, anti-kickback compliance, and the Patient Affordable Care Act in an easily understood fashion. He then described how they lead to the changes we are seeing, specifically citing the formation of Accountable Care Organizations. Joy Trimmer, JD, senior director of Government Affairs for the Academy, updated us on the Academy’s advocacy efforts and described the potential political scenarios that may arise from the presidential election and how they might affect many of the reforms that are currently underway. The BOG is committed to producing a miniseminar salient to our members and their ability to practice medicine. We are paying attention to the changing healthcare environment and are looking forward to producing another meaningful miniseminar next year in Vancouver. As the practice of medicine changes, the BOG must hear your grassroots voice. I urge each of you to be an active member of your state/local or special interest otolaryngology society and make sure your society participates in the BOG. If your society is not an active BOG member, step forward and volunteer to make sure that your society’s voice is represented. We need to know what is happening in your offices, your hospitals, your community, and in your state legislative bodies. It is the best way to be proactive and effective. The Academy cannot connect with your BOG representatives unless staff has accurate and up-to-date records of your society officers. To view your individual BOG society’s information, visit: http://www.entnet.org/Community/BOGSocieties.cfm?View=State. Email bog@entnet.org to update your society information or ask any BOG-related questions. See you at our next BOG Spring Meeting, May 5-6, and OTO Advocacy Summit, May 6-7, 2013 (www.entnet.org/bog&summit).
David R. Nielsen, MD, AAO-HNS/F EVP/CEO
Meeting Needs, Exceeding Expectations in Education
Our Academy as we know it is actually two entities: the Academy, responsible for membership, advocacy, and health policy; and the Foundation, which includes the annual meeting, educational programming, and research activities. So when I refer to the Foundation, I am speaking primarily of our meeting, educational, and quality improvement enterprises. In spite of the fact that members rate the Foundation’s educational offerings as one of their most valued benefits, it is paradoxical that survey data and member responses indicate less awareness of our current and expanding education offerings than expected. Our goal for this issue is to improve everyone’s knowledge and use of our expanding education resources and the numerous ways the Foundation works to both meet member education needs and also exceed expectations. In the past, any ACCME-accredited provider of Continuing Medical Education (CME), such as the Foundation, fulfilled a requirement to do a “needs assessment” of our members and their educational desires and demands. In the current environment of assessing and reporting on quality, this has been replaced by a requirement to identify “gaps in care,” using a method to look for ways to demonstrate our educational offerings fill such a gap and the learning that takes place leads to improved care and better patient outcomes. Related research reforms employ Comparative Effectiveness Research (CER) to look for the best care among many acceptable choices, and try to achieve the three aims of the National Quality Strategy: better individual patient care, better population health, and reduced cost of care. The AAO-HNSF is richly blessed with resources for educational content. Our members, whether academic or community-based, supply the profession with invaluable material from their research and professional practices and experience. However, there is a big difference between “content” or educational material and effective educational programming. It has been repeatedly demonstrated and published that simply presenting and learning new facts, basic science, and clinical material does not change clinical behavior for the better, nor lead to improved patient care or clinical outcomes. In the past two decades, new methods of designing educational programming, increasing interactivity between teachers and learners, focusing on the application of knowledge, and holding learners accountable for describing how they will employ what they learn seem to speed the implementation of new ideas and improve patient outcomes. Future accreditation of CME will not only require documentation of how the learner will apply new knowledge, but also eventually require documentation and reporting that the knowledge was actually applied and that measurable improvement in patient outcomes can be demonstrated. Throughout this issue of the Bulletin, you will see reference to a broad agenda of advancing educational initiatives: sharing our programming with developing nations, expanding international access, and use of our content and entirely new products, such as our AcademyQ mobile application, the “Resident Manual of Trauma to the Face, Head, and Neck,” and the ENT Exam Video Series. Shortly, a few dozen lectures from this year’s annual meeting will be added to the growing programming of online courses and lectures, and new comprehensive products to aid our members in their exam preparation will be added to the Home Study Course and Patient Management Perspectives that are already so useful in this regard. As important as all these products are, creating a comprehensive organized structure, shared with all of us, for all our programming is our goal. The integration of research, education, application, documentation, delivery reform, and payment reform with all of their health policy implications is now more obvious than ever. We are fortunate as a specialty to have such a collaborative culture, supportive members, effective specialty societies and leaders to guide us through this rapid transition. The Academy/Foundation will continue to develop and provide superior products for our residents, young physicians, and experienced senior practitioners, as well as the students and allied professionals we work with. I encourage you to become even more familiar with all the Academy offers in education, and to aggressively employ these to benefit our patients. Nowhere is the Academy’s mission to empower physicians to provide the best patient care more visible than through our educational and meeting activities. Thanks to all of you for your contributions to this great enterprise.
James L. Netterville, MD, AAO-HNS/F President
A Cycle of Learning
As the calendar year moves to the end of its rotation, we naturally can see more clearly where we have been during the past 11 months, and we can look ahead to set new goals. This calendar cycle is not unlike the professional cycle that all physicians maintain. We commit to a life of learning that winds through each year (annual meeting to annual meeting) and through our career stages as well. The need to improve our knowledge and competence is as important and compelling as our time diagnosing and treating patients. Neither of these efforts can be overlooked. Each activity needs to be relevant to maximize our effectiveness and the outcomes of our care. Since 2002, the ABO’s Maintenance of Certification requirements have also addressed this cycle, establishing a formal program for a “lifetime of study”1 to retain appropriate specialty certification. The AAO-HNS Foundation has shaped its program to address these educational needs. This December’s Bulletin is the Education Issue, and I am glad to recognize the educational accomplishments of the Foundation and its plans for the coming year. As the 2012 planning cycle began, Education and Meetings set out to push forward our stated 2012 goal: We will enhance the quality of patient care and remain the premier source of otolaryngology education and knowledge. We will deliver resources and educational activities that address gaps in care and improve the knowledge and competence of otolaryngologist-head and neck surgeons, residents, medical students, non-otolaryngologist physicians, allied healthcare professionals, and the public. The specific actions include consolidating and enhancing the otolaryngology practice gap analysis and needs assessment process; developing the next generation of otolaryngology education and knowledge resources through continuous assessment and redesign; providing resources for board certification preparation, business of medicine, trauma, robotic surgery, surgical simulation and resident education; and increasing member awareness and engagement in the generation and usage of education and knowledge resources to improve patient care and outcomes. As a result of these actions, some existing products were modified for relevance to fill gaps in educational content. The scope of offerings for physicians expanded, as have offerings to facilitate learning for physician extenders. Ongoing education products in 2012 include: Four Home Study Course issues Eight Patient Management Perspective issues A variety of online courses for both physicians and physician extenders Eight coding and reimbursement workshops To add to the options available, the AAO-HNSF added these new products in 2012: COCLIA—Questions enhanced with full-color images and a new mobile optimized website. ENT Exam—This online digital video demonstrates a thorough ENT exam. Resident Manual of Trauma to the Face, Head, and Neck—Primarily for residents and healthcare extenders, this new e-book is a concise, and easily accessible, source of diagnostic and therapeutic guidelines. AcademyQ: Otolaryngology Knowledge Assessment Tool—Designed as an exam preparation tool, this mobile app facilitates knowledge self-assessment. 2013 AcademyU® Your Otolaryngology Education Source Looking ahead to 2013, the AAO-HNSF has a new message: The new AcademyU is the single source for all your educational activities. You will see that expressed in this tagline: “AcademyU Your Otolaryngology Education Source.” The refreshed resource better represents the entire “portfolio” of educational opportunities available to members including online, print, and live activities. To make the products easily viewable and accessible to you and staff, a new “Education Opportunities” booklet will be mailed with the January Bulletin. The five different formats of learning will be clearly distinguished: e-books (four titles), subscriptions (HSC and PMP) live (coding workshops and annual meeting), online education (COOL, online lecture series, and courses), and online knowledge resources (AcademyQ, ENT Exam, Video Series, COCLIA). Each will be described in the catalog. And, of course, a complete listing of all online courses available for all stages of the career will be included. So, looking toward 2013 with the AAO-HNSF educational resource, AcademyU, in mind, I can see that the pathways are clear and the roadway is smooth. Make sure to read pages 20-29 and the Education section for additional information on this essential member value. Reference Cornett MP, Bulletin, Vol. 31, 09, p.33.
AcademyU® is Your Source for Otolaryngology Education
Audrey E. Shively, MSHSE, MCHES, CCMEP AAO-HNSF Director, Education Where do you find all the otolaryngology education you need to stay on top of your profession? It’s simple, AcademyU® is the window into all the education opportunities available to you as a member of the American Academy of Otolaryngology—Head and Neck Surgery. By visiting www.entnet.org/AcademyU you will be able to view a complete description of all our education resources, whether they are online courses, e-books, subscription products, live events, or knowledge products. You will be able to subscribe, register, download, or log onto any of these activities easily through this single portal. AcademyU brings you hundreds of education resources covering a variety of topics organized by the eight specialties within otolaryngology-head and neck surgery. Each resource appeals to the Foundation’s primary audience, including physicians and physicians-in-training who specialize in otolaryngology-head and neck surgery. Specific activities also target general practice physicians, allied health professionals, and medical students. This article describes each resource. AcademyQ: Otolaryngology Knowledge Assessment Tool This mobile application provides a series of questions designed to assist the learner in certification/recertification preparation and to understand issues of practical importance to otolaryngologist—head and neck surgeons to improve patient care. To be used for test preparation and knowledge self-assessment, the app presents hundreds of questions in an interactive interface for iPhone, iPad, and iPod touch. Each question includes answer explanations and reference material, so users can learn as they go. Audience: residents and practicing otolaryngologists AAO-HNSF Annual Meeting & OTO EXPOSM Instruction Courses: These one- or two-hour sessions address current diagnostic, therapeutic, and practice management topics, presented by both Academy members and non-members. Miniseminars: These presentations, case studies, and/or interactive discussions provide an in-depth, state-of-the-art look at a specific topic. This forum is reserved for new research in a clinical area. Oral Presentations: Hundreds of scientific papers are selected for presentation of innovative information and findings on original scientific research. Posters: Hundreds of posters are on display each day of the annual meeting. Posters contain innovative information and findings on original scientific research. Audience: otolaryngology residents, practicing otolaryngologists, general practice physicians, allied health professionals, and medical students Coding and Reimbursement Workshops The course sessions are designed to help otolaryngologists and head and neck surgeons to run a better medical practice and ensure they are coding correctly. Audience: otolaryngology residents and practicing otolaryngologists Comprehensive Otolaryngologic Curriculum Learning through Interactive ApproachSM (COCLIASM) COCLIA is a teaching tool to help residents learn otolaryngology-head and neck surgery. This resource provides discussion questions for more than 100  major otolaryngology topics. New in 2012 are questions enhanced with full color images and a new mobile-optimized website. Audience: otolaryngology residents and medical students Clinical Otolaryngology OnlineSM (COOLSM) COOL courses are interactive patient scenarios built using the latest e-learning technology. These patient scenarios are designed to identify common treatment errors and enable the learner to avoid making a clinical mistake, or to teach new methods of treatment to improve patient care. Audience: general practice physicians, allied health professionals, and medical students ENT Exam Video SeriesSM The AAO-HNSF has produced an online digital video series demonstrating a thorough ENT exam. It depicts how to perform a thorough examination of the ear, oral cavity, face, nose, neck, nasopharnyx, and larynx. Images and video of normal anatomy, normal variances, and common abnormalities enhance the learning experience. Audience: otolaryngology residents, general practice physicians, allied health professionals, and medical students ENT ImageViewer This resource provides access to otolaryngology-related images via a simple search. Images have accompanying notes and annotations when available and new images are added when received. Images can be searched alphabetically, by donor, or by MeSH tree taxonomy. Audience: otolaryngology residents, practicing otolaryngologists, general practice physicians, allied health professionals, and medical students Geriatric Care Otolaryngology Online  This e-book includes chapters from leading authors on otolaryngology topics unique to the geriatric patient. Audience: otolaryngology residents, practicing otolaryngologists, general practice physicians, allied health professionals, and medical students Guide to Antimicrobial Therapy in Otolaryngology-Head and Neck Surgery, 13th Edition Now available as an e-book, this monograph helps physicians prescribe the most effective, least expensive antimicrobials for their patients, and provides an overview of antimicrobials by category, microbiology, drug selections, prophylaxis, ototoxicity, adverse interactions, and drugs of choice according to infecting organism, dosages, and cost. Audience: otolaryngology residents, practicing otolaryngologists, general practice physicians, allied health professionals, and medical students Home Study Course (HSC) This subscription product covers all eight clinical subspecialty areas and is administered in four sections per course-year. Each section provides a format for discussion of recent literature in the field. A section contains journal article reprints, a 50-question self-assessment exam developed by the faculty, and a faculty symposium. Subscribers read the journal articles and complete the open-book exam. Audience: otolaryngology residents, practicing otolaryngologists, and medical students My Voice: A Physician’s Personal Experience With Throat Cancer This book captures three years of the author’s life following a diagnosis of throat cancer and tells the story of how Itzhak Brook, MD, faces and deals with medical and surgical treatments andadjusts to life afterward. As a physician with lifelong experience in caring for patients, the author shares his insights and perspective on these events as he undergoes the effects of a severe illness through the eyes of a patient. Audience: otolaryngology residents, practicing otolaryngologists, general practice physicians, allied health professionals, and medical students Online Courses and Online Lecture Series (OLS) These online courses offer an opportunity for participants to learn at their own pace, using rich media elements to enhance the education experience. OLS transforms content from annual meeting instruction courses into brief interactive online activities. Audience: otolaryngology residents, practicing otolaryngologists, general practice physicians, allied health professionals, and medical students Patient Management Perspectives in OtolaryngologySM (PMP) PMP is a subscription periodical that allows participants to manage an individual patient from presentation to discharge and follow-up with an interactive question-and-answer self-assessment component. The patient problem is designed to heighten awareness of the current range of possibilities for diagnosis and management and provides an opportunity to apply knowledge to real world scenarios. Like a real-life clinical problem, the simulation must be solved by a series of inquiries, decisions, and actions. Audience: otolaryngology residents, practicing otolaryngologists, and medical students Pocket Guide to TNM Staging of Head and Neck Cancer and Neck Dissection Classification This physician reference defines anatomic boundaries of lymph node dissections and fundamental principles of standardized terminology. Audience: otolaryngology residents, practicing otolaryngologists, and medical students Primary Care Otolaryngology, 3rd Edition This primer on fundamental topics in general otolaryngology and practical handbook for non-ENT clinicians has 18 chapters, including a new chapter that addresses inhalant allergies. Each chapter reflects current clinical practice guidelines. Audience: general practice physicians, allied health professionals, and medical students Resident Manual of Trauma to the Face, Head, and Neck This simple, concise, and easily accessible source of diagnostic and therapeutic guidelines for the examining/treating resident is an important tool, both educationally and clinically. It should be used as a quick-reference tool in the evaluation of a trauma patient and in the planning of surgical repair and/or reconstruction. Audience: otolaryngology residents and medical students As you can see, AcademyU remains your source for otolaryngology education, with many resources offered as a free member benefit to you. Visit www.entnet.org/academyu today and begin taking advantage of all the education resources at your fingertips.
You Asked and the Academy Answered: Introducing AcademyQ
The Academy recently published a question bank app, AcademyQ: Otolaryngology Knowledge Self Assessment Tool™. The app, available for iPhone, iPad, and iPod touch, contains hundreds of study questions to test your recall, interpretation, and problem solving skills within the practice of otolaryngology – head and neck surgery. The app can be downloaded free from the Apple App Store with 10 questions included. The entire question pack of 390 questions can be purchased for $49.99 at http://bit.ly/AcademyQ. The question pack includes roughly 50 questions from each specialty area within otolaryngology-head and neck surgery: core otolaryngology and practice medicine, facial plastics and reconstructive surgery, general otolaryngology, head and neck surgery, laryngology and bronchoesophagology, otology and neurotology, pediatric otolaryngology, and rhinology and allergy. Each question includes an instant, detailed explanation and at least one reference. Related journal articles link to their abstracts in PubMed. Early feedback indicates the app is meeting an obvious need within the otolaryngology–head and neck surgery community. Some feedback received so far: “This program is excellent. I am reviewing for the written boards and usually like to do practice questions, and there is a lack of available practice question material out there for the writtens.” “The questions are excellent and there are good explanations. I would like to see an expanded question bank with even more questions!” “I think this is a fantastic source for those taking the in-service and written certification exam. Thank you!” Sonya Malekzadeh, MD, coordinator for education, and the AAO-HNSF Education Committee chairs, Karen T. Pitman, MD; Richard W. Waguespack, MD; Brendan C. Stack, Jr., MD; Fred G. Fedok, MD; Dennis H. Kraus, MD; Richard V. Smith, MD; Catherine R. Lintzenich, MD; Bradley W. Kesser, MD; Kenny H. Chan, MD; Sukgi Choi, MD; Brent A. Senior, MD; and James A. Hadley, MD, selected the most pertinent questions from a large bank of questions used in previous education activities such as the Academic Bowl and Home Study Course. The questions were updated and enhanced. The Otolaryngology-Head and Neck Surgery Comprehensive Core Curriculum developed by the American Board of Otolaryngology (ABO) and the ABO Exam Blueprint were used as guides when deciding on the topics to cover within the app. (Both documents are available on the ABO’s website, http://www.aboto.org/publications.htm.) “The questions in AcademyQ comply with the standards of the National Board of Medical Examiners and represent many of the topics on the otolaryngology in-service and MOC exams. AcademyQ provides a great opportunity to practice test taking. More importantly, surgeons can participate in the process of continual self-assessment and review to identify areas where they can improve.” Dr. Malekzadeh said. (TEXT BELOW GOES IN THE COLORED BOX ON THE UPPER RIGHT) AcademyQ Features• Complete answer explanations • Questions in each specialty area • Journal references link to PubMed • Zoom in on images and videos • Record audio or text notes • Search by keyword or topic • Mark questions for future review • Study on the go; no connectivity is needed
New Resident Trauma Manual Is Practical, Concise, and User-Friendly
G. Richard Holt, MD, MSE, MPH, D-BE Chair, Task Force on Resident Trauma Manual The AAO–HNS Trauma Committee, chaired by Col. Joseph Brennan, MD, was formed to emphasize the role of trauma management in the military, academic, and community practice of otolaryngology-head and neck surgery. As with other surgical disciplines, significant advances in facial, head, and neck trauma care have occurred as a result of military conflict, where large numbers of combat-wounded patients require ingenuity, inspiration, and clinical experimentation to devise better ways to repair and reconstruct severe wounds. Recognizing that resident physicians are normally the first responders in major trauma centers to consult on and manage patients with trauma to the face, head, and neck, the committee has developed a comprehensive resource. The Resident Manual of Trauma to the Face, Head, and Neck is a free, downloadable, easily referenced guide to the care of trauma patients directed to the practical and educational needs of the resident physician. The manual is designed to be readily accessible when called to the emergency center, developing a management plan, or performing reconstructive surgical procedures. For many reasons, including poor reimbursement, high medical legal risks, schedule disruptions, and surgical challenges, there has been a perceived reduction in the willingness of otolaryngologist-head and neck surgeons to care for patients who sustain trauma to the face, head, and neck. The committee believes that education in trauma management is important in preparing young otolaryngologists and head and neck surgeons to accept the responsibility for caring for these injured patients—a responsibility that has helped shape the surgical skills and reputation of our specialty since its inception. For this reason too, the Trauma Committee recommends that all resident physicians in otolaryngology-head and neck surgery access the manual at www.entnet.org/trauma. This manual supplements, but does not replace, more comprehensive bodies of literature in the field. Use this manual well and often in the care of your patients.
2013 Pediatric Otolaryngology Continuing Education Webinar Series
2013 Pediatric Otolaryngology Continuing Education Webinar Series The American Academy of Otolaryngology—Head and Neck Surgery Foundation and American Society of Pediatric Otolaryngology are pleased to offer the 2013 Pediatric Otolaryngology Continuing Education Webinar Series. This webinar series is designed to provide relevant, state-of-the art, and evidence-based education content in pediatric otolaryngology for practicing otolaryngologists. Complete registration information can be found at http://aspo-cme.us/. Program January Craig S. Derkay, MD Recurrent Respiratory Papillomatosis: Update 2013 February Gresham Richter, MD Diagnosis and Management of Vascular Malformations March Robert M. Naclerio, MD Update on Allergic Rhinitis A—Burdensome Disease April Sally Shott, MD Down Syndrome: Otolaryngologic Manifestations May Kenny H. Chan, MD Evaluation and Management of Sialorrhea in Children July Margaret A. Kenna, MD, MPH Hearing Tests and Hearing Aids: More Interesting Then Thought August Hassan H. Ramadan, MD, MSc Complications of Acute Rhinosinuistis in Children September Richard M. Rosenfeld, MD, MPH Otitis Media Update October Kathleen Cy Sie, MD Assessment and Management of Velopharyngeal Dysfunction November Marci Lesperance, MD Evaluation of Pediatric Sensorineural Hearing Loss
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New ENT Exam Video Series Released
In August, the AAO-HNSF released its first all digital video demonstrating how to perform a thorough examination of the ear, oral cavity, face, nose, neck, nasopharnyx, and larynx. Images and video of normal anatomy, normal variances, and common abnormalities have been added to enhance the learning experience. The video is available at no cost on YouTube and on the Academy website, http://www.entnet.org/entexam. There was noticeable buzz about the web series at the AcademyU® Learning Station during the AAO-HNSF 2012 Annual Meeting & OTO EXPO. “I often train medical students and general surgery residents and this product is just what I need,” an annual meeting attendee said. “I tried to develop a similar video at my institution, but the costs were just too high.” Mark K. Wax, MD, immediate past coordinator for education, conceived the project. “I had been using an old VHS recording that was clearly out of date,” he said. “When the hospital’s VCR disappeared, I knew I could no longer wait to join the future. I thank Foundation staff for making it happen.” Lee D. Eisenberg, MD, MPH, with help from Jane T. Dillon, MD, enthusiastically took on the project and put in countless hours writing the script and gathering images. Sonya Malekzadeh, MD, coordinator for Education, and Karen T. Pitman, MD, General Otolaryngology Education Committee chair, oversaw the peer review process ensuring the script was thorough and unbiased. Numerous other volunteer experts willingly joined the project by reviewing the script and contributing images and video clips. “The project was a real team effort,” Dr. Malekzadeh said. Dr. Dillon volunteered her office space for the recording, but no one had guessed that a big snowstorm was going to hit on the video day. As the snow piled up outside, Dr. Eisenberg patiently recorded take after take. Special thanks to our “patient,” Rick Ramirez, assistant videographer, who never complained as he was repeatedly examined. The videographer, Stuart Meyer of Social Media Frequency, kept everyone on track and looking great. “Now I know why it takes movies years to be made,” Dr. Eisenberg said. “The process is tedious, but well worth the effort.” The web series is divided into four separate 10-minute episodes: The Ear Exam, The Oral Cavity and Neck Exam, The Face and Nose Exam, and The Nasopharynx and Larynx Exam. Each video begins with a review of anatomy and continues with discussions and illustrations of normal variances and common abnormalities found within this anatomy. Since its release in August and as of November 1, the web series has been viewed more than 6,900 times in 89 different countries. “When I taught medical students the ENT exam, I was always frustrated that they did not have a method to review the content,” Dr. Eisenberg said. “These videos provide that opportunity. More importantly, the videos enhance their Academy experience by bringing them to the AAO-HNS website. The same can be said for all those whom we teach, including residents, PAs, and NPs. The videos are also a great way to introduce otolaryngology-head and neck surgery to the patient. One of our colleagues put the link on his practice website, which is a wonderful idea.”
AcademyBowl
Academic Bowl Winner
Congratulations to Loma Linda University for winning the sixth Annual AAO-HNSF Academic Bowl at the AAO-HNSF 2012 Annual Meeting & OTO EXPO. The Academy is grateful to the additional teams that competed: Eastern Virginia Medical School Henry Ford Hospital Southern Illinois University Special thanks to Mark K. Wax, MD, who moderated the event.
Educational sessions deliver updates to core knowledge, while new learning formats help physicians to implement practice changes.
Education: Meeting the Needs of All Our Learners
Sonya Malekzadeh, MD, Coordinator for Education Each December, the Board of Directors gathers at AAO-HNS headquarters for its annual strategic planning session. During the course of the two-and-a-half day meeting last year, the members reviewed and discussed the Academy’s priorities in order to ensure that our programs benefit our patients and meet our members’ needs in today’s environment. The education and knowledge outcomes from strategic planning were to: Consolidate and enhance the otolaryngology practice gap analysis and needs assessment process. Develop the next generation of otolaryngology education and knowledge resources through continuous assessment and redesign. Provide resources for board certification preparation, business of medicine, trauma, robotic surgery, surgical simulation, and resident education. Increase member awareness and engagement in the generation and usage of education and knowledge resources to improve patient care and outcomes. Practice Gap Analysis and Needs Assessment Extensive research demonstrates that traditional continuing medical education (CME)—based on a didactic model of lectures and reading, followed by testing—has little, if any, lasting influence on the practice patterns of physicians. As a result, the “new CME” emphasizes performance improvement rather than knowledge improvement. Therefore, our educational activities should be designed to change physicians’ competence, (having the ability to apply knowledge, skills, or judgment in practice) physicians’ performance (what a physician actually does in practice), and patient outcomes. Effective design of any education activity requires understanding of the physicians’ real-world practice needs or professional practice gaps. The Accreditation Council for Continuing Medical Education (ACCME) defines a professional practice gap as “the difference between actual and ideal performance and/or patient outcomes.” In other words, a professional practice gap is the difference between what is and what should be. During the next year, we will consolidate and enhance the otolaryngology practice gap analysis and needs assessment process by surveying key stakeholders and the general membership. Education Committee leaders will be asked to participate in a SWOT Analysis regarding current education strategies, education activity participants will be asked to assess the quality of these products, and the general membership will be involved in a comprehensive education survey and focus groups. Furthermore, the depth and scope of the professional practice gaps will be explored through review of current literature and identification of new diagnostic methods, current treatments, and innovative technology. Once professional practice gap data sources are identified, we will also incorporate quality, research, and health policy gap data into education needs assessment and planning. Subsequently, corresponding education activities will be designed and prioritized to bridge the gaps between physician practice needs and desired quality outcomes. Innovative Education and Knowledge Resources The Education Committees have provided leadership and expertise to the development of the next generation of otolaryngology education and knowledge resources through continuous assessment and redesign. This year’s focus has been on new products to support board exam preparation, resident education, and emerging topics including trauma, robotics, and simulation. New this year: The online learning platform has been redesigned to improve access to all online courses and lectures. The ENT Exam Video Series is now available on YouTube. The Comprehensive Otolaryngologic Curriculum, Learning through Interactive Approach (COCLIA), has new web navigation with enhanced discussion questions. The Trauma Committee published a Resident Trauma Manual e-book. A Simulation Fair took place at this year’s annual meeting sponsored by the Simulation Task Force. The Robotic Surgery Curriculum Group is developing a Robotic Surgery Policy Statement. Upgrades are being made to the Foundation’s education tracking system to enhance evaluation and participation data and to ensure continued accreditation compliance. Now that the ABO is in its third year of recertification, our membership has voiced concerns on the lack of exam preparation materials. With the Board’s approval, we began the process of rapidly expanding our resources to support Maintenance of Certification (MOC). AcademyQ: Otolaryngology Knowledge Assessment Tool™ debuted as a mobile application during the annual meeting. It presents hundreds of questions with answer explanations and reference material. Maintenance Manual for Lifelong Learning (MMLL), a comprehensive overview of core otolaryngology education content, is undergoing revision with an expected publication date of late 2013. Clinical Fundamental Instruction Courses were introduced to fulfill the ABO MOC requirements. Sessions on Anaphylaxis and Evidence-based medicine took place and were recorded for viewing and the remaining eight topics will take place and be recorded in 2013. MOC candidates will need to attend or view these sessions and pass a post-test. Increased Member Awareness and Engagement In an effort to ensure members are aware of the education opportunities available through the Foundation, emphasis has been placed on improving the quantity and quality of education and annual meeting communications. These initiatives include: Improvements to the annual meeting website with targeted annual meeting news launched for registrants. Monthly Bulletin presence for education products and resources with a full-issue education focus in December and Education Opportunities insert annually. Resources and new e-books continually added to online bookshelf. Enhanced AcademyU® Learning Station at the annual meeting. With these strategic goals in mind, we strive to remain the premier source of otolaryngology education and knowledge. In applying a systematic process that includes practice gap analysis, followed by development of innovative activities and ultimately meaningful evaluation of performance and patient outcomes, we will effectively link education with quality initiatives. Our team of dedicated leaders, volunteers, and staff are committed to achieving these goals for the ongoing strength and relevance of the organization. Stay tuned for new strategies and efforts in 2013 that support our continued commitment to excellence.
Committee
2012 Committee Highlights
Committees are the lifeblood of the AAO-HNS/F and a great way for members to contribute meaningfully to the organization and the specialty. At the 2012 Annual Meeting & OTO EXPOSM in Washington, DC, Academy and Foundation committees met and discussed achievements during the past year and planned for 2013. On the following pages are brief summaries of actions taken by the committees. The October 2012 Bulletin included listings of all committee members and an article on how to join a committee. The deadline for applications for the 2013 committee appointment process is February 1, 2013. Standing Committees Audit Committee Kenneth W. Altman, MD, PhD, Chair The committee reviewed the audit timeline for audit of the financial statements for the year ended June 30, 2012 (FY12). The timing of the audit is on schedule for completion in mid-October. The audit partner for the AAO-HNS/F independent audit, made a presentation about internal control systems and the audit committee’s role therein. The committee will meet to review the audit with staff and the independent auditors in early November, 2012. Ethics Committee Lauren S. Zaretsky, MD, Chair Transitioned from an Academy committee to a standing committee of both the Academy and Foundation. Began the implementation of the AAO-HNS/F Code for Interactions with Companies. Submitted three miniseminars for the AAO-HNSF 2012 Annual Meeting & OTO EXPOSM. Performed an extensive review of the current “AAO-HNS/F Operational Handbook.” Finance & Investment Subcommittee of the EC (FISC) John W. House, MD, Secretary Gavin Setzen, MD, Secretary-elect The subcommittee heard proposals from investment advisors under consideration for management of the AAO-HNS/F’s investment portfolios and made a recommendation to the Executive Committee. The FISC’s recommendation to engage The Sardana Group as AAO-HNS/F’s professional investment advisory firm was subsequently accepted. The FISC had earlier received and reviewed the Treasurer’s Report for the fiscal year ended June 30, 2012 (FY12), which showed a positive variance between actual FY12 results as compared to the FY12 budget. In November FISC reviewed the report of the Audit Committee on the FY12 audit completed in mid-October. Science and Educational Committee Sonya Malekzadeh, MD, Chair The Science & Educational Committee met in September, December, and May, regularly sharing information on initiatives and activities within the Foundation’s key strategic areas of education, scientific program, instruction courses, and international outreach. The coordinators and senior staff responsible for these areas identified opportunities for further integration to mutually support the Foundation’s advancement across the entire spectrum of scientific and educational support for members. Academy Committees Airway and Swallowing (A&S) Committee Milan R. Amin, MD, Chair A representative of the A&S Committee (Stacy L. Halum, MD) attended the ITQIC meeting in Scotland, which focused on Tracheotomy Care. A&S Committee members Robert J. Stachler, MD, Albert L. Merati, MD, and Milan R. Amin, MD, are producing a manuscript based on a miniseminar that was sponsored by the committee last year regarding treatment of Zenker’s Diverticulum. The A&S Committee has ongoing database projects focused on tracheotomy and TNE that continue to collect and provide data for analysis. Allergy, Asthma, and Immunology Committee Karen H. Calhoun, MD, Chair Presented five instruction courses at the AAO-HNSF 2012 Annual Meeting & OTO EXPOSM: Eosinophilic Gastrointestinal Disorders for the ENT Skin Testing for Inhalant and Food Allergies Sublingual Immunotherapy: Why and How? Pediatric Allergy Update 2012 Unified Airway Disease: Fact or Myth? The Current Evidence Presented one miniseminar at the AAO-HNSF 2012 Annual Meeting & OTO EXPOSM: Food Allergy 2012: State of the Science Certificate Program for Otolaryngology Personnel Committee Peter A. Weisskopf, MD, Chair In June, the workshop portion of the CPOP program took place in Detroit, MI. Twenty-one individuals participated in this two-day hands-on training. Credentials and Membership Committee Pierre Lavertu, MD, Chair At this year’s meeting, the committee discussed working closely with Academy staff with the creation and implementation of new alternatives for increasing Academy membership and reinstating non-members and help in our overall efforts to ensure we do not lose members who transition out of residency. Complementary/Integrative Medicine Committee Edmund A. Pribitkin, MD, Chair At the 2012 Annual Meeting & OTO EXPOSM in Washington, DC, the committee worked on its plans for 2013 including: The committee planned for its 2013 miniseminars including the topics of atypical facial pain, headaches, and migraines, It will do a Bulletin article on “How to Initiate a Discussion about CIM with Patients.” It also discussed its current instruction course content with the intention of adding the topic of Comparison of Levels of Evidence into the “Common Ailments” topic. CPT & Relative Value Committee Jane T. Dillon, MD, Chair At the annual meeting in Washington, DC, the committee agreed to several goals for 2013 including: A multi-pronged approach to educating members and subspecialties about the importance, and process of, RUC surveys; working with ARS and other key subspecialties to survey the nasal/sinus endoscopy codes; Drafting a letter to the Centers for Medicare and Medicaid Services (CMS) urging them to assign a HCPCS J code to the new Propel, drug eluting stent; and Working with Zupko and Associates to draft a Bulletin article clarifying how to use unlisted codes to properly code for endoscopic skull-based procedures. A presentation was also made by a member of the Sleep Committee, Eric Kezirian, MD, to request consideration for a new sleep endoscopy CPT code. The committee declined the initial request, but agreed to re-review the proposal once further details on pre, intra, and post time for the new code were provided. Diversity Committee Duane J. Taylor, MD, Chair Began the process of selecting candidates for the endowment distribution. Program directors at universities are receptive to working with the committee to promote avenues for diverse residents to conduct rotations. The Diversity Committee members pledged to make some sort of donation to the Harry Barnes endowment to show 100 percent committee member support. Joseph S. Schwartz, MD, (3rd year resident in Canada) presented a report on the breakdown of U.S. otolaryngologists by racial background. Endocrine Surgery Committee Lisa A. Orloff, MD, Chair The committee, named a Model Committee for the second time, has provided volunteer faculty for another sold-out Ultrasound Workshop on the Saturday before the annual meeting. Committee members worked on the Voice Outcomes guidelines (soon to be published), and reviewed several American Thyroid Association (ATA) guidelines. The Bulletin carried articles by Drs. Orloff and Gregory W. Randolph, MD, about the ATA and Thyroid Cancer awareness. Several committee members have been on thyroid humanitarian missions led by Merry E. Sebelik, MD. Equilibrium Committee Allan M. Rubin, MD, Chair The committee reviewed and provided keywords for several webpages as part of the website content relevancy project. The committee provided input on several private payer issues including the use of intratympanic steroids and transtympanic micropressure as treatment options for Meniere’s disease. The AAO-HNS policy statement on micropressure therapy was reviewed and updated by the committee. Geriatric Otolaryngology Committee David E. Eibling, MD, Chair The committee supported the idea of researching other organizations’ documents and criteria for a policy on “the practicing of otolaryngology by the aging otolaryngologist.” It also discussed a possible miniseminar with the Sleep Committee on geriatric sleep issues. It would like to make available the Geriatric educational resources document developed by Kelly M. Malloy, MD, and Sarah H. Kagan, RN, PhD. Head and Neck Surgery & Oncology Committee Daniel G. Deschler, MD, Chair The question that came up on the 2011 HNS Steering committee meeting last year was posed again here: “Is there a way to collaborate with other committees on the selection of miniseminar topics to prevent overlap and increase the chances of acceptance for presentation?” Miniseminar topic discussion included head and neck cancer in the HPV era and skin cancer management 2013. Hearing Committee Robert K. Jackler, MD Developed a minimal reporting standard for hearing results in clinical research. Provided feedback to the Aetna request regarding the “Intratympanic Administration of Corticosteroids for Meniere’s Disease.” Imaging Committee Gavin Setzen, MD, Chair This year, the Imaging Committee worked with the American Rhinologic Society (ARS) to develop a questionnaire to jointly survey members and residents, so that the committee will be able to analyze data to provide members and payers with data on imaging services. The survey was distributed to members in October 2012. Academy members were served by the committee through continued advocacy efforts against decreased payment and prior authorization for in-office imaging services throughout the year. The Academy assisted members with advocacy efforts resulting in overturning a restrictive policy on imaging series by Highmark West Virginia. Other major health policy activities included: providing members with information on the Centers for Medicare and Medicaid Services’ (CMS) release of Comparative Billing Reports on Imaging Utilization. Reviewed and provided input on the American College of Radiology (ACR) Appropriateness Criteria. Clarified the role of education and provided members with options for CMEs to meet accreditation. Updates to CME available offerings by the Foundation were made to the Imaging Accreditation webpage. Implantable Hearing Devices Committee Jeffery J. Kuhn, MD, Chair Successful transition from a subcommittee to a committee following AAO-HNS Board of Directors approval in December 2011. Review of BCBSA Medical Policy on Cochlear Implants and Auditory Brainstem Implants (WellPoint/Anthem). United Healthcare policy review on Implantable/non-implantable Hearing Devices and Bone Anchored Hearing Aids. Infectious Disease Committee Farrel J. Buchinsky, MD, MBChB, Chair The Infectious Disease Committee presented “Local Anti-Infectives and Anti-Inflammatory Therapy,” a miniseminar moderated by Alan Shikani, MD, at the AAO-HNSF 2012 Annual Meeting & OTO EXPOSM in Washington, DC. The committee assisted the review of a 2005 Bulletin article, “Cleaning Equipment in Today’s ENT Office.” An updated article on instrument reprocessing, developed by the Patient Safety and Quality Improvement (PSQI) committee, was published in the September Bulletin. The committee provided feedback on a set of priority issues developed by the Association for the Advancement of Medical Instrumentation (AAMI) and Food and Durg Administration (FDA)summit on the reprocessing of reusable medical devices. Media and Public Relations Committee Wendy B. Stern, MD, Chair The Media and Public Relations Committee conducted a media training session for print and television reporters at the BOG Meeting, May 5-7, 2012, Washington, DC. The session covered several topics, including utilizing social media for your practice, pitching stories to print and television reporters, and using Academy media resources on the website. The committee continued to provide existing support of Academy PR Mini-campaigns for 2012 and Academy Health Observances: World Voice Day, Back to School ENT Health, Better Hearing and Speech Month, and Choking Hazards Campaign. Committee members reviewed and revised the content of AAO-HNSF literature and fact sheets for the Website Content Relevancy Project. Medical Devices and Drugs Committee Anand K. Devaiah, MD, Chair The Medical Devices and Drugs Committee (MDDC) reviewed multiple private payer policies at the request of the 3P Workgroup. The MDDC gave input on a policy from United Healthcare focusing on Transtympanic Micropressure Treatment for Meniere’s Disease. In addition, the MDDC has provided input for Wellpoint’s Policy on the use of the Propel device to maintain sinus ostial patency following functional endoscopic sinus surgery. Two miniseminars at the annual meeting in Washington, DC, were sponsored or co-sponsored by the MDDC: “Take It to Trial: Tips for Designing Your Research Study” and “Cochlear Implant Failures: Experiences and Recommendations.” Medical Informatics Committee Edward B. Ermini, MD, Chair Dr. Ermini, Medical Informatics Committee Chair, was instrumental in providing the Health Policy business unit with comments on the quality measures included in the Meaningful Use EHR incentive program. Microvascular Committee Douglas B. Chepeha, MD The Microvascular Committee is actively engaged in a national retrospective review of reconstructive techniques after surgical salvage of patients who have failed chemoradiation treatment. At present 42 institutions have indicated interest and 14 have submitted data on 257 patients. The goal of this effort is to understand how different approaches to reconstruction affect fistula rates. The information is designed to guide future reconstructive approaches and help develop evidence for how surgeons should approach high risk reconstructive cases. This work has been supported in part by a grant from the AAO-HNS. An application for presentation of this data will be made in the form of a miniseminar in time for the next meeting in Vancouver. A miniseminar was presented on “The Difficult Wound,” and was well attended with substantial audience participation. The committee has also taken on a bold effort to address redesign of the approach to the access to educational materials. Patient Safety and Quality Improvement Committee David W. Roberson, MD, Co-chair Rahul K. Shah, MD, Co-chair The PSQI Committee reached out to SSAC and other relevant clinical committees for ideas for the Choosing Wisely™ campaign. Dr. Roberson represented AAO-HNSF members at a National Summit on Overuse conducted by the Joint Commission and the American Medical Association (AMA) Physician Consortium for Performance Improvement® (PCPI). Tympanostomy Tubes for Middle Ear Effusion of Brief Duration is one of the five advisory panels formed. The PSQI miniprogram sessions included Preliminary Survey Data on Adverse Events in Facial Cosmetic Surgery; Avoiding Injuries in Sinus Surgery; Leadership View of PSQI; and Tonsillectomy Disasters. Planning for the 2013 PSQI miniprogram is underway. A patient safety web link will be launched at www.entnet.org in early 2013 to capture de-identified safety event information. Several committee members wrote an article on instrument reprocessing that was published in the Academy’s September 2012 Bulletin. Data collection continued for the study on post-admission criteria for Obstructive Sleep Apnea and the study of patient hand-offs by residents. Ideas for this year’s work plan for both database studies and survey topics included sustainability, costs, and burdens of public reporting; sterilization of office equipment; allergy; surgical competency; injuries associated with robotic surgery for treatment on peripheral nerve injury; and indication for PET scan where it may not be indicated in cancer. Pediatric Otolaryngology Committee David E. Tunkel, MD, Chair Miniseminars by the Pediatric Otolaryngology Committee included “Innovations in Pediatric Otolaryngology­­­—Video Presentations,” “Pediatric Lumps, Bumps, Cysts, and Pits: Current Concepts,” and “Management Algorithms for the Noisy Infant.” “Tympanostomy Tubes in Children” was submitted to the Guideline Development Task Force as a potential clinical practice guideline last year, and is now nearing completion by the committee assembled by GDTF. Committee members reviewed clinical practice guidelines on acute otitis media, acute pediatric sinusitis, and obstructive sleep apnea for the American Academy of Pediatrics. Physician Resources Committee David W. Kennedy, MD, Chair Continued with its focus on education and tools needed to prepare for workforce shortages and workforce changes. The committee preliminarily estimates that there will be a significant workforce shortage within the specialty. The committee discussed the importance of another formal workforce study to address issues such as surgeons’ readiness for practice, geographic trends associated with state malpractice legislation, and diversity. A formal workforce study developed with methodology expertise will define the ideology and characterization of the imminent shortfall and provide data to allow for members to have a more proactive understanding, through the Academy, of issues and trends, changing practice patterns, and specialty growth opportunities. Such data would provide the Academy with a major opportunity in terms of specialty planning and recommended changes to current training, particularly for residents and fellows. In the next year, the committee will work on reviewing baseline data of practicing otolaryngologists and using this information to move forward with a consensus document on the impending otolaryngologist shortages. Plastic and Reconstructive Surgery Committee Donna J. Millay, MD, Chair The Plastics and Reconstructive Surgery Committee has continued to be involved in Private Payer Coverage Policy reviews. To facilitate this process we will have a network set up within the committee to have members available for rapid reviews. The committee will also send in a proposal for a miniseminar involving coding in facial plastics. Rhinology and Paranasal Sinus Committee Scott P. Stringer, MD Review of three private payer policies at the request of the 3P Workgroup that included Wellpoint Chronic Headache, UHC Rhinoplasty, Septoplasty, and Repair of Vestibular Stenosis, and Wellpoint Sinus Ostial Patency. The committee also submitted three miniseminar abstracts for the 2012 annual meeting, one of which (Evidence-Based Post-Op Management of Chronic Rhinosinusitis) was approved. Its 2013 goals include the resubmission of all miniseminar topics not accepted for the 2012 meeting including: a co-sponsored session with infectious diseases on topical treatments; a co-sponsored session with infectious diseases on issues surrounding office based surgery (i.e., training, infection, safety). Sleep Disorders Committee Pell Ann Wardrop, MD Edward M. Weaver, MD, MPH represented the Academy at the Washington State Health Technology Assessment  for “Diagnosis and Treatment of Obstructive Sleep Apnea.” It offered an oral presentation “Safety of Outpatient Surgery for Obstructive Sleep Apnea” during the annual meeting. The committee completed Sleep Medicine: Basic and Translational mini-program, orals, posters, miniseminars, and instruction courses for the annual meeting. Trauma Committee Joseph A. Brennan, MD, COL, USAF, Chair With the first year under our belt, the Trauma Committee has a number of accomplishments. First, dedicated committee members, with the assistance of G. Richard Holt, MD, MSE, MPH-BE, and AAO-HNSF Director of Education Audrey Shively, created a comprehensive online handbook called, “Resident Manual of Trauma to the Face, Head, and Neck.” Many committee members served as instruction courses presenters as well presenting the miniseminar “Trauma Update 2012: Answers to your AAO-HNS Survey.” A May Bulletin article entitled, “Disaster and Mass Casualty Response for Physicians” was written by Anna M. Pou, MD, and Mark E. Boston, MD. The Trauma Committee is eager to submit a plan for approval for a Saturday workshop prior to the 2013 AAO-HNSF Annual Meeting & OTO EXPOSM. Voice Committee Clark A. Rosen, MD, Chair It was agreed that the committee should work to develop a paper on pre-op laryngoscopy, especially when there has been a history of thyroidectomy or other procedure involving the laryngeal nerve to be useful outside the specialty and for primary care. The committee responded to the request to review and integrate its Policy Statement on Voice Therapy in the Treatment of Dysphonia, its Hoarseness Guideline, and its consensus statement on the Use of Voice Therapy in the Treatment of Dysphonia. The American Thyroid Association requested Academy member review of its draft thyroid guideline and the committee responded to that request. Young Physicians Committee Monica Tadros, MD, Chair The committee co-sponsored two miniseminars at the 2012 annual meeting, “Finding Balance in a Surgical Career” and “Interviewing: What to Ask and How.” The committee plans to submit several miniseminars again for the 2013 annual meeting in Vancouver, BC. During the 2012 meeting, the committee developed several task forces and will survey all young physicians in the specialty who are active members to identify their needs and determine the best way the YPC can fulfill its mission aligned with the Academy’s guiding principles and strategic plan. The committee is also interested in working closely with Sonya Malekzadeh, MD, coordinator of education on product development for offering a pathway to leadership for young physicians who are transitioning into practice. Foundation Committees Development Committee Nikhil J. Bhatt, MD, Chair The Development Committee conducted its first meeting during the annual meeting focusing the discussion on how to best meet its committee charge to lead fundraising efforts in support of achieving AAO-HNSF mission, goals, and programs. Proposed holding a financial planning miniseminar at the 2013 annual meeting to include information that assists members in considering non-cash options of major gift level charitable donations. To increase the engagement of young physicians and residents with the Academy, the committee will pursue securing four travel grants (two young physicians and two residents) to attend the 2013 annual meeting. Award selection will be based on submission of a 300-word essay describing why the member deserves the travel grant and how he or she plans to give back to the Academy. The next meeting of the committee was planned for mid-November. Humanitarian Efforts Committee Merry E. Sebelik, MD, Chair Congratulations to the Humanitarian Efforts Committee immediate past chair James E. Saunders, MD, for being selected as the next AAO-HNSF International Coordinator. The Humanitarian Efforts Committee expressed its sincere thanks to Dr. Saunders for his strong leadership during the past six years as chair. The committee decided to sunset  the Research/Best Practices work group and to combine the Resident Travel Grants Panel with the  Residency Advocacy work group.  This year the committee will work  on putting together better guidelines for each work group. The current  work groups are: Resident Travel Grants Panel/Residency Advocacy; Gold Foundation; Emergency/ Disaster Relief/Telemedicine;  Head/Neck and Thyroid; Otology; Pediatric; Plastic Reconstructive  Surgery (PRS); and Senior Corps/Retirees. Awarded 25 residents and fellows-in-training with Humanitarian Travel Grants in 2012 to offer services in 16 less-developed countries. The Humanitarian Efforts Member Engagement Portal is up and running to help facilitate matching critical needs with medical specialty expertise. History and Archives Committee Lawrence R. Lustig, MD, Chair The Otolaryngology Historical Society’s program at the Cosmos Club was well received and Andrew G. Shuman, MD, Eduardo C. Corrales, MD, and Robert K. Jackler, MD, will write their topics for the Bulletin. Two groups visited the History Factory, the professional archivists where the Academy collection is housed. International Otolaryngology Committee Nikhil J. Bhatt, MD, Chair Dr. Bhatt announced plans to expand the number of International Visiting Scholars, and invited national societies to publicize the call for applications. Five international travel grantees attended the annual meeting and the 2013 application forms will be distributed to U.S. and Canadian department chairs. Dr. Bhatt urged the committee to actively recruit new international members. International Steering Committee Gregory W. Randolph, MD, Chair Dr. Randolph has submitted an Academy panel for the IFOS World Congress, Seoul, Korea, June 2013, and KJ Lee, MD, plans a post-Congress tour of the Far East. Seven International Visiting Scholars from India, Africa, Latin America, and Southeast Asia attended the annual meeting followed by observerships. The committee will work closely with Dr. Netterville to welcome 2013 honored countries: Canada, Kenya, Nigeria, and Thailand. Outcomes Research, and EBM Subcommittee Scott E. Brietzke, MD, Chair Chair, Scott E. Brietzke, MD, MPH, wrote an article in the July issue of the Bulletin titled, “Evidence Gaps: Prioritizing Our Research ‘To Do’ List” emphasizing the importance of prioritizing and addressing gaps in research, which is the primary focus of this committee’s efforts. Melissa A. Pynnonen, MD, and Seth M. Cohen, MD, each completed a systematic review with the assistance of several other committee members. One review has already been accepted in Otolaryngology–Head and Neck Surgery. Lisa Ishii, MD, and Stephanie Misono, MD, were awarded travel grants to attend the 2012 Cochrane Colloquium in Auckland, New Zealand, where they were to attend workshops and seminars for developing high quality systematic reviews. A survey-based study, led by Eric J. Kezirian, MD, MPH, that considers factors that may be relevant to the surgical treatment of obstructive sleep apnea, with a specific focus on procedures that treat hypopharyngeal or retrolingual obstruction was published in Otolaryngology-Head and Neck Surgery. A committee endorsed miniseminar titled, “Rapid Review: Guidelines in Pediatric Otolaryngology” was accepted for presentation at the 2012 AAO-HNS Annual Meeting & OTO EXPOSM. Panamerican Committee Juan Manuel Garcia, MD, Chair The 2012 Antonio de la Cruz, MD, scholar was Gustavo Bravo, MD, of Chile, and Jaime Fandino, MD, was the “goodwill ambassador” invited by J. Pablo Stolovitzky, MD, Latin American Regional Advisor to speak at the Global Health 2012 Symposium. The Salvadoran Society of ORL-HNS is affiliated as an International Corresponding Society and the Bolivian Society has requested affiliation. Education Committees Education Steering Committee Sonya Malekzadeh, MD, Chair, Coordinator for Education The Education Steering Committee provided leadership to several new initiatives in 2012 including an update to the COCLIASM resident discussion portal, keyword indexing of all education activities as part of the Website Content Relevancy Project, and a relaunch of the AcademyU® platform. In addition, new education products released in 2012 include AcademyQ™, the knowledge assessment mobile app for iPhone and iPad, the ENT Exam Video Series, available on YouTube, and the “Resident Manual of Trauma to the Face, Head, and Neck.” Work continues on the “Maintenance Manual for Lifelong Learning” (MMLL) update with the new e-publication expected in fall 2013. Core Otolaryngology and Practice Management Education Committee Richard R. Waguespack, MD, Chair The committee continues to provide policy and content oversight to the Coding and Reimbursement workshops conducted regionally each year. Its members serve as experts in ever-changing coding and practice management issues. In addition, the committee produced a Home Study Course on “Clinical Competency Issues.” Brendan C. Stack Jr., MD, has taken over as committee chair through 2014. Facial Plastic and Reconstructive Surgery Education Committee Fred G. Fedok, MD, Chair The committee produced a Home Study Course on “Plastic and Reconstructive Problems” and two PMP courses on “Adult with Tired Eyes” and “Adult with Saddle Nose Deformity.” The committee welcomes J. Randall Jordan, MD, as the chair-elect for 2013. General Otolaryngology Education Committee Karen T. Pitman, MD, Chair The committee provided leadership to the second successful ENT for the PA-C conference conducted in conjunction with AAPA and SPAO. They also produced a Home Study Course on “Trauma and Critical Care Medicine” and an online course, “Grave’s Disease.” In addition, this committee served as reviewers for the ENT Exam Video Series. GOEC was designated as a Model Committee for 2012. Head and Neck Surgery Education Committee Dennis H. Kraus, MD, Chair The committee is currently developing three PMP courses on “Adult with Facial Pain,” “Adult with Cystic Neck Mass,” and “Nasal Reconstruction.” Richard V. Smith, MD, assumes the role of chair for this committee through 2014. HNSEC was designated as a Model Committee for 2012. Laryngology and Bronchoesophagology Education Committee Catherine R. Lintzenich, MD, Chair The committee produced a PMP course on “Adult with Chronic Cough” and is currently developing one on “Subglottic Stenosis.” Otology and Neurotology Education Committee Bradley W. Kesser, MD, Chair The committee produced a COOL course on “Dizziness in the Elderly” and a PMP course on “Adult with Progressive Hearing Loss.” Pediatric Otolaryngology Education Committee Sugki S. Choi, MD, Chair The committee produced a Home Study Course on Congenital and Pediatric Problems and three COOL courses on “Indications for Tonsillectomy,” “Aerodigestive Foreign Body,” and “Complications of Pediatric Sinusitis.” They also published a PMP on “Child with Sudden Onset of Drooling.” New committee chair, Kenny H. Chan, MD, began his tenure in October 2012. POEC was designated as a model committee for 2012. Rhinology and Allergy Education Committee James A. Hadley, MD, Chair The committee just published a Home Study Course, “Rhinology and Allergic Disorders” and is developing a PMP course, “Epistaxis.” This committee welcomes Brent A. Senior, MD, as the new chair through 2014. Board of Governors (BOG) Committees Representatives from Board of Governors societies from across the country were well represented during the BOG meetings, conducted during the AAO-HNSF 2012 Annual Meeting & OTO EXPOSM. Highlights from the meetings included those outlined here. BOG Development/Fundraising Task Force Jay S. Youngerman, MD, Chair The BOG expressed its sincere thanks to Dr. Youngerman and the members of the Task Force for their successful fundraising efforts during the past several years. With the formation of the new Foundation Fundraising Committee, the Task Force sunsetted at the end of the 2012 annual meeting, Dr. Youngerman will continue his great work on the new Foundation committee. BOG Legislative Representatives Committee Paul M. Imber, DO, Chair The committee received updates on current federal and state legislative activities for 2012, including Medicare physician payment reform, repeal of the Independent Payment Advisory Board (IPAB), medical liability reform, cosmetic medical procedure taxes, and ongoing scope-of-practice battles.  Committee members also received an update on the recent Supreme Court decision upholding the individual mandate provisions of the Affordable Care Act. In addition, updates were provided on a new “look” for ENT PAC (the political action committee of the AAO-HNS), new “in-district” grassroots opportunities, and highlights of the 2012 OTO Advocacy Summit. The committee heard from guest speaker Ingrida Lusis with the American Speech-Language Hearing Association (ASHA) who spoke on their activities and collaborative efforts with the AAO-HNS. BOG Rules and Regulations Committee Joseph E. Hart, MD, Chair The committee conducted a strategy session for committee members to outline plans for auditing all current state/local BOG societies in the coming year. BOG Socioeconomics and Grassroots Committee Peter J. Abramson, MD, Chair Guest speaker Richard W. Waguespack, MD, updated attendees on the progress of the 3P Workgroup. Attendees reviewed and debated a proposal from the Georgia BOG Society, “Opposition to Subspecialty Certification in Pediatric Otolaryngology.”  The proposal was forwarded to the BOG Executive Committee, slightly modified and then adopted by the BOG General Assembly attendees. A discussion of insurance challenges, including mandatory outpatient thyroidectomies and PET scan charge back and pay for appeals was presented. Dr. Abramson unveiled the Committee’s Regional Representation Plan to improve communications across BOG regions and to offer members a voice where viable BOG societies don’t exist. BOG Executive Committee-sponsored Miniseminar—”Hot Topics in Otolaryngology: 2012″ Wendy R. Stern, MD, BOG Secretary Dr. Wendy Stern moderated a compelling panel presentation on current hot topics in otolaryngology. They included the changing relationship between physicians and hospitals as a response to pressures to reduce healthcare costs and consolidate the healthcare system, specifically looking at integrated healthcare systems and Accountable Care Organizations and highlighting the advocacy work of our Academy. BOG General Assembly BOG committee chairs provided updated reports on their committees’ activities from the past year. The Connecticut Ear, Nose, and Throat Society (CENTS) received the 2012 BOG Model Society Award. BOG Chair Sujana S. Chandrasekhar, MD, presented Recognition Awards to Michael D. Seidman, MD, and Susan R. Cordes, MD, for their service on the BOG Executive Committee. Dr. Chandrasekhar also presented an award to Jay Youngerman, MD, for his strong leadership and dedication as the chair of the BOG Fundraising/Development Task Force. Dr. Chandrasekhar presented BOG Chair Awards to Hosakere S. Chandrasekhar, MD; John W. House, MD; and Gavin Setzen, MD. Governors (or their alternates) in attendance elected Peter J. Abramson, MD, to the position of BOG Chair-Elect and Stacey L. Ishman, MD, to the position of BOG Member-at-Large. Sections Section for Residents and Fellows-in-Training (SRF) Jayme R. Dowdall, MD, Chair The Section for Residents and Fellows-in-Training (SRF) functions as an advisory board to the Board of Directors (BOD). During the annual meeting, Monday was officially recognized as Residents Day with several special events geared toward residents. SRF General Assembly The Section conducted a very well-attended General Assembly meeting. During the session, attendees elected the following new officers: Nikhila M. Raol, MD, Chair Nathan A. Deckard, MD, Vice Chair John M. Carter, MD, Member-at-Large Meghan N. Wilson, MD, Information Officer Estelle S. Yoo, MD, BOG Governor Kanwar S. Kelley, MD, JD, BOG Legislative Representative Brianne B. Roby, MD, BOG Public Relations Representative In addition, Jayme R. Dowdall, MD, transitioned to Immediate Past Chair. SRF-sponsored/co-sponsored Miniseminars “Interviewing: What to Ask and How” “Finding Balance in a Surgical Career” Women in Otolaryngology (WIO) Section Shannon P. Pryor, MD, Chair The Women in Otolaryngology (WIO) Section seeks to support women otolaryngologists by identifying their needs, fostering their development, and promoting women as leaders in the specialty.  The Section completed its transitional year and its committees are planning several activities in the coming year. WIO Section Committees Each of the six WIO committees conducted committee meetings to plan and coordinate their activities for the coming year.  The committees and their current leaders are: Valerie A. Flanary, MD, Chair, Awards Erika A. Woodson, MD, Chair, Communications Pell Ann Wardrop, MD, Chair, Development/Endowment Mona M. Abaza, MD, Chair, Leadership Development and Mentorship Lauren S. Zaretsky, MD, Chair, Program Linda S. Brodsky, MD, Chair, Research and Survey WIO Luncheon/General Assembly Medical blogger physician, Kevin Pho, MD, AKA “KevinMD,” kicked off the WIO luncheon with his talk, “Connect and Be Heard: Make a Difference in Healthcare with Social Media.” The Section honored Sujana S. Chandrasekhar, MD, as the recipient of the 2012 Helen F. Krause, MD Trailblazer Award. The WIO Governing Council also honored Dr. Pryor for her hard-work during the past year and welcomed incoming Chair, Susan R. Cordes, MD. General Assembly attendees had the opportunity to network with their colleagues and learn more about WIO Section committees by participating in breakout roundtable discussions. The WIO Endowment Fund has continued to be successful in their fundraising efforts and solicited “Requests for Proposals” that fulfill the Section’s charge to support the career development of women otolaryngologist-head and neck surgeons. WIO-sponsored/co-sponsored Miniseminars “Interviewing:  What to Ask and How” “Role of Women in Humanitarian Outreach” Advisory/ Other Committees Centralized Otolaryngology Research Efforts (CORE) Study Section Jay O. Boyle, MD, Head and Neck Surgery Sub-Committee Chair Christine G. Gourin, MD, Head and Neck Surgery Sub-Committee Chair-elect David R. Friedland, MD, PhD, Otology Sub-Committee Chair Rodney J. Schlosser, MD, General Sub-Committee Chair One hundred reviewers participated in the 2012 Study Section (up 30 percent from 2011) Reviewed 189 research grant applications (up 24 percent from 2011) requesting $3,517,630 in research funding. Made funding recommendations to the 11 partnering specialty societies. Provided written critiques back to all 189 research grant applicants. Ultimately, the partnering specialty societies and sponsors awarded 45 grants (up 18 percent since 2011) totaling $737,471 (up 17 percent from 2011). Instruction Course Advisory Committee Sukgi S. Choi, MD, Instruction Course Coordinator The Instruction Course Advisory Committee reviewed and organized the instruction course program for the last annual meeting in Washington, DC. The committee: Reviewed the course evaluation results completed by attendees at the 2011 annual meeting and based on the data along with attendance figures, auto-accepted 172 instruction courses to be presented at the 2012 Annual Meeting & OTO EXPOSM. Reviewed an additional 326 applications to be considered for the 2012 program, ultimately presenting a total of 355 exceptional instruction courses. Included two instruction courses specifically designed to fulfill the ABO’s Clinical Fundamental requirements for Part III of Maintenance of Certification during the 2012 annual meeting: Clinical Fundamentals: Treatment of Anaphylaxis Clinical Fundamentals: Clinical Outcome Measures/Evidence Based Medicine Physician Payment Policy (3P) Workgroup Richard W. Waguespack, MD, and Michael Setzen, MD, Co-chairs Five comment letters to CMS, including comments on proposed and final EHR Meaningful Stage Two rules, proposed rules on the 2013 Medicare Physician Fee Schedule and Hospital Outpatient and Ambulatory Surgical Centers. Successfully advocated for coverage of sinus ostial balloon dilation by Humana with continued efforts to support members who are locally advocating for change, including the availability of a new template appeal letter drafted for member’s balloon sinus ostial dilation denials. Continued ongoing third party payer advocacy efforts in support of patient safety and opposing United Healthcare’s (UHC’s) direct-to-consumer hearing aid sales program including meetings with UHC executive leadership and a letter to the FDA. Eighteen responses were provided to Third Party Payers regarding their medical policies with input received from Academy Committees in comparison to five responses the previous year. CPT and RUC efforts were significantly increased with 20 codes RUC surveyed and presented to the AMA RUC and six Code Change Proposals (CCPs) submitted to AMA’s CPT Editorial Panel. Nine Clinical Indicators were updated after detailed review by numerous Academy Committees and 3P, including “Endoscopic Sinus Surgery,” “Nasal Endoscopy,” “Canalith Repositioning,” “Tonsillectomy, Adenoidectomy, and Adentonsillectomy,” “Septoplasty,” “Adenoidectomy,” “Laryngoscopy/ Nasopharyngoscopy,” “Endoscopic Sinus Surgery: Pediatric,” and  “Neck Dissection.” Clinical Indicator page at http://www.entnet.org/Practice/clinicalIndicators.cfm. Three Health Policy Miniseminars for the 2012 annual meeting were hosted by 3P, including the 3P miniseminar on new strategies in Academy advocacy for physician payment; ICD10 transition miniseminar; and the Medicare Contractor Administrative Committee (CAC) miniseminar. Program Advisory Committee Eben L. Rosenthal, MD, Scientific Program Coordinator The Program Advisory Committee planned and conducted the scientific program for the 2012 Annual Meeting & OTO EXPOSM in Washington, DC. The committee: Reviewed 985 oral and poster applications, ultimately accepting 274 orals and 442 clinical and basic translational posters. Reviewed 143 miniseminar applications, accepting 91 thought-provoking miniseminars presented by experts in the field. Specialty Society Advisory Council Samuel H. Selesnick, MD, Chair The SSAC discussed the value of producing an SSAC miniseminar for annual meeting. Eben Rosenthal, MD, AAO-HNSF coordinator for scientific program, gave the group an overview on the submission process. Sonya Malekzadeh, MD, AAO-HNSF coordinator for education, gave the group an update on the recent educational initiatives for the AAO-HNSF. David R. Nielsen, MD, EVP/CEO, gave the group an update on the Value Based Payment Modifier and PQRS. Richard W. Waguespack, MD, and Michael Setzen, MD, from 3P discussed with the group how to better communicate with the societies on providing input on payer/insurer payment policies Surgical Simulation Task Force Ellen Deutsch, MD, Chair The Task Force researched and reported to the Foundation Board on the state of surgical simulation in otolaryngology. Throughout the year members represented the AAO-HNS/F on cross-specialty surgical simulation organizations, while continuing to gather data and information. Open surgical simulation meetings took place at both COSM and the annual meeting. A Simulation Fair took place in conjunction with several related miniseminars. The Task Force continues to work on a survey and plans for a surgical simulation summit in 2013. Robotic Surgery Task Force Eric Genden, MD, Chair The Robotic Surgery Task Force began work on best practices for training and credentialing in robotic surgery within otolaryngology-head and neck surgery. The Task Force represents the AAO-HNS/F in national robotic surgery organizations and initiatives, such as the development of Foundations for Robotic Surgery.