Published: October 24, 2013

Bridging the Gap: A Cleft Lip and Palate Mission to China

Abby R. Nolder, MD PGY-5 resident, University of Arkansas for Medical Sciences, Department of Otolaryngology—Head and Neck Surgery In July 2010, I joined a group of nine dedicated physicians, nurses, and coworkers on a cleft-lip and palate surgical mission to Hangzhou, China. The team was led by Lisa M. Buckmiller, MD, director of the vascular anomalies center of excellence and the cleft lip and palate team at Arkansas Children’s Hospital in Little Rock, AR. Dr. Buckmiller has taken part in and led many international surgical missions to China, Africa, and Central America. She is very involved in the pediatric otolaryngology and cleft fellowship program at Arkansas Children’s Hospital. One of her former fellows, Robert Glade, MD, now a pediatric otolaryngologist and cleft surgeon at Oklahoma University Medical Center in Oklahoma City, OK, was part of the team as well. In cooperation with the Operation Smile Charity Hospital, Hangzhou, our Change of Face Mission Team provided cleft lip and/or cleft palate surgeries for 20 Chinese children. Many of the children were residents of the Starfish Foster Home, a special place founded by a South African school teacher, Amanda de Lange, to save the lives of Chinese orphans with special health needs. Some of the children and their caretakers traveled more than 50 hours by train in the sweltering summer heat to reach the hospital. The tireless work and dedication shown by Amanda and her volunteers was a true testament to their commitment to providing these children with a better life. This made our contribution even more rewarding. The Operation Smile Charity Hospital was well-equipped with two operating suites as well as a pre- and postoperative patient ward with 24-hour nursing care. We worked closely with the Operation Smile surgeons in evaluating the patients preoperatively to determine the appropriate procedure and timing for each patient. The operating room staff was skillful and efficient. The surgeries went smoothly, and the transformations were amazing.  Our team provided the children with medications, diapers, arm restraints (“no-no’s”) and feeders, all much-needed supplies for the long trip back to the foster home. In China, one in 600 children is born with a cleft deformity. These children, often placed in orphanages because of their facial defects, are ineligible for adoption until they have at least had the lip repair. Many of these children will die of malnutrition and poor access to adequate care. The need for appropriate surgical treatment for these children is so great, and the rewards are immeasurable. The children we served on this mission were forever changed, and the values I learned from being a part of it will last my lifetime. Thank you to the American Academy of Otolaryngology—Head and Neck Surgery Foundation Humanitarian Efforts Committee for making this trip possible for me. To learn more about resident travel grants, contact

Abby R. Nolder, MD PGY-5 resident, University of Arkansas for Medical Sciences, Department of Otolaryngology—Head and Neck Surgery

Abby Nolder, MD, and patient.Abby Nolder, MD, and patient.

In July 2010, I joined a group of nine dedicated physicians, nurses, and coworkers on a cleft-lip and palate surgical mission to Hangzhou, China. The team was led by Lisa M. Buckmiller, MD, director of the vascular anomalies center of excellence and the cleft lip and palate team at Arkansas Children’s Hospital in Little Rock, AR.

Dr. Buckmiller has taken part in and led many international surgical missions to China, Africa, and Central America. She is very involved in the pediatric otolaryngology and cleft fellowship program at Arkansas Children’s Hospital. One of her former fellows, Robert Glade, MD, now a pediatric otolaryngologist and cleft surgeon at Oklahoma University Medical Center in Oklahoma City, OK, was part of the team as well.

In cooperation with the Operation Smile Charity Hospital, Hangzhou, our Change of Face Mission Team provided cleft lip and/or cleft palate surgeries for 20 Chinese children. Many of the children were residents of the Starfish Foster Home, a special place founded by a South African school teacher, Amanda de Lange, to save the lives of Chinese orphans with special health needs.

Some of the children and their caretakers traveled more than 50 hours by train in the sweltering summer heat to reach the hospital. The tireless work and dedication shown by Amanda and her volunteers was a true testament to their commitment to providing these children with a better life. This made our contribution even more rewarding.

The Operation Smile Charity Hospital was well-equipped with two operating suites as well as a pre- and postoperative patient ward with 24-hour nursing care. We worked closely with the Operation Smile surgeons in evaluating the patients preoperatively to determine the appropriate procedure and timing for each patient.

The operating room staff was skillful and efficient. The surgeries went smoothly, and the transformations were amazing.  Our team provided the children with medications, diapers, arm restraints (“no-no’s”) and feeders, all much-needed supplies for the long trip back to the foster home.

Robert Glade, MD, and patient.Robert Glade, MD, and patient.

In China, one in 600 children is born with a cleft deformity. These children, often placed in orphanages because of their facial defects, are ineligible for adoption until they have at least had the lip repair. Many of these children will die of malnutrition and poor access to adequate care. The need for appropriate surgical treatment for these children is so great, and the rewards are immeasurable. The children we served on this mission were forever changed, and the values I learned from being a part of it will last my lifetime.

Thank you to the American Academy of Otolaryngology—Head and Neck Surgery Foundation Humanitarian Efforts Committee for making this trip possible for me. To learn more about resident travel grants, contact

More from December 2011 - Vol. 30 No. 12

Off and Running Thanks to AAO-HNS: SoPE (aka ENTRIpreneurs Club) Update
The Society of Physician Entrepreneurs (SoPE) is an organization of more than 1,400 global members that assists bioentrepreneurs in bringing their ideas to life by providing education programs, networking, products, and services, including access to sources of financing. SoPE, a 501(c)(3) foundation, is spearheading an effort to promote a better understanding of the processes involved in the introduction of new healthcare-related products and services, while working with all stakeholders in healthcare to identify ways to improve and accelerate the process of innovation. Recognizing that physicians have a need and desire to gain entrepreneurial skills, SoPE and Acclarent (Menlo Park, CA), an Ethicon and Johnson & Johnson company, have launched the first Innovation Scholar Program (ISP). In this six-month work-study program, an otolaryngologist will rotate through the innovation commercialization functions of a medical device company at the Acclarent headquarters. SoPE is currently accepting applications from otolaryngologists for a mutually convenient 2012 start date. How did all of this come about? The inaugural meeting of the “ENTRIpreneurs Club” was held at the 2008 Annual Meeting & OTO EXPO in Chicago. The first action of the 50 attendees was to change the name to the Society of Physician Entrepreneurs (SoPE), and we were off and running. The overwhelming positive feedback from the attendees the meeting made us realize we had stumbled upon something of significant and unique value, not just for physician entrepreneurs, but for all stakeholders in the healthcare and biomedical innovation commercialization process. To those who attended the 6 a.m. breakfast meeting, to ENT Resources, Inc. (ENTRI), and the AAO-HNS for-profit subsidiary, which provided administrative support to SoPE, we are extremely grateful. SoPE continued as a community of interest for the next three years, holding a networking event at each Annual Meeting & OTO EXPO. In late 2010, the SoPE steering committee, all AAO-HNS members, requested and received AAO-HNS approval to launch SoPE as a separate legal entity with no further ties to AAO-HNS.  This separate legal entity permitted SoPE leadership  to open its membership to all medical and surgical specialties. In January 2011, SoPE formed an independent 501(c)(6) member association, and in April 2011, formed a 501(c)(3) foundation as a supporting organization for SoPE. SoPE’s key constituency, from its inception, is the community-based, private practice physician and healthcare professional entrepreneurs. SoPE’s belief is that although this group is the source of the overwhelming majority of the innovations reaching the marketplace, they are both time-constrained and ill-prepared to venture down the entrepreneurial path. SoPE’s core mission is to help doctors get their ideas to market. Here are some of SoPE’s accomplishments in its relatively short life: Creating  a global membership of more than 1,400 and with growth of about 100 each month. Launch of the first Innovation Scholar Program (ISP), a six-month work-study program for an otolaryngologist  at Acclarent.  Development of additional ISP programs with other medical device, biopharmaceutical, and healthcare IT companies interested in hosting physicians from other medical specialties. Launching and forming more than a dozen local SoPE chapters in the U.S., including Washington, DC; Denver; Chicago; Minneapolis; and New York. Creating international SoPE chapters in India, Nigeria, and Turkey, with chapters forming in England and Portugal. Forming SoPE affinity relationships with some of the best sources of bio-medical entrepreneurship education courses, such as World Medical Device Organization (WMDO), AdvaMED, and Medical Device Summit. If you have an interest in joining SoPE (membership is free); exploring entrepreneurship; finding out about early-stage investment opportunities; learning more about the ISP; joining a local chapter or taking the lead in forming a local chapter; or learning more about SoPE or its foundation and their activities, visit, call SoPE at 1-703-879-7710 or email Arlen Meyers, president and CEO at or Jim Blakely, EVP & COO, at  Reference The ENTRIpreneurs Club: Your AAO-HNS Gateway to Innovation. Bulletin, 2008, August: page 27.
Fire Safety in the Operating Room
Growth in outpatient surgery and the rise in use of oxygen and lasers for in-office procedures increase the risk of a fire. More than 1,400 fires occur annually in the outpatient setting, and at least 500 hospital operating room fires occur every year. A fire in the oxygen-rich surgical arena can be devastating for patients. It is important to assess your operating rooms to determine potential for fires. Use the “fire triangle” (air, heat, fuel) to train your team and organize your assessment. The team should identify heat and ignition sources, specific fuels, and air components. Develop a comprehensive fire plan, including these initial training requirements: Conduct annual fire drills specific to your surgical suite. Review each team member’s roles and responsibilities in controlling minor fires and in handling out-of-control fires. Review the location and use of fire-fighting tools, such as medical gas valves, electrical supply switches, and fire extinguishers. Review the best ways to protect patients both before a fire and in the midst of a fire event. Consider annual fire response training for the following locations and scenarios: Incision sites Drape fires Bowel explosion fires Tracheal tubes Throat and mouth area In addition, consider the following tips: Consider replacing alcohol-based preps with newer nonflammable solutions. If using oxygen, consider using low flows and less than 30 percent supplemental oxygen. Prior to using an ignition source, provide adequate warning to the team. Evaluate each surgical procedure, even minor ones, for fire hazards. Consider oxygen to be a drug with its own risks and benefits; use it only when needed. Add “fire risk” to the safety checklist that is discussed by the team before each surgical procedure. Contributed by The Doctors Company. For more patient safety tips and articles, visit
Discouraging Recording in the Office
Whether your office has wireless access or not, there will be patients texting, surfing the Internet, using Facebook, and otherwise engaging with the outside world on their smartphones while in your offices. These smartphones have another function: the ability to record audio or video. It is understandably tempting for patients to record consent discussions, medication, follow-up instructions, and other physician or staff interactions. Recording a medical discussion via video or audio is no proxy for paying attention, however, and the practice puts you and your office at significant risk. Video or audio recording should not be allowed in the office setting. It breaches the confidentiality rights of the other patients and infringes on the privacy rights of the physician and employees. In California, as in many other states, it’s illegal to record without prior consent. To get a handle on patients taking smartphone recordings in your office, consider the following steps: Post a sign at the reception desk, or wherever patients check in, that says: “To ensure confidentiality and privacy, any type of electronic recording is strictly prohibited at any location within these offices. Thank you for your understanding and compliance.” Draw up a written policy prohibiting the use of recording devices during office visits and include the policy in patient intake handouts. Watch for patients potentially recording conversations. Politely request that they discontinue their recording. Remind patients that they—or their caregiver—can take notes while meeting with the doctor in order to remember important information. Emphasize that the conversation will also be documented in the medical chart. Contributed by The Doctors Company. For more tips, articles, and information, visit
MedPAC Recommends Replacing SGR, Cutting Specialist Pay
The Medicare Payment Advisory Commission (MedPAC) is an independent Congressional agency established to advise the U.S. Congress on issues affecting Medicare. The commission’s statutory mandate is quite broad. In addition to advising Congress on payments to private health plans participating in Medicare and providers in Medicare’s traditional fee-for-service program, MedPAC is also tasked with analyzing access to care, quality of care, and other issues affecting Medicare. The commission issues reports several times a year based on MedPAC’s charge and ongoing analysis of the Medicare system. It should not come as a surprise that some reports are more controversial than others. For the March 2012 report, MedPAC is recommending replacing the Sustainable Growth Rate (SGR) formula with an alternative payment mechanism. While the Academy and others in the physician community have long supported and advocated for a full repeal of the flawed SGR formula, MedPAC’s latest recommendations are not the answer, and, if implemented, will likely exacerbate other problems within the Medicare program. The reforms seek to eliminate the 27.4-percent cut to Medicare physician payments scheduled for January 1, 2012, and replace it with the following four recommendations. The first recommendation is designed to realign the fee-schedule payments to support primary care. This includes a three-year, 5.9-percent reduction in the fee schedule’s conversion factor for services other than primary care, then a freeze for another seven years. Primary care rates would be frozen for 10 years, with primary care defined by specialty and utilization of Primary Care codes similar to the Primary Care bonus payment. MedPAC says these changes to fee schedule payments would limit the cost of repealing the SGR, ensure access to care for beneficiaries, and would increase fee schedule revenue through increased participation and utilization of Medicare services. The second recommendation is to collect data to improve payment accuracy. According to MedPAC, the Department of Health and Human Services (HHS) lacks current, objective data needed for work and practice expense relative value units (RVUs) because of costly implementation and low response rate, bias in surveys because of medical society’s subjectivity, and burdensome reporting measures. The recommendation calls for the collection of data from practitioner offices and basing RVUs on efficient offices’ data; using data from electronic health records (EHR), patient scheduling, and billing systems; and the evaluation and adjustment of RVUs as required by the Affordable Care Act. The third recommendation calls for the identification of overpriced services using the data collected from their second recommendation to identify and revalue overpriced services. MedPAC also recommends HHS meet an annual numeric goal of reducing RVUs at least 1 percent for a defined period of time. Finally, MedPAC calls for accelerated delivery system reform through increased opportunities for participation in new models of payment (bundled payment, accountable care organizations [ACOs], capitated models, and shared savings programs) that shift Medicare payment away from the traditional fee-for-service structure. This includes increased opportunities for shared savings for physicians and health professionals that join or lead ACOs in two-sided risk modes by basing the spending benchmark on higher fee-schedule growth rates. To pay for these reforms, MedPAC is recommending a package of $235 billion that consists of 32 percent of the savings coming from prescription drugs, 21 percent from post acute care, 14 percent from beneficiaries, 11 percent from hospitals, 9 percent from labs, 6 percent from durable medical equipment, 5 percent from Medicare Advantage, and 2 percent from other sources. These savings are Tier 1 and Tier 2 offsets, with Tier 1 offsets defined as savings MedPAC has recommended in the past and Tier 2 coming from previous recommendations from MedPAC, the Government Accountability Office (GAO), the Office of the Inspector General (OIG), the Congressional Budget Office (CBO), and HHS. The AAO-HNS supports the repeal and replacement of the SGR formula, but does not support the specific proposals MedPAC is putting forward because they retain many of SGR’s current flaws, undermine our physicians’ abilities to participate in payment and delivery reforms, and call for payment rates that the commission itself has previously said could reduce Medicare beneficiaries’ access to medical care. The Academy signed onto a letter spearheaded by the American Medical Association (AMA) on October 3, 2011, expressing this opposition. For updates as this issue progresses, go
2012 CORE Grants
Submission Deadlines Letter of Intent (LOI) to be submitted electronically by December 15, 2011, midnight ET. Application to be submitted electronically by January 16, 2012, midnight ET. The Alcon Foundation The Alcon Foundation/AAO-HNSF Resident Research Grant $10,000, non-renewable, one year to complete project. One available annually. American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNSF) AAO-HNSF Resident Research Award $10,000, non-renewable, one year to complete project. Up to eight available annually. AAO-HNSF Maureen Hannley Research Training Award $15,000, non-renewable, one year to complete project. Two available annually. AAO-HNSF Percy Memorial Research Award $25,000, non-renewable, one year to complete project. One available annually. AAO-HNSF Health Services Research Grant $10,000, non-renewable, one year to complete project. Up to two available annually. AAO-HNSF Rande H. Lazar Health Services Research Grant $10,000, non-renewable, one year to complete project. One available annually. American Head and Neck Society (AHNS) AHNS Pilot Grant $10,000, non-renewable, one year to complete project. One available annually. AHNS Alando J. Ballantyne Resident Research Pilot Grant $10,000, non-renewable, one year to complete project. One available annually. AHNS/AAO-HNSF Young Investigator Combined Award $40,000 ($20,000 per year), non-renewable, two years to complete project. One available annually. American Hearing Research Foundation (AHRF) AHRF Wiley H. Harrison Memorial Research Award $25,000, non-renewable, one year to complete project. One available annually. American Laryngological Association (ALA) ALA-ALVRE Award $10,000, non-renewable, one year to complete project. One available annually. ALA-Nestle Nutrition Institute Dysphagia Research Grant $10,000, non-renewable, one year to complete project. One available annually. The American Laryngological, Rhinological, and Otological Society, Inc., aka The Triological Society  The Triological Career Development Award $40,000, non-renewable, one to two years to complete project.  Five awarded annually. American Neurotology Society (ANS) ANS/AAO-HNSF Herbert Silverstein Otology and Neurotology Research Award $25,000, non-renewable, two years to complete project. One available every other year (even). American Rhinologic Society (ARS) ARS New Investigator Award $25,000 ($12,500 per year), non-renewable, two years to complete project. One available annually. ARS Resident Research Grants $8,000, non-renewable, one year to complete project. One available annually. American Society OF Pediatric Otolaryngology (ASPO) ASPO Research Grant $20,000, non-renewable, one year to complete project. Two available annually. The Doctors Company Foundation The Doctors Company Foundation/AAO-HNSF Resident Research Foundation Grant $10,000, non-renewable, one year to complete project. One available annually. The Educational and Research Foundation for the American Academy of Facial Plastic and Reconstructive Surgery AAFPRS Leslie Bernstein Grant $25,000, non-renewable, up to three years to complete project. One available annually. AAFPRS Leslie Bernstein Resident Research Grant $5,000, non-renewable, up to two years to complete project. Two available annually. AAFPRS Leslie Bernstein Investigator Development Grant $15,000, non-renewable, up to three years to complete project. One available annually. Knowles Hearing Center at Northwestern University Knowles Center Collaborative Grant $30,000, non-renewable, one year to complete project. Up to three available annually. OLYMPUS Olympus/AAO-HNSF Resident Research Grant $10,000, non-renewable, one year to complete project. One available annually. The Oticon Foundation The Oticon Foundation/AAO-HNSF Resident Research Grant $10,000, non-renewable, one year to complete project. One available annually. For more information visit:, or Stephanie Jones,
Public Demands!
Rahul K. Shah, MD, George Washington University School of Medicine, Children’s National Medical Center, Washington, DC In 1999, the Institute of Medicine released what has become the clarion call to rejuvenate the patient safety and quality improvement movement in U.S. healthcare. Since then, there has been an explosion of government, insurer, and public initiatives to drive success in improvements in the U.S. healthcare system. The successes have included marked decrease in central-line infection rates, the demonstrable improvements in hand hygiene practices, and the proof-of-principle of using benchmarking to drive change in surgical outcomes (American College of Surgeons National Surgical Quality Improvement Project). For the last decade, these changes have been driven by a tacit acknowledgement that it is simply the right thing to do, coupled with a fear that the public will demand such changes once they become knowledgeable about the system. Fortunately—or not—that time has come. The movement toward greater transparency has been mounting over the past couple of years. This includes taxpayer-funded programs such as the Health and Human Services ( website. I implore Academy members to spend a few minutes to understand what our patients are looking at when choosing to come to see us and have surgery in our hospitals. The sophistication of the website, the ease of use, and the ability to compare one hospital to another is seamless. For the patient, this is obviously very convenient. For the physician, it means that your outcomes are out there for evaluation and consideration. The October 3 issue of Modern Healthcare listed the hospitals with the highest 30-day readmission rate using Medicare data. It was amazing that I personally knew and have had friends or family at almost half of the hospitals listed. Furthermore, I was startled to see that many of the hospitals that were listed have a readmission rate of almost one-third of discharges! I cannot fathom that this would be a result of sub-par delivery of care or systematic breaches of patient safety and quality. My immediate explanation is that these hospitals undoubtedly must take care of the sickest patients, who inevitably would have poorer outcomes than healthy, more advantaged individuals. However, I am sure the truth lies somewhere in between. I am a self-purported expert in this arena. However, how is the lay public going to interpret this data? One cannot blame them if they are also immediately startled at some of the data. It would behoove us to know where the hospitals we practice in fall in these publicly available scorecards so that we can explain to our patients why we believe we have such ratings/rankings. Various organizations have also started bestowing quality awards upon hospitals for metrics that they deem as the most vital. This is of course good because competition is certainly healthy in a capitalist economy such as ours, and we can surmise that hospitals would strive to improve their practices in hopes of receiving such accolades and recognition. The problem is that there are a lot of organizations that are currently recognizing specific quality achievements and there are many more that are starting the process. How is the public supposed to discern the value of one quality award compared to another? One may argue that the 30-day readmission rate does not matter if someone is seeking a regional expert to care for a patient’s specific sinus complaint. However, if this is the only metric the patient is exposed to, it may be hard for him or her to interpret. Indeed, a local hospital that I would never have considered seeking care from was recently awarded a rare and prestigious quality award. Rightly or wrongly, knowledge of such an award has immediately changed my perception of this hospital. There is not too much we as otolaryngologists can do to prepare ourselves for the tremendous transparency of quality and safety metrics that are inevitably coming in the future. However, as physicians, we can take an active role in our medical staffs and our local, regional, and national organizations to ensure that the metrics that quality organizations and hospitals want to report reflect the realities of our practices, our outcomes, and our patient profiles (case mix indexes, etc.). As I often say in this column, we control the ultimate metrics—our patient outcomes. How we define and make these available to the public will ultimately play a profound role in our future. Specialty-specific databases or patient data registries will assist our practices and our efforts to collate, disseminate, and compare such outcomes. We encourage members to write us with any topic of interest, and we will try to research and discuss the issue. Members’ names are published only after they have been contacted directly by Academy staff and have given consent to the use of their names. Please email the Academy at to engage us in a patient safety and quality discussion that is pertinent to your practice.
The Academy Needs You
We need experts to fill out RUC surveys for the AMA Specialty Society/Relative Value Update Committee. The RUC is a joint effort of the American Medical Association and medical specialty societies that makes recommendations on revising and updating the resource-based relative value scale (RBRVS), which is utilized by Medicare and many private payers. Information, such as the time it takes for you to perform certain services for patients, is derived by surveying physicians, such as you, who have expertise in performing those services. This information is critical to ensure appropriate valuation. Last summer, the Academy performed a RUC survey for CPT code 31231, diagnostic nasal endoscopy. We received only the minimal number of member responses, and the results were difficult to interpret. At the September 2011 RUC meeting, Wayne M. Koch, MD, RUC Advisor for the Academy, and John T. Lanza, MD, RUC Alternate Advisor, met with RUC Panel members in a pre-facilitation to discuss potential problems with recent survey data. That panel recommended that the Academy resurvey its members in an effort to clarify the inconsistencies. As a result, the Academy had to re-survey 31231 this fall in preparation for the January 26-29, 2012, RUC meeting. The Academy strongly encourages members who are familiar with a procedure to take the time to complete surveys. Filling out a survey takes about 20 minutes. If you need guidelines on how to complete a survey, read the August Bulletin article ( and attend or view the Academy’s new webinar training. Your participation in the survey process is critical to the Academy’s efforts in establishing Relative Value Units (RVUs) for this procedure code. Due to the timing of the release of the RUC survey instrument from the AMA RUC, the Academy’s RUC team has already solicited for members interested to participate in this survey and is currently in the process of analyzing the data to submit recommendations to the RUC by their deadline. For those who have taken the time to fill out a survey, the RUC Team thanks you for your commitment to the process. Please continue to look for solicitation by the Academy for interested members to participate in upcoming RUC surveys. If you have questions or comments, contact the Health Policy Department or the RUC Team via Your Academy RUC Team Wayne M. Koch, MD, serves as the Academy’s RUC Advisor, presenting recommendations to the RUC on members’ behalf. John  T. Lanza, MD, RUC Alternate Advisor. RUC panel at a national level Jane T. Dillon, MD, RUC Panel Member Alternate. Charles F. Koopmann, Jr., MD, MHSA, RUC Panel Member and former Academy Advisor. William J. Moran, MD, DMD, the RUC Practice Expense Review Committee Chair.
We Don’t Stop Advocating for You
Joseph Cody, MA, AAO-HNS Health Policy Analyst Udo Kaja, Program Manager, AAO-HNS Health Policy  The passage of the Affordable Care Act (ACA) in the spring of 2010 was the most substantial overhaul of the healthcare system in 50 years, and the AAO-HNS Health Policy team, including staff and members of the Physician Payment Policy (3P) work group, have been hard at work tracking its implementation and actively advocating for otolaryngology—head and neck surgery throughout the process. These efforts have included providing input to government agencies charged with putting regulations into place and working with other medical associations on ACA implementation. At the end of August 2011, the Academy provided comprehensive feedback to the Centers for Medicare and Medicaid Services (CMS) on the proposed rule for the CY 2012 Medicare Physician Fee Schedule (PFS). In the letter, we addressed the evaluation of potentially misvalued codes, quality reporting initiatives, and many other important areas that impact otolaryngology—head and neck surgery. We also commented on the Physician Feedback Program and Value Based Payment Modifier included in the rule, expressing concerns about the plans for evaluating the reports and the inclusion of appropriate risk adjustment. Earlier in the year, the Academy sent a comment letter to CMS providing input on the Accountable Care Organizations (ACO) proposed rule. In the letter, we highlighted the importance of specialists in promoting care coordination and stressed that the current ACO model proposed by CMS would be very challenging to implement. We encouraged CMS to adopt surgical measures specific to otolaryngology and also recommended that CMS provide a payment option that includes shared savings only without mandatory shared-loss provision. In November 2010, we sent a letter to CMS urging them to implement retroactive payment increases for physicians stemming from provisions in the ACA. In October 2010, the Academy was part of a coalition that sent a letter urging members of the Labor-HHS-Education Subcommittee on Appropriations to fully fund a provision in the Affordable Care Act that would establish a loan repayment program for pediatric medical specialists training in underserved areas across the U.S., potentially increasing the pediatric subspecialty workforce and improving access-to-care issues for their services. Efforts are still under way to fund this important provision. Along with implementation of healthcare reform, we also were active in implementation of the American Recovery & Reinvestment Act (ARRA). Efforts included the Academy offering feedback on the Office of the National Coordinator for Health Information Technology (HIT) Policy Committee’s proposed meaningful use Stage 2 criteria. In our letter, we urged the HIT Policy Committee to allow for greater flexibility in the requirements to increase physicians’ adoption rates for EHRs. We thank the Medical Informatics Committee for reviewing the proposed criteria and for its work in drafting the letter. On September 13, 2010, in conjunction with the AMA and some specialty associations, we sent a comment letter to the Department of Human and Health Services (HHS) regarding its proposed changes to the Health Insurance Portability and Accountability Act (HIPAA). In the letter, we recommended that HHS pursue privacy and security safeguards that are practical, flexible, and affordable for physicians, suggested that they work to identify any state laws that conflict with the proposed changes, requested that they postpone the compliance deadline from 180 days after the effective date of the final rule until one year, and much more. The Health Policy team has also been actively involved in other regulatory implementations, including joining the efforts of the AMA and other specialty societies in December 2010 by supporting two separate letters to HHS Secretary Kathleen Sebelius recommending that HHS ask CMS to revise its condition to use e-prescribing activity during the first six months of 2011 as the basis for imposing penalties on physicians (in 2012 and 2013) in the Medicare E-prescribing program. As a result, CMS, on August 31, 2011, issued a final rule, which if finalized will add new exemption categories to enable physicians to avoid the 1-percent Medicare E-Rx penalty in 2012. In November 2010, we sent a letter to the Agency for Healthcare Research and Quality (AHRQ) regarding its draft Comparative Effectiveness Review (CER) of the diagnosis and treatment of Obstructive Sleep Apnea (OSA) in Adults. In the letter, we asked AHRQ to include (in their final review) that surgery was comparably effective if not better than Continuous Positive Airway Pressure (CPAP) to treat OSA. We thank the Sleep Disorders Committee for reviewing the proposed criteria and for its work in drafting the letter. The Academy will continue to monitor the implementation of the Affordable Care Act and other regulations that affect otolaryngology—head and neck surgery. You can check for regular updates to see what the Academy has been actively advocating for at the “What’s New” page located at
ENT PAC Launches Protect Our Patients Campaign
The safety of your patients is at risk, and we need your help. Legislation (H.R. 2140) is currently being considered in the U.S. House of Representatives that would grant audiologists unlimited direct access to Medicare patients without a physician referral. We must act now to defeat this ill-advised legislation and preserve Medicare’s current policies protecting our nation’s seniors. To aid the Academy’s efforts to defeat H.R. 2140, we have launched “Protect Our Patients,” a new ENT PAC fundraising campaign to further build our political resources to defeat legislators and/or candidates who support H.R. 2140. Support the effort by becoming an ENT PAC investor today at (AAO-HNS member log-in required.) *Contributions to ENT PAC are not deductible as charitable contributions for federal income tax purposes. Contributions are voluntary, and all members of the American Academy of Otolaryngology-Head and Neck Surgery have the right to refuse to contribute without reprisal. Federal law prohibits ENT PAC from accepting contributions from foreign nationals. By law, if your contributions are made using a personal check or credit card, ENT PAC may use your contribution only to support candidates in federal elections. All corporate contributions to ENT PAC will be used for educational and administrative fees of ENT PAC, and other activities permissible under federal law. Federal law requires ENT PAC to use its best efforts to collect and report the name, mailing address, occupation, and the name of the employer of individuals whose contributions exceed $200 in a calendar year.
2011 State Legislative Wrap-Up
In 2011, the AAO-HNS reviewed thousands of bills introduced across the country to determine relevancy to the specialty. Of those bills, the Academy has been actively tracking more than 620 state bills, including many held over from the 2010 session, and has identified approximately 40 key bills in 29 states. The Academy has been 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 (, which provides real-time access to active state legislation and relevant information. The following is a brief summary of some of the Academy’s 2011 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 has advocated to modify and/or defeat several potentially harmful bills that would have inappropriately expanded the scope of practice of non-physician professionals. In South Dakota, the AAO-HNS successfully opposed a bill regulating the practice of speech-language pathology. The bill, as proposed, would have inappropriately expanded  the scope of practice of speech-language pathologists, allowing them to diagnose, manage, and treat speech disorders. The bill passed the House, but was tabled in a Senate committee. Similarly, the West Virginia legislature considered a scope-of-practice expansion bill for speech-language pathologists and audiologists. The AAO-HNS worked closely with the state medical association to highlight concerns as the bill moved through the legislative process. The bill passed the House, but the Senate committee declined to move it forward prior to the end of the legislative session. Companion bills 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 with other physician groups to defeat these bills and submitted letters to both the Senate and Assembly opposing the proposal. The legislation passed the Senate, but did not progress further in 2011. The bills will continue to be a concern as New York bills being considered in 2011 will be carried over to the 2012 session. The Massachusetts legislature is considering a bill that encourages the practice of primary care services by nurse practitioners and physician assistants. The AAO-HNS and the Massachusetts Society of Otolaryngology (MSO) sent a joint letter to members of the Massachusetts legislature urging their opposition to the bill. The bill remains in committee and the Academy will continue to monitor this concerning proposal. 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 Connecticut, a 6.35-percent cosmetic medical procedures tax was included in the Governor’s final budget. The AAO-HNS and other coalition members submitted written testimony to the Connecticut legislature and a letter to the Governor in opposition to the tax. The AAO-HNS will continue to work closely with the coalition to oppose the implementation of this new tax. The Washington House proposed a sales and use tax on cosmetic procedures to fund the maintenance of basic health program enrollment. The bill failed to clear the House by the “cross-over” date, so the legislation died in the 2011 session. New Jersey reintroduced a bill to repeal the 6-percent tax currently imposed on cosmetic procedures. Under the proposal, the tax would be reduced by 2 percent each year, for 3 years, ending with a 0 percent tax rate. The AAO-HNS submitted written testimony to the New Jersey legislature in support of repealing the tax. The bill has passed the Senate, and is waiting to be heard in the house. Hearing Aid Services The coverage, sale, and dispensing of hearing aids is an issue considered by several states in various forms each year, and 2011 was no different. In New York, the AAO-HNS worked with the Patient Access to Hearing Aids (PAHA) Coalition to pass a bill that would expand patients’ access to hearing aid services by striking an archaic law prohibiting physicians from deriving a profit on hearing aid sales. This year, the PAHA Coalition attained introduction of both a Senate and an Assembly bill. The AAO-HNS and PAHA will continue to advocate on these bills as they will be carried over to the 2012 session. Several states considered bills to require insurers to cover the cost of or expand benefits for hearing aids and/or cochlear implants, including California, Hawaii, Illinois, Kansas, Maryland, Massachusetts, Minnesota, New Hampshire, New York, Tennessee, and Vermont.  Several states also considered bills that would provide a tax credit and/or exemption for hearing aids, including Arizona, Arkansas, Florida, Michigan, and Oklahoma. Truth in Advertising With the emergence of clinical doctoral programs for non-physician providers  and many degree holders referring to themselves as “doctors,” there has been  growing confusion within the patient population about the level of training and education of their healthcare providers. In 2011, there were 13 truth-in-advertising bills introduced in the states, a few of which are highlighted below. In Colorado, there was a proposed bill that failed to progress beyond committee. The bill would have required practitioners to wear photo ID badges that stated their type of license. Practitioners would have also been responsible for communicating to their patients if care was being provided by someone other than a medical doctor or doctor of osteopathic medicine. Connecticut became the most recent state to pass truth-in-advertising legislation in 2011. The bill requires healthcare providers to wear a photo identification badge during work hours that displays the facility name, provider name, type of license, and title/position with the facility. The Massachusetts legislature considered a bill that would add the term “oral physician” for dentists’ scope of practice and for compliance with the state’s current truth-in-advertising language. The Academy submitted joint testimony in opposition to the proposed bill. At this time the bill remains in committee. Tobacco Use  and Smoking Cessation The AAO-HNS supports legislation and regulations that will help to reduce the use of tobacco products and exposure to secondhand smoke in order to promote healthy environments and lifestyles for the public. This year, bills were introduced in 14 states that sought to strengthen existing smoking ban laws, including Alabama, California, Connecticut, Indiana, Iowa, Maryland, Massachusetts, Michigan, Mississippi, New Jersey, Oklahoma, South Carolina, West Virginia, and Wyoming. A number of states considered proposals to mandate insurance coverage and/or benefits for tobacco cessation, including California, Connecticut, Hawaii, Massachusetts, Mississippi, New York, and Washington. Two states, Hawaii and Illinois, proposed legislation to exempt certain establishments from a smoking ban if they were to become “licensed” as exempt—a potential revenue source for the state. Medical Liability Reform In 2011, 22 states 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. Oklahoma and Tennessee successfully enacted caps on non-economic damages in civil actions; Pennsylvania passed new joint and several liability reforms; and Michigan enacted an apology inadmissibility bill. Looking ahead to 2012, the AAO-HNS will continue to track and advocate on these important issues and others as they arise. Many of these issues will continue through 2012 and beyond, as states look to adjust to the ever-changing healthcare environment. The AAO-HNS will continue to actively engage with specialty societies and the 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 or  1-703-535-3794.
2011 Millennium Society Donors
January 1, 2011 through November 15, 2011 The Foundation would like to thank all of our 2011 Millennium Society donors for their incredible generosity, and more importantly, for their commitment to advancing our specialty.  To join, please visit Life Members Kenneth W. Altman, MD, PhD, and Courtney Altman American Association of Otolaryngologists of Indian Heritage Vijay K. Anand, MD J. Noble Anderson, Jr., MD Seilesh Babu, MD, and Abbey Crooks-Babu, MD Robert W. Bastian, MD, and Jan Bastian Neal S. Beckford, MD Leslie Bernstein, MD, DDS Nikhil J. Bhatt, MD, and Anjali Bhatt, MD Neil Bhattacharyya, MD, and Anjini Bhattacharyya, MD Andrew Blitzer, MD, DDS Mark E. Boston, MD Marcella R. Bothwell, MD I. David Bough, Jr., MD Linda S. Brodsky, MD Robert E. Butler, MD Sujana S. Chandrasekhar, MD, and Krishnan Ramanathan Ajay E. Chitkara, MD Felix W. K. Chu, MD Noel L. Cohen, MD, and Baukje Cohen Robin T. Cotton, MD James Croushore, MD James C. Denneny, III, MD David E. Eibling, MD Lee D. Eisenberg, MD, MPH, and Nancy Eisenberg Janelle A. Y. Engel, MD, and  E. Rodney Engel, MD Deborah J. Freehling, MD Lisa T. Galati, MD Raghuvir B. Gelot, MD, and Carolyn Gelot Samuel J. Girgis, MD Michael E. Glasscock, III, MD Jack L. Gluckman, MD, and Vickie Gluckman Barbara Goldstein, PhD Mary E. Gorman, MD Anna Kristina Elise Hart, MD, and William Todd Harder Jack V. Hough, MD John W. House, MD Stacey L. Ishman, MD, and Jim McCarthy Barry Jacobs, MD, and Mary Lynn Jacobs Jonas T. Johnson, MD, and Janis Johnson Srinivas R. Kaza, MD David W. Kennedy, MD Frank C. Koranda, MD Jamie Koufman, MD Dennis H. Kraus, MD Helen F. Krause, MD Vandana Kumra, MD Ronald B. Kuppersmith, MD, MBA, and Nicole Kuppersmith Rande H. Lazar, MD, FRCS Thomas B. Logan, MD, and Jo Logan Rick G. Love, MD Frank E. Lucente, MD Rodney P. Lusk, MD, and Constance C. Lusk, RN Sonya Malekzadeh, MD Phillip L. Massengill, MD Christina M. McAlpin, MD Pravina and Dinesh C. Mehta, MD Ralph B. Metson MD James L. Netterville, MD David R. Nielsen, MD, and Becky Nielsen Michael M. Paparella, MD, and Treva Paparella Spencer C. Payne, MD Angela M. Powell, MD Eileen M. Raynor, MD Richard M. Rosenfeld, MD, MPH Steven H. Sacks, MD Harlene Ginsberg and Jerry M. Schreibstein, MD Michael D. Seidman, MD, and Lynn Seidman Gavin Setzen, MD, and Karen Setzen Donna E. Sharpe, MD Abraham Shulman, MD Herbert Silverstein, MD William H. Slattery, III, MD Nancy L. Snyderman, MD James A. Stankiewicz, MD J. Pablo Stolovitzky, MD, and Silvia P. Stolovitzky Krishnamurthi Sundaram, MD Duane J. Taylor, MD Dana M. Thompson, MD, MS Ira D. Uretzky, MD, and Beth J. Uretzky P. Ashley Wackym, MD, and Jeremy Wackym Pell Ann Wardrop, MD Richard Alan Weinstock, DO, and Cheryl Weinstock Leslie K. Williamson, MD Lorraine M. Williams-Smith, MD, MPH Peak Woo, MD Geoffrey L. Wright, MD Jay S. Youngerman, MD Mark E. Zafereo, Jr., MD Patron Members Phyllis B. Bouvier, MD Newton J. Coker, MD, and The Coker Foundation Andrew L. de Jong, MD Hung J. Kim, MD Eugene N. Myers, MD, FRCS Edin (Hon) Rance W. Raney, MD Sustaining Members Eugene L. Alford, MD James H. Atkins, Jr., MD Douglas D. Backous, MD David L. Callender, MD, MBA Ted A. Cook, MD Amelia F. Drake, MD Marvin P. Fried, MD Michael Friedman, MD Cynthia Go, MD, PhD Jayson S. Greenberg, MD Joseph E. Hart, MD, MS Stephanie Joe, MD Nedra H. Joyner, MD C. Ramadas Kamath, MD Scott M. Kaszuba, MD J. Walter Kutz, Jr., MD Lisa A. Liberatore, MD James A. Manning, MD Philip A. Matorin, MD J. Cary Moorhead, MD Arthur B. Morgan, MD Warren E. Morgan, MD Bert W. O’Malley, Jr., MD Samuel M. Overholt, MD Robert B. Parke, Jr., MD, MBA Lisa Perry-Gilkes, MD Ravi N. Samy, MD Adam M. Shapiro, MD Sanford C. Snyderman, MD Joseph R. Spiegel, MD C. Richard Stasney, MD Michael G. Stewart, MD, MPH Mariel Stroschein, MD Debara L. Tucci, MD Robert A. Weatherly, MD Randal S. Weber, MD Stephen Kenneth Wolfe, MD Members Gregory M. Abbas, MD David A. Abraham, MD Peter Abramson, MD Finn R. Amble, MD Ronald G. Amedee, MD Nancy H. Appelblatt, MD Richard G. Areen, MD James E. Arnold, Sr., MD Oneida A. Arosarena, MD Moises A. Arriaga, MD Herbert J. Ashe, Jr., MD Dole P. Baker, Jr., MD Jeffrey L. Barber, MD William E. Barfield, III, MD David D. Beal, MD Edward G. Behrens, MD, PhD Michael S. Benninger, MD Peter D. Berman, MD Philip Bernstein, MD Todd Blum, MHA, MBA, CMPE Roger L. Boles, MD William R. Bond, Jr., MD Peter C. Bondy, MD Francis M. Bonner, III, MD Derald E. Brackmann, MD Carol R. Bradford, MD Jean Brereton, MBA Robin M. Brody, MD Patrick E. Brookhouser, MD Eugene G. Brown, III, MD Jimmy J. Brown, DDS, MD Neil E. Brown, MD Lani Cadow C. Ron Cannon, MD Linda M. Carroll, PhD, CCC-SL Salvatore M. Caruana, MD Roberta M. Case, MD David L. Cash, MD Ralph Cepero, MD Stephen J. Chadwick, MD C. Y. Joseph Chang, MD A. Craig Chapman, MD David I. Chenault, MD Jeffrey S. Chimenti, MD Khalid Chowdhury, MD, MBA Donald J. Clutter, MD Arthur S. Cohn, MD J. Christopher Colclasure, MD Jonathan D. Cooper, MD Stephanie Cordes, MD Susan R. Cordes, MD Anthony J. Cornetta, MD Stephen P. Cragle, MD Donald E. Crawley, MD R. Tyson Deal, MD Jennifer Derebery, MD Craig S. Derkay, MD Daniel G. Deschler, MD Eduardo M. Diaz, Jr., MD John E. Dickins, MD Elizabeth A. Dinces, MD Linda J. Dindzans, MD Thomas S. Dozier, MD Carl Drucker, MD Newton O. Duncan, III, MD David R. Edelstein, MD Jolene Eicher Wayne B. Eisman, MD John R. Emmett, MD Moshe Ephrat, MD Stephanie J. Epperson, PA-C David A. Evans, MD M. Bradley Evans, MD Jose N. Fayad, MD Ilana Feinerman, MD Alberto D. Fernandez, MD Valerie A. Flanary, MD and Casey Flanary W. Mark Flintoff, Jr., MD Robert A. Frankenthaler, MD Enrique T. Garcia, MD Edward K. Gardner, MD Glendon M. Gardner, MD James Geraghty, MD Mark D. Ghegan, MD Douglas A. Girod, MD Robert Glazer Cameron D. Godfrey, MD David A. Godin, MD Steven M. Gold, MD Scott H. Goldberg, MD Richard L. Goode, MD Barbara Salmon Grandison, MBBS Stacy T. Gray, MD Robert P. Green, MD Daniel Grinberg, MD Lawrence Grobman, MD Horacio P. Groisman, MD Eli R. Groppo, MD John R. Gross, FHFMA John J. Grosso, MD Benjamin Gruber, MD, PhD Steven D. Handler, MD Brenda Hargett, CPA, CAE J. Douglas Harmon, MD Willard C. Harrill, MD Graves Hearnsberger, MD Jacques A. Herzog, MD Barry Hirsch, MD Kenneth M. Hodge, MD Robert D. Hoffman, MD Lauren D. Holinger, MD G. Richard Holt, MD, MSE, MPH John R. Houck, Jr., MD Paul M. Imber, DO Tracy Jakob, MD Gina D. Jefferson, MD Alan J. Johnson, MD Ernest E. Johnson, MD Romaine F. Johnson, MD Daniel L. Jorgensen, MD V. Vasu Kakarlapudi, MD Michael J. Kearns, MD James F. Kimbrough, MD Matthew T. Kirby, MD Paul Kleidermacher, MD James J. Klemens, MD Evelyn A. Kluka, MD Timothy D. Knudsen, MD Darius Kohan, MD Mimi S. Kokoska, MD Howard S. Kotler, MD Frank G. Kronberg, MD John H. Krouse, MD, PhD Jeffrey J. Kuhn, MD David I. Kutler, MD Denis C. Lafreniere, MD Estella Laguna Christopher D. Lansford, MD Donald C. Lanza, MD, MS Pierre Lavertu, MD Jimmy W. Lee, MD Patty Lee, MD Marc J. Levine, MD Steven B. Levine, MD Roy S. Lewis, MD Alan F. Lipkin, MD Philip G. Liu, MD William M. Luxford, MD Keith Lynn Ellie Maghami, MD Robert H. Maisel, MD Wolf Jurgen Mann, MD, PhD Laurie E. Markowitz Spence, MD Bradley F. Marple, MD Theodore P. Mason, MD Edith A. McFadden, MD, MA Michael A. McGhee, MD Jeanne McIntyre, CAE Kevin X. McKennan, MD Claude A. McLelland, MD Edward L. McNellis, RPh, MD G. Walter McReynolds, MD David L. Mehlum, MD Jeffrey Miller, MD Richard T. Miyamoto, MD, MS Walter P. Moore, III, MD Barbara Morris, MD John R. Morris, MD Tara M. Morrison, MD Nathan E. Nachlas, MD J. Gail Neely, MD Mark L. Nichols, MD Michael C. Noone, MD Douglas A. O’Brien, MD Rick Odland, MD, PhD J. David Osguthorpe, MD Randall A. Ow, MD R. Glen Owen, Jr., MD John F. Pallanch, MD Rajiv T. Pandit, MD Simon C. Parisier, MD Bradford Patt, MD Linnea Peterson, MD James K. Pitcock, MD Christopher P. Poje, MD Jennifer P. Porter, MD Edward A. Porubsky, MD Loring W. Pratt, MD Shannon P. Pryor, MD Robert Puchalski, MD Gregory W. Randolph, MD Elisabeth H. Rareshide, MD John S. Rhee, MD, MPH Eugene A. Rivera, MD Richard A. Rosenberg, MD Eben L. Rosenthal, MD Michael A. Rothschild, MD Thomas A. Salzer, MD Perry M. Santos, MD, MS Robert T. Sataloff, MD, DMA Matthew David Scarlett, MD B. Todd Schaeffer, MD Robinson W. Schilling, MD Kristine Schulz, MPH Vanessa G. Schweitzer, MD and James W. Blair, MFG C. Willy Schwenzfeier, III, MD Shaun Scott, MD Samuel H. Selesnick, MD Michael Setzen, MD John J. Shea, Jr., MD Paul F. Shea, MD Clough Shelton, MD Stanford M. Shoss, MD H. Steven Sims, MD Richard V. Smith, MD Gary M. Snyder, MD Robert J. Stachler, MD J. Gregory Staffel, MD Wendy B. Stern, MD Fred J. Stucker, MD Marcelle Sulek, MD Erik R. Swanson, MD David J. Terris, MD J. Regan Thomas, MD Elizabeth H. Toh, MD Julio D. Torres, MD Christopher L. Vickery, MD Michael C. Vidas, MD Richard W. Waguespack, MD Hayes H. Wanamaker, MD Brian Shih-ning Wang, MD Marilene B. Wang, MD Mark K. Wax, MD Edward M. Weaver, MD, MPH Samuel C. Weber, MD Brian H. Weeks, MD Samuel B. Welch, MD, PhD W. Andrew Wells, MD Stephen J. Wetmore, MD Benjamin White, MD Alan B. Whitehouse, MD Adrian Williamson, III, MD John D. Witherspoon, MD Daniel L. Wohl, MD Gayle E. Woodson, MD Rhoda Wynn, MD Eiji Yanagisawa, MD Ken Yanagisawa, MD Kathleen Yaremchuk, MD John K. Yoo, MD Nancy M. Young, MD Bevan Yueh, MD, MPH Randall S. Zane, MD Lee M. Shangold, MD, and Lauren S. Zaretsky, MD David P. Zarin, MD Lee A. Zimmer, MD, PhD Karen B. Zur, MD Young Physician Members Nadir Ahmad, MD Ronda E. Alexander, MD Eric R. Anderson, MD Alba Miranda Azola, MD Charles J. Ballay, II, MD Margo M. Benoit, MD James T. Brawner, MD Gabriel Calzada, MD Daniel C. Chelius, Jr., MD Steven B. Chinn, MD David M. Cognetti, MD Carleton E. Corrales, MD Vasu Divi, MD Joni K. Doherty, MD, PhD Charles S. Ebert, Jr., MD, MPH Jonathan R. George, MD, MPH Tamer Abdel-Halim Ghanem, MD, PhD Rebecca D. Golgert, MD Heather J. Gomes, MD, MPH Selena E. Heman-Ackah, MD, MBA Brandon Isaacson, MD Suwicha Isaradisaikul, MD Alexis H. Jackman, MD Andreas Kaden, MD Ayesha N. Khalid, MD Oleg V. Kravtchenko, MD Jeffrey C. Liu, MD Amber U. Luong, MD, PhD Kelly Michele Malloy, MD Michael G. Moore, MD Samantha Marie Mucha, MD Daniel I. Plosky, MD Ksenia Prosolovich, MD Liana Puscas, MD Rahmatullah Rahmati, MD Nikhila Raol, MD Scott M. Rickert, MD Brianne B. Roby, MD Sarah L. Rohde, MD Lawrence M. Simon, MD Michael C. Singer, MD Lee P. Smith, MD Angela K. Sturm-O’Brien, MD Jonathan Y. Ting, MD Betty S. Tsai, MD Eric P. Wilkinson, MD Estelle S. Yoo, MD Philip B. Zald, MD Staff Members Rudy Anderson Caitlin Belford Jean Brereton, MBA Lani Cadow Irma Chavez Mary Pat Cornett Jenna Dean Brenda Hargett Eve Humphreys Estella Laguna Catherine R. Lincoln,  MA (Oxon) Jeanne McIntyre Heather McGhee Megan Schagrin Kristine Schulz, MPH Peter Taylor, MBA Joy L. Trimmer, JD Julie Wolfe Pamela S. Wood, SPHR b As of November 15, 2011
2011 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 2011 AAO-HNSF Annual Meeting & OTO EXPO in San Francisco, Academy and Foundation committees met and discussed achievements during the past year and planned for 2012. On the following pages are brief summaries of actions taken by many of the committees. The November 2011 Bulletin included listings of all committee members and an article on how to join a committee. The deadline for applications for the 2012 committee appointment process is February 1, 2012. Standing Committees Finance and Investment Subcommittee of the Board (FISC) John W. House, MD, Chair The subcommittee received and acknowledged the year-end June 30, 2011, Treasurer’s Report. Even though the audit had not begun at the time of the FISC meeting, the financial position of AAO-HNS/F is strong. Prodigy Asset Management provided the subcommittee with a status report of the AAO-HNS/F investments, noting that the recent downturn in the market was also affecting the returns on investment. The current portfolio strategy reflects a weighting toward high-quality, large-cap stocks. On November 2, 2011, the FISC met to review the Report of the Audit Committee.  An additional meeting of the FISC is scheduled for December. Budget development for 2012-2013 will begin in February 2012. Academy Committees Airway and Swallowing Committee Milan R. Amin, MD, and Joel H. Blumin, MD, Co-Chairs The A&S Committee has developed a comprehensive database of tracheotomy complications that has been initiated and run by committee member Stacey Leigh Halum, MD, in concert with several other members. The findings from the data were presented in a miniseminar at this year’s Academy meeting. The A&S Committee had several miniseminar proposals accepted for presentation this year at the Annual Meeting and all were well attended. The A&S Committee has embarked upon a project to collect data regarding transnasal esophagoscopy and its indications. This process is being spearheaded by committee member Michael J. Pittman, MD. Allergy, Asthma  and Immunology Committee Karen H. Calhoun, MD, Chair 2011 AAO-HNSF Annual Meeting & OTO Expo committee contributions. Presented four instruction courses: Sublingual Immunotherapy (SLIT)—Why and How? Skin Testing for Inhalant and Food Allergies. Eosinophilic Gastrointestinal Disorders for the ENT. Pediatric Allergy Update. Presented four miniseminars including: Food Allergy 2011: State of the Science. Facts and Fictions about Non-Allergic Rhinitis. Reviewed and updated the AAO-HNS Allergy Testing Clinical Indicator. Reviewed and updated AAO-HNS patient leaflets including: Allergies and Hay Fever. Antihistamines, Decongestants, and Cold Remedies. How Allergies Affect Your Child’s ENT. Reviewed and provided recommendations for edits to the Local Coverage Determination (LCD) draft for Allergen Immunology. Submitted the topic of Sublingual Immunotherapy (SLIT) to the Guidelines Development Task Force (GDTF) for consideration. Certificate Program  for Otolaryngology Personnel Committee  Peter A. Weisskopf, MD, Chair The Certificate Program for Otolaryngology Personnel (CPOP) hosted two workshops in Detroit, MI, and Dallas, TX, and the committee began a comprehensive CPOP program review and analysis. Credentials and Membership Committee  Pierre Lavertu, MD, Chair The Credentials and Membership committee is charged with determining eligibility for Academy membership, continuing review of Academy member categories, and developing campaigns to increase membership by making all otolaryngologist—head and neck surgeons aware of the need to support the Academy’s overall mission. At this year’s meeting, the committee discussed working closely with state societies to recruit and reinstate non-members and help in our efforts to ensure that we do not lose members who transition out of residency. It plans to review the Academy Bylaws—Article II Membership Section to see if the Bylaws should reference the maintenance of board recertification. Complementary/Integrative Medicine Committee Edmund A. Pribitkin, MD, Chair  In conjunction with the Medical Devices and Drugs Committee presented a standing room-only miniseminar on Alternative Treatments to Common ORL Problems: Help or Harm? Agreed to provide editors and authors a special issue of Otolaryngology Clinics of North America on Integrative Medicine. Numerous members presented well-received instruction courses on topics such as Herbal Therapy, Acupuncture for Otolaryngologists, and Improving Patients’ Quality of Life After Cancer Treatment. CPT and Relative Value Committee  Jane T. Dillon, MD, Chair During the 2010 Annual Meeting & EXPO in Boston, the CPT/RUC Committee voted to request a new CPT code to capture the work done in endoscopic Zenker’s diverticulum surgery.  The Physician Policy Payment Work Group (3P) agreed to this position since there is no specific code to report the procedure when it is performed endoscopically. Two surveys were conducted in 2011 to gauge members’ need for a new code. At the 2011 Annual Meeting & EXPO in San Francisco, the committee agreed to work closely with specialty societies (ALA, ABEA, and AHNS) that perform this procedure in order to craft the language for the code submission to the CPT Editorial Panel. The committee added representatives from many of the subspecialties to provide broader representation and to achieve the charge of coordinating efforts involving the CPT and RVU review of otolaryngology—head and neck services and other related policy issues. Diversity Committee  Duane J. Taylor, MD, Chair Received Model Committee Award. Established the initial funds for the Diversity Committee Endowment. Diversity Committee member Phyllis B. Bouvier, MD, gave an instruction course at 2011 meeting, which came out of the 2010 miniseminar. Dr. Taylor attended the Residents and Fellows Section meeting and encouraged continued involvement with the Committee. We have several new resident members. Working the Academy U® with volunteer members to establish modules on health disparities, cultural competency, and health literacy. Working on miniseminar for 2012 on health disparities, cultural competency, and health literacy. Plan to encourage and identify instructional courses that may relate to Diversity Committee’s charge and make sure attendees at next year’s meeting have collection of relevant courses prior to meeting. Coordination of multicenter research projects pertaining to health disparities and prevalence and treatment of otolaryngology disorders in diverse populations and looking at ways to increase the diversity of our specialty workforce in both clinical, and academic/research arenas, including mentoring programs. Endocrine Surgery Committee  Lisa A. Orloff, MD, Chair Ultrasound Workshop: Robert A. Sofferman, MD, reported on the second successful Ultrasound Workshop, with full attendance. Merry E. Sebelik, MD, will conduct a critical needs assessment survey in the fall asking residents how each program handles ultrasound issues. Guideline: Dr. Orloff reported that the Guidelines Development Task Force accepted the Recurrent Laryngeal Nerve Monitoring (RLN) proposal. The rigorous, formal process appoints a non-thyroid specialist as leader of the task force, with societal representatives having equal rank, and includes several medical organizations. Ralph P. Tufano, MD, stated that the American Thyroid Association (ATA) will recognize our guidelines; however, the Academy will not seek endorsement from other organizations. The comment phase will be completed in six months. ATA Guidelines: David L. Steward, MD, announced that the first meeting is at the ATA conference in October, when the current guidelines will be reviewed. The Endocrine Society holds another face-to-face meeting June 2012. Dr. Tufano and Maisie L. Shindo, MD, are working on a draft paper to present to the American Head and Neck Society (AHNS) in October, summarizing the miniseminar presented at the annual meeting by Robert L. Witt, MD. Miniseminar Proposals: Dr. Orloff recognized other thyroid miniseminars, representing much hard work. She invited proposals for next year and encouraged expanding speaker panels, such as CPT coding issues on new terms for neck dissection. Dr. Tufano and Gregory W. Randolph, MD, suggested handling of difficult cases, repeating the success of a few years ago. Relations with other Societies: ATA surgical affairs committee is including new members, and otolaryngology should be represented. Dr. Randolph, who is on the council of the International Association of Endocrine Surgeons, reported he would be happy to help committee members join this excellent organization. It meets every two years with the next one in Helsinki in 2013. David J. Terris, MD, stated that with Ashok R. Shaha, MD, as president of the American Association of Endocrine Surgeons (AAES), there are many opportunities to discuss a concrete timeline for changing membership status from associate to full member. Four committee members are AAES members. The Academy and AHNS should collaborate on placing members in other organizations, including the American Society of Clinical Endocrinologists (ASCE) and the Endocrine Society. The committee approved a motion to encourage Academy members to join thyroid-related organizations. Ethics Committee  Lauren S. Zaretsky, MD, Chair Responded to the American Medical Association (AMA) request on Opinions in the Code of Medical Ethics. Conducted a miniseminar during the 2011 Annual Meeting & OTO EXPO on ethical considerations of humanitarian efforts in the international arena. Actively contributed to the AAO-HNS/F Code for Interactions with Companies approval by the AAO-HNS/F Boards of Directors during the September 10, 2011, Board meetings. Moratorium on Expert Witness Testimony lifted, responsibility of oversight added to the charge of the Ethics Committee. Equilibrium Committee  Allan M. Rubin, MD, PhD, Chair The committee continues to work on the development of a set of treatment criteria for Meniere’s disease. The committee provided input into the update of the “Canalith Repositioning” clinical indicator. The committee provided feedback on a Dizziness Quality Measure developed by the Audiology Quality Consortium. Geriatric Otolaryngology Committee  David E. Eibling, MD, Chair The online book text for Geriatric Otolaryngology needs to be reviewed for website keywords and relevancy. The goals are: Look and review for missing topics such as Balance. Do review for currency and relevance and identify key words. While the deadline for keyword list is November 15, the goal is to have a total revision by our meeting next September 15. The study “Hearing Loss and Cognition Among Older Adults in the U.S.” (J Gerontal A Biol Sci Med Sci. 2011: July 18) from Johns Hopkins Center on Aging and Health was discussed as an important study to be shared throughout the membership and particularly with the Hearing Committees as a possible miniseminar topic. Head and Neck Surgery  and Oncology Committee Daniel G. Deschler, MD, Chair The committee was congratulated for the honor of being named a Model Committee by the AAO-HNSF at the Annual Meeting in San Francisco.  Members were thanked for their continued and significant educational and academic efforts which led to this award. This year the committee continued the strong tradition of successful miniseminar presentations with Oropharyngeal Cancer Tumor Board and Management of the Neck in Head and Neck Cancer in conjunction with the Head and Neck Education Committee.  The committee also co-sponsored the highly successful Sixth Annual Head and Neck Oncology Resident Education Symposium in conjunction with the AHNS. Hearing Committee Robert K. Jackler, MD, Chair Completed a review and update of 28 patient education materials. Established a comprehensive hearing classification scale, which will be submitted to the AAO-HNS Board for approval in December 2011. Imaging Committee Gavin Setzen, MD, Chair As of the 2011 annual meeting, the CT Imaging Workgroup officially became the Imaging Committee. Recent Academy wins as a result of Committee members’ efforts include National Imaging Associates recognizing accreditation for advanced imaging from the Accreditation of Computed Tomography Laboratories (ICACTL), and a collaborative effort with the American Medical Association, Kentucky state societies, and the Association of Otolaryngology Administrators that resulted in Humana reversing its coverage position on mini-CT scans. Other major health policy activities included:  review and input on the American College of Radiology (ACR) Appropriateness Criteria, with coordination from many other Academy committees; and coordinated advocacy efforts to oppose the Medicare Payment Advisory Commission (MedPAC) recommendations on in-office imaging services in its June 2011 report. Also, committee members reviewed all relevant 2011 annual meeting instructional courses and miniseminars, and identified any that were relevant to imaging services and would meet accreditation requirements for ICACTL. A list of the courses was provided to members via the Academy website and communicated to members via The News. The Committee will continue its policy advocacy efforts and is working to expand educational offerings on imaging through the Academy to meet ICACTL accreditation requirements. Implantable Hearing Devices Subcommittee Jeffery J. Kuhn, MD, Chair New fact sheet for Cochlear Implants and Meningitis Vaccination. Published an article in February Bulletin: “Pneumococcal Vaccination: Updated CDC Recommendations for Cochlear Implant Patients.” Academy website updates for Cochlear Implants and Meningitis Vaccination plus revised links to updated vaccination information. Cochlear Implants and Meningitis Vaccination Awareness Campaign II launched in conjunction with cochlear implant manufacturers. Review of Medical Policy on Cochlear Implants from WellPoint and United Healthcare. Currently participating in CMS MEDCAC (Medicare Evidence Development and Coverage Advisory Committee) meeting on AHRQ Technology Assessment review of bilateral cochlear implantation. Infectious Disease Committee Patrick J. Antonelli, MD, Chair The committee reviewed materials provided by the Infectious Diseases Society of America regarding the  10 x ’20 Initiative. The campaign seeks to promote research and development to produce 10 new antibiotics by 2020. The committee assisted the Centers for Disease Control and Prevention in reviewing materials for Recreational Water Illness and Injury Prevention Week. Media and Public Relations Committee Wendy B. Stern, MD, Chair The committee will continue its existing support of Academy PR minicampaigns and develop the 2012 minicampaign calendar. They are working on branding and exploring new marketing opportunities for the “Primary Care in Otolaryngology” handbook for medical students and nurses, currently on the Academy website. The committee also will hold a spring meeting and media training session at the 2012 BOG Spring meeting (May 6-7, 2012) for the committee and the BOG PR representatives. Patient Safety and Quality Improvement Committee  David W. Roberson, MD, Co-Chair, and Rahul K. Shah, MD, Co-Chair This year the committee focused on a number of projects, including: A database study on trends in ORL closed claims and risk factors for closed claims in Endoscopic Sinus Surgery 2005-2009. The purpose of this claims-based study, data provided through The Doctors Company, was to gain access to de-identified liability claims data, identify opportunities for interventions for particular patterns of practice that led to safety events/claims, and development of targeted tools for members addressing these issues. Catastrophic Outcomes with Tracheotomy survey was designed to gauge the experience of otolaryngologist—head and neck surgeons in caring for tracheotomies and potential complications. There were 480 respondents to this survey. A miniseminar was presented at the 2011 AAO-HNSF Annual Meeting & OTO EXPO. A manuscript is in development. Tonsillectomy disasters survey. The survey was designed to determine the variation in post-tonsillectomy admission practices and create a better understanding of the likelihood of apneic death on post-op day one. Also, the survey was designed to evaluate delayed bleeding complications in tonsillectomy patients. There were 546 respondents to the survey. Analysis and manuscript development is under way. Studies on post-admission criteria for Obstructive Sleep Apnea and a handoffs project are also under way. During their meeting, members submitted many ideas for this year’s work plan for both database studies and survey topics. The committee determined that it would focus on EMR/CPOE and patient safety; use of surgical checklist and universal protocol in ORL; patient safety culture: perspective from otolaryngologists; and balloon sinuplasty utilization. Dr. Shah continues to address the most recent and relevant information on patient safety and quality improvement in his monthly Bulletin column. Pediatric Otolaryngology Committee David E. Tunkel, MD, Chair Miniseminars at the 2011 Annual Meeting & OTO EXPO in San Francisco sponsored by the pediatric otolaryngology committee included “Safer Imaging of Children with Otolaryngologic Disease,” submitted by Julie L. Wei, MD, and “Advances in Pediatric Cholesteatoma,” submitted by David R. White, MD. “Tympanostomy Tubes in Children” was successfully submitted to the Guideline Development Task Force by Dr. Tunkel as a potential clinical practice guideline. Committee members reviewed and revised the content of AAO-HNSF literature and fact sheets with pediatric content.  This will continue as part of the website content relevancy project. Physician Resources Committee David W. Kennedy, MD, Chair This committee continues with its focus on education and tools needed to prepare for workforce shortages and workforce changes. During its meeting, the committee discussed formulating small subcommittees to look at several of the issues affecting ORL future work force. The committee heard from the AAPA liaison about progress in physician assistant training initiatives over the past year and discussed a parallel project on training in addition to the work by subgroups on workforce supply models and exploring geographic issues affecting workforce numbers. Plastic and Reconstructive Surgery Committee James R. Jordan, MD, Chair Donna J. Millay, MD, Chair-Elect The committee has primarily been involved in drafting responses to a variety of issues raised by third-party payer policy changes. For example, when United Healthcare sought to change its policy concerning coverage of septoplasty and rhinoplasty, members of the committee were called on to respond. After several conference calls, favorable revisions were made to the policy to remove some of the more restrictive language. The committee continues to work to foster improved relations with other societies that perform plastic surgery of the facial structures. Rhinology and Paranasal Sinus Committee Scott P. Stringer, MD The committee provided expert input to letters the Academy sent to Blue Cross Blue Shield Association (BCBSA) regarding a reference medical policy on “Balloon Sinuplasty for Treatment of Chronic Sinusitis” and to WellPoint on “Functional Endoscopic Sinus Surgery (FESS).” The committee also reviewed nine Clinical Indicators. They have discussed several miniseminar topics, including infectious disease safety and training and regional variation in management of sinusitis, to co-sponsor with American Rhinology Society (ARS) for the 2012 Annual Meeting in Washington, DC. Medical Devices and Drugs Committee Udayan K. Shah, MD, Chair The committee co-sponsored the following 2011 miniseminars: “Alternative Treatments to Common ORL Problems: Help or Harm?,” “Device Complications: What Does the Surgeon Do?,” “Pediatric Sinusitis: Drugs and Devices,” and the instructional course: “Talking to Lawyers: Effectively Managing Legal Relationships.” A survey was conducted of members to provide data on industry reps in the OR and the committee plans to solicit members again the end of 2011 to obtain more data. The committee plans to submit the following miniseminars for 2012: “Cochlear Implant Device Failures,” co-sponsored with Otology & Neurotology & Education Committee and Implantable Hearing Devices Subcommittee; “Interplay of Innovation and Scope of Practice,” to be co-sponsored by the BOG Legislative Committee; “Stents and Sciences,” to be explored for content with the Rhinology & Allergy Committee; and “Tonsillectomy—Which Device When,” to be explored for content with the Pediatric Otolaryngology Education Committee. Medical Informatics Committee Edward B. Ermini, MD, Chair Reviewed Meaningful Use recommendations from Health and Human Services Office of the National Coordinator and provided extensive comments. Published the article, “Meaningful Use of Electronic Health Records in Otolaryngology: Recommendations from American Academy of Otolaryngology–Head and Neck Surgery Medical Informatics Committee,” in the February 2011 issue of Otolaryngology–Head & Neck Surgery. Provided Instruction Courses at 2011 annual meeting on “EHR/EMR and Meaningful Use” and “Using HIT/EHR for Quality Care.” Represented the Academy at the Federation of State Medical Boards (FSMB) conference on Telemedicine. Microvascular Committee Douglas B. Chepeha, MD, MSPH 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 five have sent in their data on 75 patients. The goal of this effort is to understand how different approaches to reconstruction affect fistula rate. 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-HNSF. The committee has also taken on a bold effort to post educational videos of donor site elevations of autogenous transplantation. Skull Base Surgery Committee Gregory J. Artz, MD Douglas D. Backous, MD, Chair The committee presented a miniseminar, moderated by Carl H. Snyderman, MD, “Avoiding Disaster at the Skull Base: Case Studies in 3D,” at the annual meeting in San Francisco. The committee plans to submit another miniseminar to be considered for the 2012 AAO-HNSF Annual Meeting & OTO EXPO in Washington, DC. Sleep Disorders Committee Pell Ann Wardrop, MD The committee drafted a policy statement for Midline Glossectomy, which has been approved by the BOD. The committee updated the clinical indicators for Uvulopalatopharyngoplasty, Tonsilloadenoidectomy, and Adenoidectomy, and these are pending approval.  The committee also updated the following patient education materials: Continuous Positive Airway Pressure, Oral Appliances, Pediatric Obstructive Sleep Apnea, Surgical Treatment for Obstructive Sleep Apnea, Treatment Options for Adults with Snoring. The Board of Directors approved the committee’s request that a sleep medicine track be developed under the Academy’s educational and annual meeting offerings. Two clinical studies, headed by members of the Sleep Disorders Committee investigating the effect of tonsillectomy on OSA, are enrolling patients. The committee, with the assistance of the AAO-HNS Health Policy division, responded to several third-party payer issues or policies relating to treatment of patients with sleep disordered breathing. Twelve committee members have volunteered to participate in the website relevancy project. Throughout the year, there was active participation by members of the committee and by many other non-official committee member physicians with an interest in sleep medicine. Trauma Committee Joseph Brennan, MD, Col., USAF, Chair After years of preparation, the Trauma Committee held its first meeting as an official committee of the Academy. With more than 25 members, consultants, and guests of the Trauma Committee present, there was much to discuss. The committee is looking forward to educating the specialty on trauma by creating a comprehensive plan for next year that includes submitting: four miniseminars, at least two research areas for instruction courses, multiple Bulletin articles throughout the year, and the opportunity for a Saturday workshop on disaster preparedness. The Trauma Committee is excited to get started on their many different endeavors and hopes that everyone within the specialty will gain a greater knowledge and awareness of how trauma will affect their patient population. Voice Committee Clark A. Rosen, MD, Chair The committee is opposed to the recent reversal of the CMS stroboscopy supervision rules for speech pathologists and will work toward a compromise between the present “no supervision, no otolaryngology involvement” status and toward a goal of improving otolaryngology involvement in speech pathologists performing stroboscopy. The committee has partnered with medical industry to submit a series of HCPCS codes for vocal fold injection material billing that will allow otolaryngologists to bill for vocal fold injection material in an outpatient setting. CMS decision regarding this submission is pending. Young Physicians Committee (YPC)  Monica Tadros, MD, Chair Ayesha N. Khalid, MD, Co-Chair At this year’s meeting, the committee voted to 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. James L. Netterville, MD, President-Elect of the AAO-HNS, has made it clear that he wants us all to have an active voice and participate in AAO-HNS activities. The YPC is planning on developing a work taskforce for collaborating with the Women in Otolaryngology Section, Section for Residents and Fellows-in-Training, and the Board of Governors in developing a successful mentorship program and pathway to leadership for young physicians who are transitioning into practice. The committee is also interested in working with Wendy B. Stern, MD, chair of the Media and Public Relations Committee to offer young physicians media training in May 2012 during the BOG Spring Meeting and Annual Advocacy Conference. Foundation Committees International Steering Committee Gregory W. Randolph, MD, Chair Dr. Randolph welcomed new members, Milan Profant, MD, and Ashok R. Shaha, MD. The third Global Health symposium in 2012 will offer descriptive or clinical papers. David W. Kennedy, MD, recommended geopolitical topics from each country, such as workforce management and scope of practice. Dr. Randolph announced the International Speakers Bureau will have a new credentialed format. The white journal is soliciting international manuscripts and regional advisors will be invited to select articles and write an introduction. The journal publisher is promoting subscriptions, including an Internet subscription portfolio. James E. Saunders, MD, reported the Kenya society is now an ICS affiliate; the second Africa Caucus met at the 2011 annual meeting; and the Central African meeting, June 3-6, 2012, is a high priority. Pablo J. Stolovitzky, MD, reported on many Latin American meetings, including joint meetings. Eugene N. Myers, MD, honorary president of the Balkan Society, attended a strategic meeting in Antalya, Turkey, and in spring 2012 will visit the Balkan Congress venue in Romania. Dr. Kennedy attended an all-Scandinavia meeting, and in 2012 will attend the Romanian Society’s congress, Prof. Heinz Stammberger’s meeting in March, and the European Rhinology meeting, Toulouse, France, June 2012. G. Richard Holt, MD, MSE, MPH, reported on the Middle East Arab spring, noting the joint meeting in Egypt January 12, 2013. We have active relations with Jordan, Iraq, Turkey, and Syria. Ramon A. Franco, Jr., MD, reported on three or four joint meetings in 2011 and 2012 in Central America. Dr. Randolph reminded the committee that the 2011 guest countries were Australia, France, Germany, Japan, and Switzerland, and the 2012 guest countries will be Chile, Israel, Spain, and Vietnam. Dr. Shaha reported that the International Federation of Head and Neck Oncological Societies (IFHNOS, founded in 1988) now has 48 societies in 42 countries. IFHNOS has held Congresses in Mumbai, Rio de Janeiro, Prague, and Seoul, with 800 to 900 attendees. Memorial Sloan Kettering Cancer Center will celebrate its centennial July 22-26, 2014, by hosting the IFHNOS congress together with AHNS. IFHNOS has organized a month-long Global Tour in 2008, 2010, and 2012. International Otolaryngology Committee Nikhil J. Bhatt, MD, Chair Dr. Bhatt encouraged committee members to be active, inviting inactive members to step down, and congratulated the International Visiting Scholars and International Corresponding Societies programs. Dr. Bhatt introduced representatives of the Association of Otolaryngologists of India Congress (AOICON) who discussed planning of the January 2013 meeting in Pune, India. Stella E. Rowley, MD, urged attendance at the Panamanian Society’s joint meeting January 26-28, in Panama, featuring J. Regan Thomas, MD, and 11 other American Academy members as speakers. Prof. Karl Hormann stated that the joint European Academy/EUFOS meeting July 2011 in Barcelona totaled 4,000 attendees. The next step is the fourth board examinations in Vienna. Dr. Saunders reported that the WHO staff position now has bridge funding through donations; government funding/lobbying is still needed. The committee supported active member recruitment, including inviting a resident or fellow to attend the annual meeting. Michael J. Rutter, MD, urged the committee to use Academy promotional PowerPoint slides at conference and courses, with the Call for Papers and membership information. Nikhila Raol, MD, will review Twitter and Facebook as recruitment channels. Instruction Course Advisory Committee The Instruction Course Advisory Committee reviews and develops the afternoon instruction course programs for the Annual Meeting  & OTO EXPO. At the 2011 Annual Meeting & OTO EXPO, 344 instruction courses were presented. Humanitarian Efforts Committee James E. Saunders, MD, Chair Dr. Saunders reported the committee met face-to-face at COSM and held two conference calls. The WHO staff position received bridge funding through directed donations, of which the Academy contribution was key. International Visiting Scholarships have quadrupled in the last four years from two to eight. The Coalition for Global Hearing Health will meet early June 2012 in South Africa at an educational facility with temporal bone labs before the Central Africa meeting. Nazaneen N. Grant, MD, gave an update on the Humanitarian Opportunities pilot phase, recreated with searchable tools at The next steps are to populate the database, adding more organizations and a field for urgent need. The committee’s work groups interact with other disciplines, including Susan R. Cordes, MD, (thyroid instruction committee, liaison head and neck thyroid) and Eric P. Wilkinson, MD, (otology). The Emergency/Disaster Relief (earthquakes, floods) was separated from Telemedicine as a new work group for patient prescreening and follow-up. Peggyann Nowak, MD, urged members to get vetted for disaster relief through the AMA Disaster relief database. The American College of Surgeons (ACS) Operation Giving Back offers procedure-based disaster response training. Dr. Saunders and Eric P. Wilkinson, MD, will submit a humanitarian otology miniseminar for the IFOS World Congress 2013. Steven L. Goudy, MD, reported on his liaison with the Pediatric Committee and the American Cleft Palate Association. History and Archives Committee Lawrence R. Lustig, MD, Chair The committee discussed: Showing the value for Otolaryngology Historical Society (OHS) membership, such as an OHS member certificate and directory, an archive of past talks, a Facebook group, an essay competition, and a speakers’ bureau with talks on the specialty heritage for Grand Rounds, local libraries, and communities. A miniseminar abstract for 2012 on the history of hearing conservation, the birth of Medicare/Medicaid, and other topics. A Bulletin 2012 editorial calendar for monthly historical items. A reduced membership rate for residents and military members. The chair recruited volunteers to staff the booth. Next year, the booth will display historical artifacts. The committee will review procedures for acquisitions, donations, and retention. The committee approved digitizing the oral histories. Charles R. Pettit, MD; Jeremy D. Prager, MD; and Robert J. Ruben, MD, volunteered to review the website. Outcomes, Research, and EBM Subcommittee Scott E. Brietzke, MD, MPH, Chair This year, two members were awarded travel grants to attend the Cochrane Colloquium in Madrid, Spain; they will each develop a systematic review, one on chronic cough and the other on macrolide therapy for rhinosinusitis, to be published over the next year. Three committee-sponsored miniseminars were accepted for presentation at the annual meeting in San Francisco. Featured in the research section of the July Bulletin, an article titled, “Evidence-based Practice and Otolaryngology: Where Are We Now and Where Are We Going?” was written by the leadership subcommittee to highlight existing evidence-based medicine publications and to highlight a prioritized list of evidence gaps requiring further research.  Currently, the leadership subcommittee is developing a new work plan for 2012 and prioritizing abstracts for submission to the 2012 annual meeting in Washington, DC. Panamerican Committee Hector E. Ruiz, MD, Chair Dr. Ruiz introduced Juan Manuel Garcia Gomez, MD, as chair-elect. The committee made a motion for the chair to review symposium proposals for the 2012 meeting. Dr. Garcia suggested hot topics such as compare/contrast Panamerican approaches to sleep apnea, HPV prevalence, robotic surgery, and setting up a clinic. Roxana Cobo-Sefair, MD, recommended offering handouts in both Spanish and English. Luis F. Encarnacion, MD, stressed keeping a Latin American space at the meeting because industry support is changing. The committee proposed developing a database of Latin American ENTs in the U.S. as well as U.S. members who speak Spanish. Dr. Garcia will write a Bulletin article about the Panamerican Association, noting that it was launched in 1946 in Chicago. Dr. Ruiz announced upcoming joint meetings, e.g., Paraguay, Argentina, and Colombia. Program Advisory Committee The Program Advisory Committee reviews and develops Scientific Program content for the Annual Meeting & OTO EXPO. At the 2011 annual meeting, 88 miniseminars were presented, 299 oral presentations were delivered, and 468 posters were on display. Board of Governors Committees Representatives from Board of Governors societies across the country were well represented during the BOG meetings held during the 2011 AAO-HNSF Annual Meeting & OTO EXPO. Highlights from the meetings include: BOG Development/Fundraising Task Force Jay S. Youngerman, MD, Chair The Task Force chair gave an overview of the Foundation’s development programs including the Millennium Society, Partners for Progress, and the Hal Foster, MD, Endowment and welcomed Nikhil J. Bhatt, MD, as the newly appointed AAO-HNSF Board of Directors’ Development Coordinator. Following the meeting, Task Force Members worked to raise more than $125,000 for the AAO-HNSF mission and speak with members about the upcoming deadline (December 31, 2011) to become a Hal Foster, MD, Endowment Founding Donor. Visit On October 4, 2011, taskforce members mourned the loss of our Task Force Co-Chair, Helen F. Krause, MD. Dr. Krause will be remembered fondly for her significant contributions to the specialty and for her dedicated work to this committee and the BOG. BOG Legislative Representatives Committee Paul M. Imber, DO, Chair The Committee received updates on current federal and state legislative activities for 2011, including Medicare physician payment reform, repeal of the Independent Payment Advisory Board, and ongoing scope-of-practice battles. In addition, it received an update on new programs and fundraising activities for ENT PAC, the political action committee of the AAO-HNS. The committee also heard about grassroots efforts and advocacy programs, such as JSAC 2011 and plans for an advocacy day in 2012, the ENT Advocacy Network Recruitment Contest, and coalition efforts. Guest speakers included Larry N. Smith, MD, a member of the committee who presented a proposed resolution on uncompensated and undercompensated healthcare tax deductions, and Ms. A. J. Kennedy with the Californians Allied for Patient Protection (CAPP), who spoke on medical liability reform efforts in California. BOG Socioeconomic and Grassroots Committee  Denis C. Lafreniere, MD, Chair Featured a panel discussion of Scope of Practice (SOP) issues. Guest speaker, Deb Osborn, Executive Director, Connecticut Ear, Nose and Throat Society presented, “How to Make Your State Society Work for You.” Invited guest speaker, Richard W. Waguespack, MD, presented an update on the recent Zenkers Diverticulum Survey. Guest speaker, Larry N. Smith, MD, monitored additional discussion of his proposed resolution, “Uncompensated and Undercompensated Healthcare Tax Deduction.” BOG Executive Committee-sponsored Miniseminar—Hot Topics in Otolaryngology Peter Abramson, MD, BOG Secretary Dr. Abramson moderated a compelling panel presentation on current hot topics in otolaryngology. They were reimbursement for emergency department coverage, hospital/physician joint adventures, and an update on payments for EHR and meaningful use. BOG General Assembly BOG committee chairs provided updated reports on their committee’s activities from the past year Marcella R. Bothwell, MD, received the 2011 BOG Practitioner Excellence Award. The Pennsylvania Academy of Otolaryngology—Head and Neck Surgery received the 2011 BOG Model Society Award and the Virginia Society of Otolaryngology/Head and Neck Surgery received an Honorable Mention 2011 Model Society Award. Michael D. Seidman, MD, BOG Chair, presented Recognition Awards to Gavin Setzen, MD, and Dr. Abramson for their service on the BOG Executive Committee. Dr. Seidman presented BOG Chair Awards to Rick G. Love, MD, Richard D. Nichols, MD, and Herbert Silverstein, MD, in memory of John Kemink, MD, and Academy BOG staff liaison, Richard Carson. Governors (or their alternates) in attendance elected Dr. Lafreniere to the position of BOG Chair-Elect and Dr. Stern to the position of BOG Secretary. Education Committees Education Steering Committee Mark K. Wax, MD, Chair, Coordinator of Education The Education Steering Committee discussed several new initiatives for the education committees to focus on in 2012. These new initiatives include COCLIA and Image Viewer updates, the Maintenance Manual for Lifelong Learning revisions, question pool development, and the Website Content Relevancy project to identify key words for all education activities. 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 held regionally each year. Its members serve as experts in ever-changing coding and practice management issues. In addition, the committee produced courses on “Implementing an Electronic Medical Record System” and “Lessons Learned in 20 Years in the Medicolegal System.” Facial Plastic and Reconstructive Surgery Education Committee Fred G. Fedok, MD, Chair The committee produced an AcademyU® course on “The Use of Botulinum Toxin in Otolaryngology” in addition to online lectures in “Incisionless Otoplasty,” “Adult with Complex Maxillofacial Trauma,” “Advanced Aesthetic and Functional Rhinoplasty,” and “Surgical Rejuvenation of Forehead and Brow.” General Otolaryngology Education Committee Karen T. Pitman, MD, Chair The committee was pleased to publish the third edition of Primary Care Otolaryngology, the primer on otolaryngology for medical students, residents, and non-otolaryngologists. In addition, it provided leadership to the successful ENT for the PA-C conference held in conjunction with AAPA and SPAO. It also produced courses on “Laryngopharyngeal Reflux,” Adult with Oral Cavity Lesion,” and “Pediatric Neck Mass Due to MRSA.” Head and Neck Surgery Education Committee Dennis H. Kraus, MD, Chair The committee produced several courses including online lectures and Patient of the Month and AcademyU® courses. Topics covered include “Neck Dissection for Thyroid Cancer,” “Pregnant Patient with Thyroid Mass,” and “Basic Head and Neck Pathology.” In addition, HNSEC completed a section of the Home Study Course on Inflammatory Diseases of the Head and Neck. Laryngology and Bronchoesophagology Education Committee (LBEC) J. Dale Browne, MD, Chair The committee produced online lectures covering such topics as “Phonomicrosurgery for Benign Pathology,” “The Office Dysphagia Consult,” and “Professional Singers: The Science and Art of Clinical Care.” In addition, LBEC completed a section of the Home Study Course on Laryngology, Voice Disorders, and Bronchoesophagology. Otology and Neurotology Education Committee (ONEC) Cliff A. Megerian, MD, Chair The committee produced several AcademyU® courses and online lectures in 2011, including “Steroids for Sudden Hearing Loss,” “Techniques to Simplify Myringoplasty,” and “Cochlear Implants in Children and Adults.” In addition, ONEC completed a section of the Home Study Course on Otology and Neurotology. Pediatric Otolaryngology Education Committee Sugki S. Choi, MD, Chair The committee produced a Patient of the Month course on “Child with Nasal Congestion,” and online lectures on Autism and Asperger’s for the Practicing Otolaryngologist,” “Sensorial Hearing Loss in Infants and Children,” and “Stridor and the Pediatric Larnyx.” POEC also completed the Pediatrics section of the Home Study Course. Rhinology and Allergy Education Committee James A. Hadley, MD, Chair The committee completed a section of the Home Study Course on Rhinology and Allergy Disorders. In addition, RAEC produced an AcademyU® course on the “Management of Sinonasal Cerebrospinal Fluid Leaks” and online lectures on “Radiation Safety and Point of Service CT Imaging” and “Medical Strategies for Treatment of Refractory Sinusitis.” Sections/ Advisory/ Other Committees Centralized Otolaryngology Research Efforts (CORE) Study Section Jay O. Boyle, MD, Co-Chair, Lawrence R. Lustig, MD, Co-Chair, and Richard R. Orlandi, MD, Co-Chair Seventy-seven individuals participated in the Study Section, including 11 residents. Reviewed 151 grant applications requesting $2,310,922 in research funding. Identified 38 grant applications for funding and made recommendations to the participating subspecialty society leadership. Ultimately, $629,067 was awarded by the subspecialty society leadership. Physician Payment Policy (3P) Work Group Richard W. Waguespack, MD, and Michael Setzen, MD, Co-chairs 3P is the senior advisory body to Academy leadership and staff on issues related to socioeconomic advocacy, regulatory activity, coding or reimbursement, and practice services or management. 3P and the Health Policy staff continue to ensure that members’ interests are appropriately represented.  Coordination with other Academy committees, subspecialties, and medical specialty societies are critical to 3P’s success. We thank all involved in recent advocacy efforts. We continue to maintain the Academy’s visibility with top Medicare representatives at the CMS during formal and informal face-to-face meetings and comment letters submitted on behalf of members. The Academy has excellent representation at the AMA’s CPT and RUC meetings. 2010-2011 highlighted advocacy efforts include: Receiving Separate Payment from the CMS for Epley Maneuver as of January 1, 2011, and a joint effort with subspecialities to successfully advocate for changes to United Healthcare Rhinoplasty, Septoplasty and Repair of Vestibular Stenosis coverage guideline. The 2011 Socioeconomic Survey was launched, received a 23-percent response rate, and the data was analyzed with trend results unveiled at the annual meeting in San Francisco. Template appeal letters on septoplasty, image guidance, and patient notification of additional costs to some diagnostic procedures performed in-office were drafted and made available to members. Six CPT Assistant articles were drafted, and 3P leaders provided guidance to 22 coding inquiries received by the AMA. The following health policy sessions were held in San Francisco at the 2011 annual meeting: 3P miniseminar on new strategies in Academy advocacy for physician payment, RUC survey instrument education seminar, the Medicare Contractor Advisory Committee (CAC) education, and ICD-9 transition to ICD-10. 3P and the Health Policy Team plan on providing these educational sessions again in 2012 in Washington, DC. In the next year, an increased effort will be made to emphasize the importance of filling out RUC surveys. For additional information on any of these issues, contact Section for Residents and Fellows-in-Training (SRF) Mark E. Zafereo, Jr., MD, Chair The Section for Residents and Fellows-in-Training (SRF) functions as an advisory body to the Board of Directors (BOD).  During the annual meeting, Monday was officially designated as Residents Day with several events specially geared toward residents. SRF General Assembly The Section held a well-attended General Assembly meeting.  During the session, attendees elected the following new officers: Jayme R. Dowdall, MD, Chair Nikhila Raol, MD, Vice Chair Nathan A. Deckard, MD, Information Officer Angela K. Sturm-O’Brien, MD, Member-at-Large Estelle S. Yoo, MD, BOG Governor Kanwar S. Kelley, MD, BOG Legislative Representative Alba M. Miranda, MD, BOG Public Relations Representative In addition, Dr. Mark Zafereo, Jr., transitioned to Immediate Past Chair. SRF-sponsored Miniseminars “Practice Considerations and Contracts for New Employment” (with Women in Otolaryngology, WIO Section) “Mentor and Mentee Skills: Tools from Residency to Practice and Beyond” Other Featured Resident Event Opportunities Available During the Annual Meeting & OTO EXPO Included: Free Instruction Courses for Residents Academy Members Poster Presentations ENT Careers Live! AcademyU® Learning Lab Women in Otolaryngology (WIO) Section Sonya Malekzadeh, 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. In December 2010, the Board of Directors (BOD) unanimously approved the transition of the WIO Committee to full section status. To this end, the Section’s governing council leaders hit the ground running and organized an impressive program of events that were held during the annual meeting. WIO Luncheon/General Assembly Following the Nancy L. Snyderman, MD, Keynote “Transitions,” the Section honored Ronald B. Kuppersmith, MD, MBA, and Dr. Malekzadeh as co-recipients of the first Helen F. Krause, MD, Trailblazer Award. The WIO Governing Council also honored Dr. Malekzadeh, WIO Section Chair, for her dedication and hard work in making the Section so successful. 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 Section has six committees that members can serve: Leadership Development and Mentorship; Awards; Program; Research and Survey; Communications; and Endowment. The WIO Endowment Fund has continued to be very successful in its fundraising efforts. WIO-sponsored Instruction Courses and Miniseminars (SSAC) Instruction Course: “Gender and Leadership in OHNS.” Instruction Course: “Ten Essentials to Negotiating Otolaryngology.” Miniseminar: “International Healthcare and Women: The Roles and Challenges of Women in Sustainable Humanitarian Outreach.” Miniseminar: (with Young Physicians Committee, YPC) “Mentor and Mentee Skills: Tools from Residency to Practice and Beyond.” Miniseminar: “Finding Balance in a Surgical Career.” Miniseminar: “Practice Considerations and Contracts for New Employment.” (with Section for Residents and Fellows, SRF). Instruction Course: “Avoiding Academic ‘Burn-Out’ for Women in Otolaryngology.” Specialty Society Advisory Council (SSAC) Marvin P. Fried, MD, Chair The Specialty Society Advisory Council had a productive meeting in September, identifying many opportunities for collaboration among societies. The AAO-HNS presented its newly adopted “Code for Interactions with Companies,” modeled after the code developed by the Council for Medical Specialty Societies (CMSS). Content collaboration will be at the forefront of the SSAC agenda over the next year. Working closely together, the AAO-HNSF is proceeding with educational initiatives in collaboration with the specialty societies, producing content that encompasses the entire specialty and eliminating duplications.
AAO-HNS/F: Code for Interactions with Companies
On May 2, 2011, following several in-depth discussions at the AAO-HNS/F Executive Committee and Board levels, including a Board-appointed task force, and after a thorough comparison of the Council for Medical Specialty Societies (CMSS) Code to existing AAO-HNS/F policies, the AAO-HNS/F Boards of Directors approved our sign-on to the CMSS Code for Interaction with Companies. Annually, AAO-HNS/F will affirm to CMSS that its code continues to be adhered to.  On September 10, 2011, the AAO-HNS/F Boards of Directors approved the adoption of the AAO-HNS/F Code for Interactions with Companies. The AAO-HNS/F Code is based on the CMSS Code and its Annotations, and has been adapted to the specific situations of AAO-HNS/F. Certain aspects of the AAO-HNS/F Code are more rigorous than the CMSS Code.  Lauren E. Zaretsky, MD, Chair  Ethics Committee As the practice of medicine evolves, and, more specifically, the business of medicine becomes more complicated, our definition of professionalism must also change. The AAO-HNS/F Boards and Ethics Committee are charged with keeping the Code of Ethics current. The Council for Medical Specialty Societies (CMSS) asked all medical specialty societies to look at the relationship between physicians, societies, and industry. A task force of representatives from more than 30 CMSS member organizations worked collaboratively to draft a document in response to this charge. It is crucial that the programs, policies, and advocacy positions of organized medical societies achieve independence and minimize conflicts of interest. After a thorough evaluation of the CMSS Code and changes to account for the unique practice of otolaryngology, AAO-HNS/F, in conjunction with the Ethics Committee, adopted its own version of the document. The AAO-HNS/F Code for Interactions with Companies is now a formal part of our Code of Ethics and can be referenced by going to It is important to remember that each of us as Academy members agrees, as part of our membership, to use our Code of Ethics as a guide for our behavior. This code is meant to be a tool for otolaryngologists to help navigate the issues that arise in taking care of patients and running a business, and maintaining industrial transparency and credibility. It is important that all members take the time to review this information. Managing these relationships allows AAO-HNS/F to continue to have the independent voice that our patients and members count on.
Stacey L. Ishman, MD
The Evolution of Healthcare?
Stacey L. Ishman, MD, and Paul M. Imber, DO With an array of healthcare reforms being implemented in our nation, many wonder what the final outcome will be. Will it be an improvement or a weakening of our already fragile system? What additional reforms are on the horizon, and can we learn from the experiences of other countries? Attendees at the recent Annual Meeting & OTO EXPO in San Francisco were given the opportunity to hear about and discuss these very questions at a miniseminar, titled “Healthcare for All? Economics, Politics, and Delivery Systems.” The miniseminar, which was sponsored by the Board of Governors’ Legislative Representatives Committee, provided an evidence-based comparison of worldwide government healthcare systems and perspectives on the challenges and successes associated with various delivery models, their impact on otolaryngologist—head and neck surgeons and their patients, and the politics surrounding the single-payer healthcare debate in the United States. The miniseminar’s panelists collectively offered expertise from a wide range of healthcare systems including private, academic, and government programs for the United States, Canada, and the United Kingdom. Panelists included moderator Mimi S. Kokoska, MD, MHCM, VISN 11 chief surgical consultant, Veterans Affairs, and professor at Indiana University; Joy Trimmer, JD, senior director of AAO-HNS Government Affairs; Lee D. Eisenberg, MD, MPH, past AAO-HNS board coordinator for Governmental Relations and member of ENT and Allergy Associates, LLP; Brendan C. Stack, Jr., MD, professor and vice chairman of the University of Arkansas for Medical Sciences; S. Mark Taylor, MD, MSc, MHCM, senior physician executive, Ontario, Canada; and Martin J. Burton, DM, MA, FRCS, consultant otolaryngologist, Radcliffe NHS Trust and senior lecturer at the University of Oxford. The miniseminar concluded with an interactive session where two key questions were posed to the audience. When attendees were asked if they favored or opposed legislation to establish a national health insurance program, 68 percent indicated their support for such a system. This percentage is slightly higher than the 59 percent approval rating garnered when the same question was posed to a group of nearly 2,000 physicians in a 2007 Annals of Internal Medicine study. As a follow-up, the audience was then asked their preferred structure for a nationalized healthcare system. Responses indicated: 37 percent supported a government-run single payer system without government ownership or employment of providers (similar to Medicare); 30 percent supported select government ownership of facilities and employees to “compete” with private facilities and employees; 20 percent supported complete privatization; and 13 percent supported government-owned and paid facilities and employees (similar to the VA or DOD). Does this mean the majority of our members are ready for a change? Is the desire for change a result of disappointment and dissatisfaction with the current system? If this is the case, we can think of no better reason to attend the AAO-HNS BOG Spring Meeting and Advocacy Day (May 6-8, 2012). Help us raise our voice on Capitol Hill and influence positive change in our healthcare system.
David R. Nielsen, MD, AAO-HNS/F EVP/CEO
The Movement to Address Quality in Healthcare
David R. Nielsen, MD AAO-HNS/F EVP/CEO Implications for integrating education, research, clinical quality improvement, and advocacy A recurrent theme over the years in this column has been quality healthcare, the ethical and professional duty we have to continually seek improvement, and the politics and public attention that have increasingly become a part of quality improvement. Our focus always has been, and will remain, on the patient’s best interest and needs. One of the most critical aspects of the quality movement that we as otolaryngologists and Academy members need to understand is the manner in which our approach to quality improvement has led to positive improvements and integration of our educational offerings, health policy, government affairs, annual meeting program, and research. Knowing how this is occurring (and why it is essential) will not only help us as Academy members provide better care, but will reinforce the great value of Academy membership and engagement in Academy activities. Integration of quality, education, research, and advocacy is not just an essential structural, governance, and operational concern; it is the natural consequence of addressing better patient care. While it may be our instinct to feel uncertainty and fear about the “unknown” issues of the future, there is great opportunity for us to make significant positive progress in patient care and advancing medical training and science. Surgeons will be expected to adapt, change, and improve over the next decade in remarkable ways. Learner-centered educational processes and systems are taking over the old didactic lecture amphitheater. Interactive focused learning will also include simulation, both cognitive and procedural. Residents beginning their first clinical rotations gain experience through simulation “boot camps” in many encounters and procedures, making them more adept, confident, and effective from the first day of patient care. Using these techniques combined with hands-on clinical experience, we will train to mastery, not just to competency or proficiency. Continuing medical education (CME) will be more properly called continuous professional development (CPD), including much more than acquiring more knowledge throughout professional life. It will involve real time and “point of care” access to educational material through mobile devices; decision support systems with links and references to clinical practice guidelines (CPG) and validated performance measures (PM); and links to journal articles, live, streaming video, and online content. Not only will this improve the application of new knowledge to better patient care, but this will allow physicians to get credit and acknowledgment for the real improvement in patient outcomes that arise from education. Health services research will integrate with basic science and traditional translational research more effectively with rapid “bench to bedside” applications of advances in science. This implies links to systems of documentation of care, EMRs, registries for benchmarking of improvement; privileging and accrediting systems; maintenance of certification (MOC); maintenance of licensure (MOL); and physician payment requirements. Eventually, you can see how education, research, and health policy integration is both the inevitable consequence of quality improvement and the intentional goal for ensuring patient-centered, quality care. We as practicing surgeons will be including simulation in our own CPD and daily practice. We will have our own “boot camps” for improving skills, applying new technologies, using augmented reality, simulation “warm-ups” and virtual “escapes” to reduce medical error and improve patient safety. Real patient images will be used to construct the virtual surgical environment in which we can “operate” on the actual anatomy of a real patient with virtual instrumentation, with haptic feedback giving us the real feel of the instruments in our hands. Robotics will increasingly be applied to our surgical armamentarium. Lest you think that simulation is limited to surgical procedures, cognitive simulation can advance training and improve skills—from medical school through our entire professional practice. Envision simulation applications that encompass teaching interview techniques with virtual patients, physical examination, imaging, emergency assessment, audiological testing, differential diagnosis, medical management with observable patient responses, and much more. We applaud the leaders in our field who are already employing this type of integration and advancing of education and performance improvement at all levels. This is an exciting time to be a physician and an otolaryngologist.
Rodney P. Lusk, MD AAO-HNS/F President
Technology for Learning and Knowledge
Rodney P. Lusk, MD AAO-HNS/F President In October, I said that as technology continues to evolve, the Academy will have to continue to adapt. The Academy has embarked on a major revision of content and search functionality of our website. The Foundation is also embarking on major changes with the education program, including a focus on individual learner groups, continuing technological adaptations, and the full integration of education, quality, and research. Our website is on its way to being the conduit to all your education and literature research needs. We also intend to be your resource for patient education. Your information needs vary with the application and situation. As David R. Nielsen, MD, says, “What you need on Monday morning prior to a consult with a patient is very different from what you want Thursday afternoon when you are working on a presentation.” What doesn’t change is your expectation for fast, easy-to-find, and accurate information. The Academy is developing tools to ensure that you can access and search the resources on our website any time you are connected to the Internet. This is my goal; if you are connected to the web through any device, you will be able to efficiently get to the desired content through the Academy at any time you need it. The Academy has developed a “Find an ENT” application and is working on the development of an app for searching content. The site will be optimized for visibility from any device, be it tablet, smartphone, EHR, or computer. These technological adaptations are not static. We will need to continually adapt our content presentation as different devices emerge. None of us could have foreseen the use of tablets and smartphones 10 years ago and the impact these mobile devices would have on our daily lives and the practice of medicine. Likewise, we cannot predict what we will be using 10 years from now. The presentation and format of information consumption will change over time. What will not change is your need for increasingly rapid, efficient access to the information. Another one of my goals is to provide you with a search tool that you prefer over other search engines. Our search should be narrower and more targeted than Google, yet broader than PubMed. Therefore your search would include not only the wealth of the Academy content, but you will also search other pertinent websites for appropriate content. The search would include results from other specialty society websites and access to 10 to 15 of the most relevant journals. Just as advances in technology represent an area of constant, rapid, and important change for the Academy, so too does education. The website enhancements will increase the ease and efficiency with which you can find educational material matched to your needs. In the meantime, the Foundation’s education committee volunteers invite you to browse the website. Explore the courses available to members at no charge via AcademyU®. Also check the Home Study Course, the newly renamed Patient Management Perspectives in Otolaryngology, Clinical Otolaryngology OnLine, eBooks, COCLIA, and the 2012 Annual Meeting & OTO EXPO. The Bulletin this month highlights the vast array of educational resources available to you from the Academy. Read more about the changes ahead in “Education: Fast Action and Focus on the Future.” (p. 31) and the article “Educating for Knowledge and Competence: Looking Back at 2011” (p. 28). I am personally looking forward to the update of COCLIA for residents, the development of resources to support the members preparing for Maintenance of Certification, and the ultimate integration of education, quality, and research. The Academy is also categorizing all of its content with key words and subspecialties so that you can find resources and information across all Academy platforms. Learning happens anywhere, anytime, but is most effective when you need it. The quest for information at the point of care, between patients, and in the operating room is as important as traditional knowledge-based CME, performance improvement CME, and the required components of Maintenance of Certification. Directing access to all of these resources through one source, the Academy website enhances your continuous professional development. Your Academy is working hard to ensure that you have the access to information and learning opportunities that are critical to you, your practice, and your patients.
Attendees took in the nearly 500 posters on display.
2011 AAO-HNSF Annual Meeting & OTO EXPO Highlights
Ranked as one of the highest member benefits, more than 9,400 attendees and exhibitors flocked to the Annual Meeting & OTO EXPO in San Francisco, CA. The conference began the morning of Sunday, September 11, with a moment of silent tribute in honor of the 10-year anniversary of the victims of the September 11, 2001, attacks. The tribute took place during the Opening Ceremony for the attendees and concurrently in the OTO EXPO to allow our exhibitors time to acknowledge the day. This year’s Opening Ceremony included addresses from the AAO-HNS/F President J. Regan Thomas, MD, AAO-HNS/F EVP/CEO, David R. Nielsen, MD, and President-Elect, Rodney P. Lusk, MD.  Marlee Matlin, Academy Award-winning actress and activist, delivered the John Conley Lecture on Medical Ethics to a captivated audience. At the conclusion of the Opening Ceremony, Dr. Thomas announced the opening of the OTO EXPO and led the attendees into the hall to witness the official ribbon cutting. Thousands of physicians, allied health professionals, and administrators then flooded the OTO EXPO to visit with device manufacturers and pharmaceutical companies, learn about the latest in waiting room solutions, discuss financial planning, locate an EMR/EHR company, and much more. The OTO EXPO featured nearly 300 companies whose products and services offer advice and solutions for otolaryngologists from the exam room to operating room. Over the course of the next four days, annual meeting attendees were exposed to a wide gamut of educational offerings. The annual meeting also featured four honorary guest lectures: The Cotton-Fitton Endowed Lecture in Pediatric Otolaryngology delivered by Lauren D. Holinger, MD; Eugene N. Myers International Lecture on Head and Neck Cancer presented by Professor Karl Hörmann, MD; Howard P. House, MD, Memorial Lecture for Advances in Otology delivered by Professor Vittorio Colletti, MD; and the Neel Distinguished Research Lecturepresented by James Christopher Post, MD, PhD. The Scientific Program was comprised of 88 miniseminars and featured almost 300 oral presentations. During their free time, attendees had a chance to explore the nearly 500 posters and later meet with the authors during the Tuesday night Poster Presentation Reception. Each afternoon, the Instruction Course program included more than 300 courses amounting to more than 393 hours of programming presented by the world’s leading experts in otolaryngology. AAO-HNS/F resident members were also able to enjoy more than 100 hours of complimentary instruction course programming. The evening events were full of excitement and entertainment for all. Sunday kicked things off with the President’s Reception featuring scrumptious food, music, and the chance to meet with friends and colleagues from around the world. The Tuesday receptions closed out the conference with Alumni Night followed by the International Reception with dancing. Both events provided yet another opportunity to network with friends and to make new acquaintances. As the annual meeting continues to evolve, several innovations were presented this year that increased engagement and productivity for the attendees. Annual Meeting & OTO EXPO mobile app. Continuing Education credit/evaluation mobile app. Expanded social media–Twitter, YouTube, LinkedIn, and Facebook. Improved delivery of online Instruction Course handouts. Planning for the 2012 Annual Meeting & OTO EXPO to be held September 9-12 in Washington, DC, is already under way. We will soon begin accepting applications for the Scientific Program (Oral & Poster Sessions) starting January 23, 2012, and running through February 20, 2012. For more information, visit our website at Set to the backdrop of Washington, DC, next year’s Annual Meeting & OTO EXPO promises superior educational opportunities and continued innovation. We look forward to seeing you at the 116th Annual Meeting & OTO EXPO next fall.
University of Mississippi
Fifth Annual Academic Bowl Showcases Wide Range of Competitors
She graduated cum laude from Princeton University with a degree in religion and was active in a cappella singing. Her teammate also graduated with honors from Southern Methodist University. Their competitor completed his medical school training at Mercer University School of Medicine, where he graduated Alpha Omega Alpha. This Dallas native studied medicine at the University of Texas San Antonio. His teammate was also born in Texas but grew up in New Orleans, and both were selected from the third-oldest otolaryngology department in the nation. This Indianan is heading to the University of Miami for a head and neck fellowship. His teammate from the suburbs of Chicago is also considering a head and neck fellowship. Four teams of three residents each were selected from the U.S. residency programs with the best aggregate score on the Home Study Course. The participating institutions were Loyola University Medical Center, University of Mississippi Medical Center, Tulane University School of Medicine, and University of Texas Southwestern. This year’s winners came from the University of Mississippi Medical Center (UMMC), where Byron K. Norris, MD, serves as the chief otolaryngology resident. Fellow teammate and third-year resident Sarah E. B. Thomas, MD, boasts medical training from University of South Carolina School of Medicine. Alan R. Grimm, MD, attended Ohio State University for undergraduate and medical school. The department of otolaryngology and communicative sciences at UMMC has 23 full-time faculty members, covering the spectrum of otolaryngology specialties and providing the residents with an extensive clinical and operative experience. UMMC prides itself on flexible rotation scheduling for its senior residents, which allows opportunity for elective rotations to pursue individual interests and humanitarian mission trips. Emily E. Crozier, MD, is a fourth-year resident at University of Texas Southwestern Medical Center (UTSW). Teammate Lindsay E. Young, MD, recently went on a humanitarian medical mission trip to Honduras. She graduated from UTSW Medical School. She plans on going into private practice in the Lone Star State when she finishes training next year. Ryan E. Neilan, MD, also a fourth-year resident, graduated as valedictorian of his class from University of Texas Medical Branch, Galveston. UTSW provides a robust training program that allows residents to train at six different hospitals. Loyola University Medical Center, a well-established and leading program in Chicago since 1979, hosts three residents each year, and its recent graduates have been placed in several fellowships and private practice positions around the country. For example, fifth-year Avinash Mantravadi, MD, was matched with a head and neck fellowship at the University of Miami. Also in his fifth-year of postgraduate training, Brent J. Benscoter, MD, has an interest in neurotology. Fourth-year Chicagoan Ryan Burgette, MD, is deciding between general otolaryngology or a head and neck fellowship. Residents Adil A. Fatakia, MD, MBA; Daniel A. Glass, MD; and Bradley T. Johnson, MD, belong to Tulane University School of Medicine, the third-oldest otolaryngology department in the country. Dallas-born Dr. Johnson has secured a fellowship in head and neck surgical oncology at University of Toronto. Dr. Fatakia will pursue a rhinology and skull base fellowship next year. Dr. Glass will focus on general otolaryngology. The Academic Bowl has become a must-see event each year at the annual meeting. The Academy is especially grateful to J. David Osguthorpe, MD, for his vision and leadership in the creation and long-term success of this competition. Over the past five years, he has been instrumental in making the Academic Bowl a prestigious event. As Dr. Osguthorpe ends his tenure as the Academic Bowl director, the Academy welcomes Mark K. Wax, MD, immediate-past Coordinator for Education, as its new leader.
Education: Fast Action and Focus on the Future
Mary Pat Cornett, AAO-HNSF Sr. Director, Education and Meetings In the “Changing Face of Foundation Education” article in the April  Bulletin (, Sonya Malekzadeh, MD, incoming Coordinator for Education, promised that education activities in the future would build upon the current program, but may look very different than they do today. Plans are in motion for new and revised education offerings for 2012, while the comprehensive long-term planning for more change ahead as outlined by David R. Nielsen, MD, gains momentum. Members of the Foundation’s eight education committees returned from San Francisco and went to work developing content to address general, specialty-specific, and practice management gaps in care within otolaryngology—head and neck surgery for the Foundation’s core education activities. Simultaneously, committee members are working on exciting new initiatives for launch in late 2012. “I was fortunate to spend a year working directly with Dr. Wax as Coordinator-Elect and the education and meetings staff. That experience and the strength of our education committees allowed us to hit the ground running when I took over as coordinator on October 1, 2011,” said Dr. Malekzadeh. “I am incredibly appreciative of Dr. Wax’s guidance and the support of the Education Steering Committee, their respective committee members, and the Academy staff. “While we take some quick action to address the pressing needs for resident education and support for members preparing for Maintenance of Certification (MOC), we are identifying the next phase of improvements geared to ensure that the education program meets the needs of all learners,” said Dr. Malekzadeh. A comprehensive assessment of all current education offerings is under way to validate their usage and effectiveness. The next step is a comprehensive member needs assessment in early 2012. “We will be reaching out to you—to learn more about what you need from the Foundation’s education program and get information on what, when, and how you want to learn,” said Dr. Malekzadeh. In the meantime, take advantage of the wide variety of education activities created by your colleagues and offered by the Foundation. The Foundation is committed to increasing awareness and use of education and knowledge resources in 2012. Data from the 2010 member survey, the Voice of the Member, showed that members were not aware of the education offerings of the Foundation. In addition, education committee members are identifying key words for all education activities as part of the overall Academy web content review project referenced by Rodney P. Lusk, MD, in his column on page 9. Dr. Malekzadeh said, “I share Dr. Lusk’s goal to ensure that our education content is not only relevant to your needs, but also accessible and easy to find whenever and wherever you need access.” Whether or not you attended the highly successful 2011 Annual Meeting & OTO EXPO in San Francisco, you won’t want to miss the highlights and photos on page 33. “I congratulate John H. Krouse, MD, PhD, Scientific Program Coordinator, and Eduardo M. Diaz, Jr., MD, Instruction Course Coordinator, and look forward to working with both of them and the Coordinators-Elect, Eben L. Rosenthal, MD, and Sukgi S. Choi, MD, as we ensure a seamless education program across all live and enduring education formats,” Dr. Malekzadeh said. Collaboration among the Foundation Coordinators does not stop there. John S. Rhee, MD, MPH, Coordinator for Research and Quality, Richard M. Rosenfeld, MD, MPH, Otolaryngology—Head and Neck Surgery Editor, and Gregory W. Randolph, MD, International Coordinator, work closely with senior staff in education, meetings, quality, and research to integrate the entire scientific and education program of the Foundation. Increasingly, this collaboration extends into health policy, advocacy, and government affairs. As the year of education draws to a close, we have set our sights even farther into the future than 2012. The Foundation Board of Directors charged the Science and Educational Committee to develop a plan for the integration of education, quality, research, health policy, advocacy, and government affairs. Read Dr. Nielsen’s column in this issue to learn more about the forces converging to necessitate a major shift in how we connect some very critical pieces of the Academy and Foundation puzzle. Planning for this integration will be the focus of the Science and Educational Meeting in December.
Educating for Knowledge and Competence: Looking Back at 2011
Audrey Shively, MSHES, MCHES AAO-HNSF Sr. Mgr., Education The Foundation’s education efforts in 2011 focused on its strategic plan to identify gaps in care and deliver education activities that improve knowledge and competence in the field of otolaryngology. A major focus of these efforts was increasing member awareness and use of AAO-HNSF education resources. A look back at the education accomplishments of 2011 will let you know how we did. AcademyU®  and Online Education There are more than 38 courses in AcademyU®, our online library of professional education activities and resources developed by education committee members; five of them were developed this year. They include courses on Basic Head and Neck Pathology, Cleft Lip and Palate, and Hearing Assessment. The Online Lecture Series, which highlights key sessions from the annual meeting, continues to be popular. This year’s most sought-after lectures included Medical Strategies for Treatment of Refractory Sinusitis, Mastoidectomy for the General Otolaryngologist, Advanced Aesthetic and Functional Rhinoplasty, and Robotic Thyroid Surgery. Other popular online resources are COOL (Clinical Otolaryngology Online) courses designed for non-otolaryngologists and allied health professionals. Through our continued partnership with the American Academy of Physician Assistants, these courses reach a significant number of physician assistants, with more than 2,500 course completions in 2011. COOL courses published this year include General Exam of the Nose, Chronic Rhinosinusitis, Indications for Tonsillectomy, Adult with Otitis Media Due to MRSA, and Pediatric Neck Abscess Due to MRSA. Overall, online education is on the rise at the Foundation. This year saw a 10-percent increase in AcademyU® subscriptions to more than 3,000 subscribers. Primary Care Otolaryngology Through the efforts of the General Otolaryngology Education Committee, the third edition of “Primary Care Otolaryngology” ( was published as an e-book this year and can be found on the Foundation website. This popular handbook continues its goal of improving clinical judgment by teaching the basics of otolaryngology. Targeted to medical students and allied health professionals with an interest in otolaryngology–head and neck surgery, this e-book helps readers manage uncomplicated clinical problems and recognize when to refer more serious conditions to an otolaryngologist. A key feature of this edition is that each chapter was updated to reflect current clinical practice guidelines. Coding and Reimbursement Workshops The Foundation continued its partnership with Karen Zupko and Associates to once again offer eight regional coding and reimbursement workshops. The two-day events offer improved office management skills training and extensive, up-to-date, and critical information on coding issues affecting the otolaryngology practice. Nearly 1,000 physicians and office staff personnel received valuable print resources and hands-on skills training to tackle tough coding issues. Eight additional workshops are planned for 2012 under the guidance of the Core Otolaryngology and Practice Management Education Committee. Patient Management Perspectives To better reflect the scope of its education content, the Patient of the Month Program (PMP) has changed its name. Beginning with Volume 41, PMP is now Patient Management Perspectives in Otolaryngology (PMP). This eight-part subscription series continues its popular hands-on, case-based approach to an interesting and common patient problem developed by content expert volunteers. Subscriptions continue to be available in print, CD-ROM, and online versions. CME Accreditation  and the AMA PRA  The Foundation was awarded another four-year accreditation in 2011 from the Accreditation Council for Continuing Medical Education. This accreditation recognizes the Foundation’s ongoing commitment to providing quality professional education to its members. In response to new rules from the American Medical Association Physician’s Recognition Award, the Foundation has implemented a minimum score requirement for all its enduring materials. Beginning July 2011, members wishing to receive credit for participating in the Home Study Course, Patient Management Perspectives, or any AcademyU® course must pass a post-test with a score of 70 percent or higher. This new rule will provide useful knowledge assessment data for each of our education products. Education Coordinator Change Mark K. Wax, MD, officially completed his four-year term as the Foundation Coordinator for Education on September 30, 2011. Dr. Wax’s leadership and guidance was instrumental in the Foundation’s continued delivery of top-notch otolaryngology education to members, residents, and allied health professionals. Sonya Malekzadeh, MD, assumed the leadership of the Foundation education program as she became Coordinator for Education on October 1, 2011. She will advance the continuous improvement of the Foundation’s educational offerings for all learners across all existing and soon-to-be-developed formats. The Education and Meetings staff are exceedingly grateful to Dr. Wax for his support and leadership, and wholeheartedly welcome Dr. Malekzadeh and are excited to work with her in the continuous improvement of the Foundation’s education mission. Looking Forward to 2012 Under Dr. Malekzadeh’s leadership, the Foundation is preparing to enhance its service to members by launching several exciting and timely education activities in 2012. COCLIA COCLIA is a teaching tool to help residents learn otolaryngology—head and neck surgery. This online resource provides discussion questions on more than 100 major otolaryngology topics. COCLIA will be updated in 2012 with new questions, images, and references. Maintenance Manual  for Lifelong Learning First published in 1998, this thorough study guide was published to keep members up to date with dramatic developments occurring in the otolaryngology specialty. This publication is now being considered for renewal and conversion into an extensive exam preparation manual to cover all subspecialty areas. Question Bank Development As an expansion of the live Academic Bowl, an online question pool will be created in AcademyU®. Comprehensive questions will be generated from a variety of sources, including the eight education committees and the Home Study Course working groups. This will be a useful tool for residents and as exam prep for practicing otolaryngologists. Website Content Relevancy Project As requested by the AAO-HNS/F president, Rodney P. Lusk, MD, Education staff will improve the search capability of all its activities by identifying key words for each. This step will be completed for new activities developed, activities going through review, and all currently active courses. ENT Exam The Foundation is updating the ENT Exam video by creating it in a digital format on the Academy’s website and on YouTube. This action-oriented exam can be used to train medical students, residents, and allied healthcare professionals. The project is being led by Lee D. Eisenberg, MD, MPH, and Jane T. Dillon, MD, and will be available to the public. Surgical Simulation and Robotic Surgery Task Force Two task forces were created by the Foundation Board in early 2011 to spearhead AAO-HNS/F efforts in surgical simulation and robotic surgery. The task forces independently gathered information on the current state of surgical simulation and robotic surgery training in otolaryngology and beyond our specialty, working to identify opportunities. The task forces will continue their work while providing guidance to the Board on the actions that provide the best opportunity for the AAO-HNS/F to make within these new frontiers.