Published: October 24, 2013

Template Appeal Letter for SCAN Denials

In response to the increased denials that members have been receiving from private payers for the new procedure code for Stereotactic Computer-Assisted Navigation (SCAN) (+ 61782 – cranial, extradural [(List separately in addition to code for primary procedure]), the Physician Payment Policy workgroup (3P) has drafted an appeal template letter, which members may use to appeal these denials. Although the +61782 is a new code, it replaces a procedure code (+61795 – Stereotactic computer-assisted volumetric [navigational] procedure, intracranial, extracranial, or spinal[ List separately in addition to code for primary procedure]) that private payers previously reimbursed. This appeal template letter is also available at http://www.entnet.org/Practice/Appeal-Template-letters.cfm This letter is generic and acts only as guidance for you to construct your appeal letter. You should use your company letterhead/logo and fill in the blanks and header information. We recommend that you also submit any other relevant supporting documents, for example, medical notes, operative reports, policy statement, and coding guidance for SCAN, etc. If you receive a denial for image guidance, please also report this denial and the denial reason to healthpolicy@entnet.org or 1-703-535-3727 [Insurer Name] [Insurer Address] Re: Patient: [Name] Policy Number:  Group Number: Claim Number: Date of Service: Dear [Medical Director]: Please consider this letter a formal request for reconsideration of a denial received for a stereotactic computer-assisted navigation (SCAN) procedure (image guidance) performed on [Patient’s Name] on [Date of Service] by [Name of Physician].  The claim for the SCAN procedure was billed with CPT ©code +61782 – cranial, extradural (List separately in addition to code for primary procedure). Although CPT code +61782 is a new CPT code and became effective on January 1, 2011, it describes an existing procedure that [Insurer Name] previously covered and reimbursed. The former code for the SCAN procedure was CPT © code +61795 – Stereotactic computer assisted volumetric (navigational) procedure, intracranial, extracranial, or spinal (List separately in addition to code for primary procedure); it was deleted because the CPT Editorial Panel split it into three separate add-on codes (+61781 Stereotactic computer-assisted (navigational) procedure; cranial, intradural – , +61782 – Stereotactic computer-assisted (navigational) procedure; cranial, extradural and +61783 – Stereotactic computer-assisted (navigational) procedure; spinal) to differentiate distinct anatomic regions. Of course, one can no longer report a service with a deleted code, but CPT code +61782 is the same procedure that was previously covered by +61795. Therefore, your denial of +61782 as experimental and/or investigational or otherwise considered non-reimbursable is totally illogical. The full allowable amount should be paid for CPT code +61782 because it is an add-on procedure code, and its Medicare fee work relative value already accounts for the procedure never being performed alone. As you may be aware, SCAN provides the surgeon with 3D real-time positioning within the nasal cavity and paranasal sinuses, allowing him/her to appropriately remove diseased tissue and avoid damage to the orbital, other extra-cranial, and/or intra-cranial areas. This is particularly useful in patients who have experienced a loss of surgical landmarks and barriers due to previous surgery, sinonasal polyposis, neoplasms, or severe infections/inflammatory processes. The purpose of using stereotactic computer-assisted navigation in sinus surgery is to maximize accuracy and safety of the surgical procedure. I am enclosing the previously submitted claim, the Explanation of Benefits, operative notes, and the American Academy of Otolaryngology – Head and Neck Surgery’s policy statement, Intra-Operative Use of Computer Aided Surgery and Coding for Stereotactic Computer Assisted Navigation. Please reprocess this claim for the payment of CPT code +61782. If you require additional information, please contact me at [Phone number]. Thank you for your prompt action. Sincerely, [Physician Name, MD] Enclosures: [insert number of enclosures] cc: [Patient’s Name]   Link to Intra-Operative Use of Computer Aided Surgery Policy statement: http://www.entnet.org/Practice/policyIntraOperativeSurgery.cfm Link to Coding for Stereotactic Computer Assisted Navigation: http://www.entnet.org/Practice/Coding-for-Stereotactic-Computer-Assisted-Navigatione.cfm

In response to the increased denials that members have been receiving from private payers for the new procedure code for Stereotactic Computer-Assisted Navigation (SCAN) (+ 61782 – cranial, extradural [(List separately in addition to code for primary procedure]), the Physician Payment Policy workgroup (3P) has drafted an appeal template letter, which members may use to appeal these denials.

Although the +61782 is a new code, it replaces a procedure code (+61795 – Stereotactic computer-assisted volumetric [navigational] procedure, intracranial, extracranial, or spinal[ List separately in addition to code for primary procedure]) that private payers previously reimbursed. This appeal template letter is also available at http://www.entnet.org/Practice/Appeal-Template-letters.cfm

This letter is generic and acts only as guidance for you to construct your appeal letter. You should use your company letterhead/logo and fill in the blanks and header information. We recommend that you also submit any other relevant supporting documents, for example, medical notes, operative reports, policy statement, and coding guidance for SCAN, etc.

If you receive a denial for image guidance, please also report this denial and the denial reason to healthpolicy@entnet.org or 1-703-535-3727

[Insurer Name]
[Insurer Address]
Re: Patient: [Name]
Policy Number: 
Group Number:
Claim Number:
Date of Service:

Dear [Medical Director]:
Please consider this letter a formal request for reconsideration of a denial received for a stereotactic computer-assisted navigation (SCAN) procedure (image guidance) performed on [Patient’s Name] on [Date of Service] by [Name of Physician]. 

The claim for the SCAN procedure was billed with CPT ©code +61782 – cranial, extradural (List separately in addition to code for primary procedure).

Although CPT code +61782 is a new CPT code and became effective on January 1, 2011, it describes an existing procedure that [Insurer Name] previously covered and reimbursed. The former code for the SCAN procedure was CPT © code +61795 – Stereotactic computer assisted volumetric (navigational) procedure, intracranial, extracranial, or spinal (List separately in addition to code for primary procedure); it was deleted because the CPT Editorial Panel split it into three separate add-on codes (+61781 Stereotactic computer-assisted (navigational) procedure; cranial, intradural – , +61782 – Stereotactic computer-assisted (navigational) procedure; cranial, extradural and +61783 – Stereotactic computer-assisted (navigational) procedure; spinal) to differentiate distinct anatomic regions. Of course, one can no longer report a service with a deleted code, but CPT code +61782 is the same procedure that was previously covered by +61795. Therefore, your denial of +61782 as experimental and/or investigational or otherwise considered non-reimbursable is totally illogical. The full allowable amount should be paid for CPT code +61782 because it is an add-on procedure code, and its Medicare fee work relative value already accounts for the procedure never being performed alone.

As you may be aware, SCAN provides the surgeon with 3D real-time positioning within the nasal cavity and paranasal sinuses, allowing him/her to appropriately remove diseased tissue and avoid damage to the orbital, other extra-cranial, and/or intra-cranial areas. This is particularly useful in patients who have experienced a loss of surgical landmarks and barriers due to previous surgery, sinonasal polyposis, neoplasms, or severe infections/inflammatory processes. The purpose of using stereotactic computer-assisted navigation in sinus surgery is to maximize accuracy and safety of the surgical procedure.

I am enclosing the previously submitted claim, the Explanation of Benefits, operative notes, and the American Academy of Otolaryngology – Head and Neck Surgery’s policy statement, Intra-Operative Use of Computer Aided Surgery and Coding for Stereotactic Computer Assisted Navigation.

Please reprocess this claim for the payment of CPT code +61782. If you require additional information, please contact me at [Phone number].

Thank you for your prompt action.

Sincerely,
[Physician Name, MD]
Enclosures: [insert number of enclosures]
cc: [Patient’s Name]

 

Link to Intra-Operative Use of Computer Aided Surgery Policy
statement: http://www.entnet.org/Practice/policyIntraOperativeSurgery.cfm
Link to Coding for Stereotactic Computer Assisted Navigation: http://www.entnet.org/Practice/Coding-for-Stereotactic-Computer-Assisted-Navigatione.cfm

More from May 2011 - Vol. 30 No. 05
Resources from Members: Sinus Surgery
Ashok Jagasia, MD, PhD, is a private practice otolaryngologist based in Chicago with an academic position at Rush University Medical Center. In the last few years he has developed a patient educational software program on sinus surgery. This software is web based and a patient can access either from home or in the office. It focuses on sinus anatomy, disease process (chronic sinusitis), treatment options, and the risks/complications. The software has can be viewed at http://www.innovatemedicine.com/clients/ with a password upon request. It has been reviewed by the American Rhinologic Society’s Internet Technology Committee. It is Dr. Jagasia’s hope that this patient information be offered as free patient access and that in time, he can add programs including those related to tonsillectomy, PE tube placement, and other procedures. For more information contact: jagasiai@yahoo.ocm or A. Jagasia, MD, PhD; Dreyer Medical Clinic; Chairman Dept. of Otolaryngology; 1221 N. Highland Avenue; Aurora, IL 60506. Or, call 1 630-264-8569.
Nikhil J. Bhatt, MD
Regional Advisors Featured at Global Health 2011 Symposium
To follow up the great success of the Global Health 2010 at the AAO-HNSF Annual Meeting & OTO EXPO in Boston, the International Steering Committee’s Regional Advisors will present a new and updated program of its worldwide mission at the 2011 Annual Meeting & OTO EXPO. “I am looking forward to the Global Health 2011 session in San Francisco, and would like to encourage you to attend and hear many excellent international presenters share their experiences from around the world,” said Past President Ronald B. Kuppersmith, MD.  “I also would like to congratulate Dr. Gregory W. Randolph on organizing this extraordinary forum that provides a great opportunity for exchange and collaboration.” “The goal of Global Health 2011 is to highlight how Academy members work actively to share their knowledge and glean new ideas from their international colleagues, collaborate on research, organize joint educational meetings, and assist in underserved areas and disasters. Please join us at this exciting program,” said President J. Regan Thomas. The goal of this groundbreaking global gathering will be to enhance the vision for international collaboration. Dr. Randolph will introduce Dr. Thomas, who will give an overview of the Academy’s commitment to international otolaryngology. Regional advisors will describe the history of their regions and then introduce experts from those regions to share their experiences as international ambassadors. The 11 Regional Advisors are: Nancy L. Snyderman, MD, regional advisor at large; Eugene N. Myers, MD, FRCS Ed (Hon), regional advisor for the Balkans, Greece, and Turkey; David W. Kennedy, MD, and Karl Hormann, MD, regional advisors for Europe; K.J. Lee, MD, regional advisor for the Far East/Pacific Rim; G. Richard Holt, MD, regional advisor for the Middle East; J. Pablo Stolovitzky, MD, regional advisor for Latin America; Ramon A. Franco, Jr., MD, regional advisor for Central America; Terry A. Day, MD, regional advisor for Haiti and the Caribbean; Nikhil J. Bhatt, MD, regional advisor at large;  and James E. Saunders, MD, and James Netterville, MD, regional advisors for Africa. At the conclusion, President-Elect Rodney P. Lusk, MD, Dr. Randolph, and the regional advisors will present certificates of appreciation designating the visiting speakers as “American Academy Goodwill Ambassadors,” who will bring the message of mutual collaboration to their own countries and regions, together working for the best ear, nose, and throat care worldwide.
Mark Your Calendars
On behalf of Professor Hiroshi Moriyama, president, 30th ISIAN, Dr. David Kennedy announced the new dates of IRS/ISIAN. September 20-23, 2011 ANA Intercontinental Tokyo Tokyo, Japan The host hotel is in the center of Tokyo near the Imperial Palace and other landmarks. To learn more, email irs-isian2011@convention.co.jp or visit www.irs-isian2011.com.
David W. Kennedy, MD, Receives National Clinical Excellence Award
David W. Kennedy, MD, professor of rhinology, Department of Otorhinolaryngology-Head and Neck Surgery at the University of Pennsylvania School of Medicine and past president of the Academy, has received the Castle Connolly Medical Ltd.’s Clinical Excellence Award. The award, from the creators of America’s Top Doctors® guide, is designed to recognize physicians who exemplify excellence in clinical medical practice and is part of their National Physician of the Year Award honors. “We congratulate Dr. Kennedy on receiving this very prestigious honor,” said Bert W. O’Malley, Jr., MD, Gabriel Tucker professor and chair of otorhinolaryngology-head and neck surgery at Penn. “Dr. Kennedy is a pioneer in sinus surgery in the U.S., and has taught its techniques throughout the world. His leadership in the field of otorhinolaryngology–head and neck surgery has led to new standards of patient care, and advances in scientific discovery, education, and clinical innovation.” Dr. Kennedy is widely noted for bringing endoscopic sinus surgery to the United States and fundamentally changing how these procedures – used to remove blockages in the sinuses – are performed. He created the first international course dedicated to teaching endoscopic transnasal techniques and the first rhinology academic fellowship – thus promoting rhinology as a sub-specialty. In addition to other achievements, Dr. Kennedy helped advance image-guided surgery, minimally invasive endoscopic skull-base surgery, and transnasal endoscopic orbital surgery, and continues to define and develop these techniques.  He has contributed about 200 articles to the medical literature, largely related to sinusitis and research involving its management, and is the author of several books in this field. Past recognition of Dr. Kennedy’s achievements includes a Presidential Citation from the AAO-HNS, the Practitioner Excellence Award from the AAO-HNS, and the Lyons Memorial and Fitzsimmons Medals for Surgery.  He has also been previously elected to the Institute of Medicine of the National Academy of Sciences. Dr. Kennedy accepted the honor at Castle Connolly’s Sixth Annual National Physician of the Year Awards event on March 28, 2011, at the Hudson Theatre in New York City.
Team member Joseph Rousso, MD, with pre-op complex cleft-lip patient.
Healing the Children: Bringing Colombia the Universal Language of Smiles
Joseph J. Rousso, MD Fourth-year resident, ORL New York Eye & Ear Infirmary, New York, NY In February, a team of 27 volunteers from New York and Texas boarded two flights with one destination: the Hospital Universitario Fernando Troconis in Santa Marta, Colombia. The U.S.-based Healing the Children and the Colombia-based UNIMA organizations partnered for a surgical mission to Colombia’s north coast. On the late-night flights, the excitement was palpable. Many team members were repeat volunteers who have taken part in missions to the Colombia site since the partnership’s inception several years ago. The team was led by Manoj T. Abraham, MD, a facial plastic and reconstructive surgeon based in Poughkeepsie, NY, who has headed up several mission trips around the world.  Members included four attending surgeons (among them Augustine L. Moscatello, MD, and Andrew A Jacomo, MD), a facial plastic and reconstructive fellow, and a fourth-year otolaryngology resident. Also, a team of anesthesiologists, nurse anesthetists, pediatricians, speech pathologists, administrators, nurses, surgical technicians, and local Colombian volunteers contributed a large amount of time and effort to help these young patients receive the best care. More than 150 patients, many of whom had previously undergone surgery, were evaluated for speech and swallowing.  In total, more than 100 surgical candidates were evaluated on one screening day, with 65 patients undergoing surgery over the course of four days. Most surgical patients needed complex repair of craniofacial malformations, particularly cleft lip and palate. In addition, the team also performed concurrent tympanostomy tube placement and cleft rhinoplasty for several patients. The patients made their way across the 8,953-square-mile Magdalena department for surgical evaluations. Many traveled for days, riding donkeys, walking through hilly terrain and extensive marshland valleys typical of the region, to get to Santa Marta, the capital of Magdalena’s 30 municipalities. Unfortunately, there is a wide disparity in access to healthcare in northern Colombia. Healing the Children, with its stated goal of organizing humanitarian medical missions to perform surgeries on needy children around the globe, has made a large impact on the youngest, most vulnerable of the impoverished indigenous inhabitants of the rural coast. There are no words to describe the gratitude on a mother’s face as she walks into the post-anesthesia care unit to see that her baby no longer has a cleft that prevents him or her  from eating, speaking, and socializing within their very stigmatizing communities. The experiences we shared, the smiles that made us well up, and the difference that we all made in such a short time will forever be imprinted on our memories. We are all grateful to those who have motivated us to do whatever is in our capacity to help heal the children in need, worldwide. To learn more about Healing the Children, contact dbuffin@htcne.org or visit www.htcne.org.
Lower No-Shows with Tech Reminder Systems
By Drew Franklin and Nicole Monti ENT and Allergy Associates® Today’s healthcare environment is marked by higher costs and dwindling reimbursement, so physicians are looking for ways to optimize their practices to achieve higher efficiencies, lower overhead, and better “throughput.” And that begins, fundamentally, with getting patients to show up for their appointments. One of the ways we have increased revenues is by maximizing and leveraging technology to drastically reduce our no-show rates. Once armed with these best practices, you will be poised to maximize the benefits that a robust reminder system offers.  The Physician’s Schedule  A practice’s no-show strategy actually begins with the way a doctor’s schedule is set up. Intuitively and empirically, enterprises that suffer from exaggerated wait times experience higher no-show rates based on patient dissatisfaction. Correspondingly, the number of breaks in the schedule, coupled with the number of appointments booked per hour, affect patient behavior. Each of our 35 offices schedules a one-and-a-half hour to two-hour lunch break, which not only gives the staff a much-needed respite during the day, but also mitigates any adverse effect a late-running morning might have on afternoon wait times. (For reference, our average physician has 29 to 32 clinic hours per week, excluding lunch.) Further, our physician-populated board of trustees unanimously adopted a policy that limits the number of patients seen per hour to five,with a sixth patient booking available any given hour for truly emergent visits. The policy is not intended to dictate the way a physician practices medicine as much as it is an insurance policy to guarantee the average patient an appropriate visit time, history, medical decision-making, and documentation/charting chairside. On this subject, Wayne Eisman, MD, president of ENT and Allergy Associates, said, “Our scheduling policy limiting the number of patients our doctors can see in an hour has reduced our risk exposure…reassuringly, we have not seen any reduction in practice revenues because spending more time with patients allows our physicians to do a more complete history and workup. It’s just good medical care.” This risk-reducing scheduling policy is equally important in light of our group’s newly formed self-insured company for medical malpractice. Data Capture  Almost everyone has an e-mail address and mobile phone number these days, including your patients. But do you have that information? If not, you likely have a higher no-show rate than necessary. In this age of smartphones, why not communicate with patients even when they’re on the go? Your ability to communicate with that individual in a convenient, real-time way — across multiple platforms — often means you can eliminate or reduce the chance of a no-show. Over the past 24 months, we have ramped up our efforts to ensure the collection of cell phone numbers and e-mail addresses. In our quest to gather data, we have posted signage in acrylic frames at check-in and check-out to notify patients why we are asking for cell phone numbers and e-mail addresses. Signs such as, “We’re going Green” and “Get Your Appointment Reminder Electronically” are both eye-catching and compelling. When collecting patient co-pays, we use a standardized script to inform patients about our reminder systems and request e-mail addresses and cell phone numbers. We have used promotional contests to challenge (and reward) our office staffs to collect 80 percent of patient email addresses for three months. Our new patient forms explain why we are asking for these e-mail and cell phone fields. And on our online patient portal, new patients cannot complete their paperwork in advance if they do not provide an e-mail address and cell phone number. In the examination room, our medical assistants and physicians chip in if the front staff is unsuccessful in capturing this info. There are myriad database reminder software systems available, but make sure you choose one that has phoning, texting, and e-mail capabilities. Three, Two, One  Use each technology to your advantage. We send HTML-rich e-mail reminder messages three days prior (except for patients booking inside of three days, who get their reminders sent the day before). These e-mail messages are constructed in such a way that if a patient hits the confirm button inside the e-mail, a subsequent reminder message will not be sent. If the patient has not clicked the confirm button on the e-mail, then he or she will receive a text message 48 hours prior to the scheduled appointment. Like the e-mail, our SMS texting system allows patients to reply with “confirm,” “cancel,” or “reschedule.” Patients also can cancel the appointment or click a button to reschedule. Once the reschedule notification is received at the front desk, someone calls the patient. Finally, 24 hours before a scheduled appointment, the patient receives an automated phone call. Patients can push “1” to confirm, “2” to cancel, or “3” to speak to a live operator who can help reschedule an appointment or help the patient navigate through his or her appointment concerns. No-show rates vary by specialty, practice type, and location, though one study shows that nearly 50 percent of practices that are not using appointment reminders have no-show rates greater than 10 percent, whereas only one in four that are using some type of appointment reminder system are experiencing no-shows above the 10 percent threshold. Our focus on reducing last-minute cancellations and no-shows has produced tangible success. In fewer than eight months, the practice’s no-show rate has been reduced by nearly 30 percent, and well below a 10 percent rate overall. This tells us that our new reminder technology is off to a healthy start. Higher efficiencies, lower overhead, and better “throughput” are already burgeoning. Implement an enhanced scheduling policy and an e-mail address/cell phone number collection program today, and reduce your no-shows tomorrow. For more information, contact nmonti@entandallergy.com or dfranklin@entandallergy.com.
Annual Meeting Offers Health Policy Educational Sessions
There will be a number of excellent educational opportunities and resources presented at the annual meeting. These are open to all members. So, be sure to watch the program for information on the dates and times for these specific sessions. • CPT/RUC Education Session: You will learn about the AMA’s Current Procedural Terminology (CPT) and Specialty Society/Relative Value Update Committee (RUC) processes. You will also learn why it is critical to fill out the RUC surveys you receive in order for your Academy representatives to advocate for appropriate values at the AMA meetings. • Medicare Contractor Advisory Committee (CAC) Session: You will learn about the importance of getting involved in these local meetings held in your area, the role of your local CAC, and the impact of local policies on your practice, as well as how providers can avoid and prepare for potential audits by the Recovery Audit contractors. • 3P Miniseminar on Academy Advocacy for Physician Payment and New Strategies: As declining reimbursement over many years continues to threaten the viability of physician practices across specialties and practice settings, this seminar will provide updates on the efforts of our Academy to advocate for fair reimbursement for our members in increasingly challenging public and private payer environments. • ICD-9-CM to ICD-10-CM Transition Miniseminar: There will be a miniseminar covering the required October 1, 2013, transition from ICD-9-CM to ICD 10 for all U.S. healthcare providers. During this session, the speaker will provide an overview of the ICD-10 transition, identify and crosswalk groups of ICD- 9 codes that pertain to otolaryngology—head and neck surgery, and much more.
What Is the RUCKUS with the AMA/Specialty Society Relative Value Update Committee (RUC) Survey?
Jane T. Dillon, MD, and Tricia Bardon The AMA advocates for fair and accurate valuation for all physician services within the Resource-Based Relative Value Scale (RBRVS). To ensure that physician services across all specialties are well-represented, the AMA established the AMA/Specialty Society Relative Value Scale Update Committee (RUC). The RUC makes recommendations regarding valuation for new and revised Common Procedural Terminology (CPT) codes to the Centers for Medicare and Medicaid Services (CMS). The Academy actively participates in the RUC process, and as part of that process, you may be asked to participate in a survey to help value a CPT code. Familiarity with the survey instrument and methodology is essential for accurate completion of a survey and has important implications for code valuation. Survey instruments are standardized across all specialties. The purpose of the survey of a CPT code is to obtain estimates of: • Physician time and intensity/complexity; and • The relative value of the physician work component of the total relative value (total relative value includes physician work, practice expense, and professional liability components). RUC methodology involves determining the proper fit of the surveyed code within the existing relative value system. Definition of Physician Work Physician work includes the following elements: • The time it takes to perform the service; • Three intensity/complexity measures: • The mental effort and judgment necessary with respect to the amount of clinical data that needs to be considered, the fund of knowledge required, the range of possible decisions, the number of factors considered in making a decision, and the degree of complexity of the interaction of these factors; • The technical skill required with respect to knowledge, training, and actual experience necessary to perform the service and physical effort involved to perform the service; and • Psychological stress factors such as risk of significant complications, morbidity, and mortality; risk of a malpractice suit with a poor outcome. Physician work does not include services provided by support staff that are employed by your practice and cannot be billed separately including registered nurses, licensed practical nurses, medical secretaries, receptionists, and technicians. Survey Process A request for survey may originate from the CPT process (new or revised codes) or the RUC process (existing codes that are deemed by various criteria to require review). Once the request is received, the Academy must follow a well-defined process with short time frames. The major steps are: • Develop a short description of the service and typical patient for each code being surveyed. These “vignettes” will be included on the questionnaire form distributed to the survey participants. • Identify a representative sample of physicians who are familiar with the service or procedure they are being asked to evaluate. To be considered representative, samples must include a range of sub- specialization and generalists in the specialty (as appropriate for the codes being surveyed), practice circumstances and settings (e.g., solo practice, academic settings, large group practice, and HMOs), and relevant geographic and other dimensions. • Select a set of reference codes representative of a broad range of services and work relative values, which are well understood and commonly performed by members of the specialty. The work of the surveyed code will be compared to the work of the codes on this list. • Obtain responses from at least 30 physicians. A high response rate lends heightened credence to the results and facilitates an easier process for the Academy to gain support for the code values. • Discuss the survey results with a specialty-specific expert consensus panel to formulate specific recommendations for physician work value, procedure times, and number/level of visits. The panel also formulates recommendations for practice expense and physician liability insurance (PLI). Our Academy’s panel is the Physician Payment Policy Work Group (3P). Other physicians within our specialty are often asked to participate by providing expert opinion to the panel. • Submit the recommendations to the AMA. • Present the recommendations at the RUC meeting. Meetings take place three times per year. • The RUC may take one of several actions: approve the specialty society recommendation, modify the recommendation, or send it back to the specialty society or CPT for further input/modification. • The RUC sends its recommendations for work values, practice expense inputs, and PLI crosswalks to CMS. The recommendations are confidential until the CMS publication of the Final Rule in November. • Values go into effect in January of the following year. Please note that CMS determines the final value of any code for payment by Medicare. Throughout this process, it is important that we coordinate with the other specialty societies whose members also perform the surveyed procedure or service. Each society involved in developing a recommendation for a code should be involved in developing the vignette; reviewing the reference service list; selecting a sample of survey participants; convening a meeting to discuss the survey results; preparing a consensus recommendation; and presenting the recommendation to the RUC. The Academy often works with other specialty societies such as the American College of Surgeons (ACS), the American Society of Plastic Surgery (ASPS), and American Academy of Neurology (AAN) The Survey Instrument The survey instrument is based upon the service to a “typical patient,” which should guide responses. If you do not believe the vignette reflects the typical patient, this can be indicated on the survey. Other things to be aware of when you fill out a survey are: • Although contact and basic practice information is collected, your name is never forwarded to the AMA or used for tracking purposes. • If you have any questions, a specialty society’s contact information will be provided but the society cannot interfere in how you answer the survey. The survey includes a list of procedures that have been selected for use as comparison for this survey because their relative values are sufficiently accurate and stable to compare with other services. Select a procedure from the list that is most similar in time and work to the new/revised CPT code descriptor and typical patient/service described. This code does not have to be equal but should be similar in work. • It is very important to consider the global period when you are comparing the new/revised code to the reference code. • A service paid on a global basis includes: • Visits and other physician services provided within 24 hours prior to the service; • Provision of the service; • Visits and other physician services; for a specified number of days after the service is provided (000 day global = 0 days of post care included in the work relative value unit (RVU); 090 day global = 90 days of post care included in the work RVU). • Using the vignette and the description of service periods, the survey asks you to estimate how much time it takes you when you perform the procedure. These estimates should be based on personal experience. • The pre-service period includes physician services provided from the day before the operative procedure until the time of the operative procedure. • The intra-service period includes all “skin to skin” work that is a necessary part of the procedure. Immediate post service period includes physician services provided from the end of the intra-service period until discharge from recovery. • E&M visits both in the facility and in the office are assigned as the proxy for the physician work performed postoperatively. Although these services are not paid to surgeons separately for those procedures having greater than a 0 day global period, it is very important to carefully consider these visits, as they are built into the value of the code. • In the final step of the survey you are asked to estimate the work RVU. The value should be considered relative to the value assigned to the reference code you have chosen as a best fit to the surveyed code. Although this process may seem complicated, after you complete a few surveys you will become more comfortable with the survey process. Academy Representation at the RUC The Academy is fortunate to have dedicated and experienced representation at the RUC. Wayne M. Koch, MD, serves as the Academy’s RUC advisor. Serving on the RUC panel at a national level is Jane T. Dillon, MD, RUC panel member alternate and former Academy advisor, Charles F. Koopmann, MD, MHSH, RUC panel member, and Willard B. Moran, Jr., MD, the RUC practice expense review committee chair. Tricia Bardon, assistant director of health policy, serves as Academy staff to support the considerable efforts of these physicians. Any questions can be directed to her at TBardon@entnet.org.
Updating Clinical Indicators
The Clinical Indicators (CI) for Otolaryngology—Head and Neck Surgery were first developed in 1988 by the Academy’s Quality Improvement Committee (now the Patient Safety and Quality Improvement [PSQI] Committee). In 2000, the PSQI revised the CIs to include a logical argument to justify any given diagnosis. By doing so, there was greater importance attached to the quality of the history, physical examination, and diagnostic tests. The PSQI also expanded each CI to include procedure-specific post-operative observations, outcome issues suggested for use by institutions and surgeons, and a patient information section that physicians could use during surgical counseling. The PSQI also decided to develop clinical practice guidelines that would be more comprehensive and include documentation of opinions from scientific literature. We stress that CIs are not a substitute for the experience and judgment of a physician. They serve as a checklist for practitioners and a quality care review tool for clinical departments. They are intended as suggestions, not rules, and should be modified by users when deemed medically necessary. In no sense do they represent a standard of care. The applicability of an indicator for a procedure must be determined by the responsible physician in light of all the circumstances presented by the individual patient. Adherence to CIs will not ensure successful treatment in every situation. The AAO-HNS emphasizes that CIs should not be deemed inclusive of all proper treatment decisions or methods of care, nor exclusive of other treatment decisions or methods of care reasonably directed toward obtaining the same results. The AAO-HNS is not responsible for treatment decisions or care provided by individual physicians. Because the last revision of the CIs was made well over a decade ago, AAO-HNSF decided to review the CIs to ensure they were still accurate and reflected current medical practice. As such, Bradley Marple, MD, and Richard Waguespack, MD, led the effort to review the CIs and selected 11 that needed immediate attention. These CIs are being reviewed by the Rhinology Paranasal Sinus, Pediatric Otolaryngology—Head and Neck Surgery and Oncology, Facial Plastic & Reconstructive Surgery, Airway & Swallowing, and Equilibrium Committees. Because these CIs are being reviewed, we have removed them from the website, and they will be re-posted after they are thoroughly reviewed and revised. There are 18 CIs that are not in the first group for updating, and CIs are available on our website. They are: • Acoustic Neuroma Surgery • Auditory Brainstem • Mastoidectomy • Myringotomy/Tympanostomy Tubes • Stapedectomy/Stapedotomy • Tympanoplasty • Parotidectomy • Uvulopalatopharyngoplasty • Thyroidectomy • LeFort Fracture • Mandibular Fracture • Nasal Septal Fracture • Endoscopic Debridement • Ethmoidectomy • Inferior Turbinate Surgery • Laryngectomy • Rhinoplasty • Tracheostomy If you have comments or questions about any of the CIs that are currently being updated, please email healthpolicy@entnet.org. A list of CIs being reviewed and an estimated review timeframe is listed below. To access all of the CIs, visit http://www.entnet.org/Practice/clinicalIndicators.cfm The following CIs will be posted to the website by June 2011: • Allergy Testing for Allergic Rhinitis • Caldwell-Luc • Canalith Repositioning • Diagnostic Nasal Endoscopy • Endoscopic Sinus Surgery, Adult The following CIs will be posted to the website by August 2011: • Adenoidectomy • Neck Dissection • Endoscopic Sinus Surgery, Pediatric • Laryngoscopy/Nasopharyngoscopy • Septoplasty
Patient Safety and Quality Improvement (PSQI): Annual Meeting Preview
Rahul K. Shah, MD George Washington University School of Medicine, Children’s National Medical Center, Washington, DC This fall, the AAO-HNSF Annual Meeting & OTO Expo will once again dedicate a programming track to patient safety and quality improvement (PSQI) and related topics. Last year’s session, moderated by David W. Roberson, MD, co-chair of the AAO-HNS PSQI Committee, included several prominent national speakers who discussed the role of apology and disclosure when an error or adverse event occurs. Several leaders within the Academy were present for this session and strongly urged that it appear again on the 2011 program. There is myriad literature as well as anecdotal evidence demonstrating the value of such in mitigating and reducing liability. Brian Nussenbaum, MD, and Matt A. Kienstra, MD, will moderate a miniseminar on the most recent trends and findings in the PSQI realm. There has been an explosion in the peer-reviewed literature and in the consultancy realms regarding PSQI material. Last year, this session highlighted the World Health Organization (WHO) surgical checklist collaborative, as well as the role of chlorhexidine in surgical site sterilization. This year’s program topics will come from the Academy leadership, PSQI Committee, and the AAO-HNS membership. The final session will focus on the regulatory-required and hospital-required metrics that Academy members are going to be pressed to report on in the near future, including the Joint Commission’s Ongoing Professional Practice Evaluation (OPPE) and Focused Professional Practice Evaluation (FPPE), which are self-generated and tracked by physicians, divisions, and hospitals to attest to standards of care. This part of the session will demonstrate what our colleagues are tracking and how to ensure the metrics are apropros and meaningful. With a collective discussion, the burden of defining such metrics and tracking these may be somewhat mitigated. A significant amount of time and attention has been committed to ensuring that the four-hour track on PSQI touches on the major themes in this realm, as well as leaving Academy members with actual ideas and materials to make an immediate impact on their practice. We encourage members to write us with any topic of interest. 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 e-mail the Academy at qualityimprovement@entnet.org to engage us in a patient safety and quality discussion that is pertinent to your practice.
Legislative and Political Advocacy Opportunities at Annual Meeting
The ENT PAC booth serves as the Government Affairs hub at the AAO-HNSF Annual Meeting & OTO EXPO. There, attendees can learn more about how they can support the Academy’s legislative and political advocacy efforts on Capitol Hill. ENT PAC, the political action committee of the AAO-HNS, financially supports incumbent Members of Congress and viable candidates who support and advance the specialty’s legislative priorities. Stop by the ENT PAC Booth to: • Obtain information on becoming an ENT PAC donor* in 2011; • View the renowned ENT PAC “Wall of Donors” for 2011; • Receive the latest updates on federal legislation affecting the specialty; • Join the ENT Advocacy Network to receive timely updates on political and legislative issues that affect otolaryngology—head and neck surgery and a free subscription to a biweekly e-Newsletter, The ENT Advocate; • Pick up forms to participate in the 2011 ENT Advocacy Network Recruitment Drive; • Register for the Key Contacts Network, a network of members dedicated to helping advance the AAO-HNS grassroots efforts by strengthening their personal legislative contacts; and • Learn ways to effectively advocate on behalf of the specialty.   Just for ENT PAC Members New this year, 2011 ENT PAC members donating $365 or more are invited to an exclusive Investors Briefing, hosted by the ENT PAC Board of Advisors during the Annual Meeting & OTO EXPO. PAC members will receive an insider’s update on current federal legislative activities, upcoming elections, and new PAC programs. PAC members can expect a dynamic presentation outlining the politics and policy fueling efforts on Capitol Hill. In recognition of the generous contributions received in 2011, all PAC members are invited to a donor reception on Sunday, September 11, 2011. All 2011 PAC contributors will be listed on the 2011 “Wall of Donors” located at the ENT PAC Booth. *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. ENT PAC is a program of the AAO-HNS which is exempt from federal income tax under section 501 (c) (6) of the Internal Revenue Code. The ENT Advocacy Network Recruitment Drive Returns Help Build Our ENT Advocacy Network by Recruiting New Advocates During the 2011 AAO-HNSF Annual Meeting & OTO EXPO, members are challenged to recruit U.S. AAO-HNS members for the ENT Advocacy Network to help strengthen otolaryngology’s voice and influence in the legislative and political arenas. Urge your colleagues to sign up for the ENT Advocacy Network using forms available for download in advance from the Legislative and Political Affairs website (www.entnet.org/advocacy). Forms will also be available onsite at the ENT PAC Booth. Recruitment drive participation will be recognized in several ways. The top recruiter will receive a $200 American Express gift card, and the top two recruiters will be awarded one (1) Honor Point and be featured in the BOG eNews and The ENT Advocate. New ENT Advocacy Network members and contest recruiters will receive an Advocacy Goodie Bag, which can be picked up at the ENT PAC Booth. (Limit one per person). The recruitment drive will officially run from September 1 to October 1, 2011. For more information, please contact the Government Affairs team at govtaffairs@entnet.org, or visit www.entnet.org/advocacy.
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JSAC Participants Make a Difference
At the Fourth Annual Joint Surgical Advocacy Conference (JSAC) held March 27-29, 2011, more than 240 surgeons from 18 surgical specialties advocated for medicine with a united voice on Capitol Hill. The AAO-HNS Government Affairs team thanks all our members who participated in this important event. Once again, the AAO-HNS was the second largest group represented at the conference, with 69 otolaryngologist—head and neck surgeons in attendance. Due to publishing deadlines, a more comprehensive summary of JSAC 2011 events will be featured in the June edition of the Bulletin. For more information on JSAC, please visit www.entnet.org/jsac. Sponsoring organizations of JSAC 2011 included: American Academy of Facial Plastic & Reconstructive Surgery, American Academy of Ophthalmology, American Academy of Orthopaedic Surgeons, American Academy of Otolaryngology—Head and Neck Surgery, American Association of Neurological Surgeons, American College of Obstetricians & Gynecologists, American College of Osteopathic Surgeons, American College of Surgeons, American Osteopathic Academy of Orthopedics, American Osteopathic Colleges of Ophthalmology and Otolaryngology—Head and Neck Surgery, American Society for Metabolic and Bariatric Surgery, American Society of Anesthesiologists, American Society of Breast Surgeons, Congress of Neurological Surgeons, Society for Vascular Surgeons, Society of Gynecological Oncologists, The American Society of Cataract & Refractive Surgery, and The Society of Thoracic Surgeons. Bold denotes JSAC 2011 planning committee members.
Millennium Society Enriches Our Mission
The Millennium Society is our philanthropic annual fund program that provides a vital means of financial support for the AAO-HNSF mission. Millennium Society gifts are essential to expanding the significant accomplishments of the AAO-HNSF in improving patient care. The 2011 Millennium Society program year runs January 1 through December 31. Donors to the Millennium Society can choose to support a personal area of passion, whether it be education, research/quality, residents programs, humanitarian, or international, or choose to support the general mission of our Foundation. This year, donors will receive early notice of registration and an invitation to the Millennium Society Appreciation Lounge at the Annual Meeting & OTO EXPO. There they will enjoy a place to relax, eat breakfast and enjoy hot lunches and snacks. The lounge also offers concierge and business services. Joining the 2011 Millennium Society will grant you many advantages, including: • Year-round recognition and special acknowledgements in the Bulletin and other publications and on the AAO-HNS website; • Early access to annual meeting registration and housing reservations; • Access to a special concierge lounge at the annual meeting with complimentary breakfast, lunch, and VIP seating at the annual meeting Opening Ceremony; • Recognition on the Donor Wall of Honor during the annual meeting; • Tax deductions for philanthropic gifts. There are several new levels of membership: • Life Member: Life Membership is a one-time pledge of $50,000, which can be paid over a period of five years. Naming opportunities are available for this level. • Patron Member: Joining as a Patron requires a one-time pledge of $10,000, which can be paid over a period of three years. • Sustaining Member: Membership as a Sustaining Member requires a one-time pledge of $5,000, which can be paid over a period of three years. • Member: Member status in the Millennium Society is attained with an annual contribution of $1,000. • Young Physician: Membership can be attained with an annual contribution of $250 and is only for members who are in training and up to five years out. Membership in the Millennium Society grew last year, with more than 390 members pledging more than $2 million and many increasing the positive effects of their gifts by extending their pledges over multiple years. These multi-year pledges enable a more reliable source of funding for our mission. At our highest giving category, the number of Life Members in the Millennium Society more than doubled in calendar year 2010. Philanthropic contributions to the AAO-HNSF last year helped to facilitate the following: • An annual meeting for practicing otolaryngologists and residents that boasts some 500+ instruction courses, 90+ workshops, peer networking, and an exhibit hall with more than 300 vendors; • Awarding more than 300,000 CME credit hours through more than 750 different learning opportunities each year, with more than 3,000 annual subscribers to the popular Home Study Course; • Four new Endowed Funds: Bobby R. Alford Endowed Research Grant, Women in Otolaryngology Endowment, Harry Barnes Society Endowed Leadership Grant, and the Nancy L. Snyderman Endowed International Visiting Scholar Grant; • Three new Named Funds: Dinesh and Pravina Mehta International Visiting Scholarship Grant, Vijay and Nanda Anand International Indian Visiting Scholarship Grant, and the Association of Otolaryngologist of Indian Heritage International Visiting Scholarship Grant; • Helping to develop the evidence base for otolaryngology through awarding of 47 CORE research grants, four International Visiting Scholar grants, five International Travel Grants, three research studies and three published manuscripts, three manuscripts under development, and three new clinical guidelines; • Awarding of 169 Resident Leadership grants to help defray costs associated with attendance at educational meetings; • Funding 17 humanitarian grants, humanitarian service and aid, and international exchange and outreach; • Practice management and business of medicine tools designed to aid you and your staff in the complex management of today’s otolaryngology practice; • And more than 2,900 users of AcademyU. You can make a donation online quickly and securely at www.entnet.org/donate, or contact our development staff at development@entnet.org, or 1-703-535-3718. We would like to thank our 2011 Millennium Society members who have so graciously contributed to the AAO-HNSF and its otolaryngological—head and neck surgery endeavors. 2011 Millennium Society Life Members Kenneth W. Altman, MD, PhD, and Courtney Altman American Association of Otolaryngology of Indian Heritage Vijay K. Anand, 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 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 Daniel C. Chelius, Jr, MD 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 Joni K. Doherty, MD, PhD 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 Barbara Goldstein, PhD Mary E. Gorman, MD Anna Kristina Elise Hart, MD, and William Todd Harder Jack V. Hough, MD John W. House, MD 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 Sonya Malekzadeh, MD Phillip L. Massengill, MD Pravina and Dinesh C. Mehta, MD Ralph B. Metson, MD James Netterville, MD David R. Nielsen, MD, and Becky Nielsen Michael M. Paparella, MD, and Treva Paparella 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 Krishnamurthi Sundaram, MD Dana M. Thompson, MD, MS Ira D. Uretzky, MD 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 Sustaining Members Eugene L. Alford, MD James H. Atkins Jr., MD Douglas D. Backous, MD David L. Callender, MD, MBA Newton J. Coker, MD, and The Coker Foundation Ted A. Cook, MD Cynthia Go, MD, PhD Jayson S Greenberg, MD Willard C. Harrill, MD Joseph E. Hart, MD, MS Scott M. Kaszuba, MD J. Walter Kutz, Jr, MD James A. Manning, MD Philip A. Matorin, MD J. Cary Moorhead, MD Arthur B. Morgan, MD Warren E. Morgan, MD Eugene N Myers, MD, FRCS, Edin (Hon) Bert W. O’Malley, Jr, MD Samuel M. Overholt, MD Robert B. Parke, Jr, MD, MBA Rance W. Raney, MD Sanford C. Snyderman, MD C. Richard Stasney, MD Michael G. Stewart, MD, MPH Mariel Stroschein, MD Robert A. Weatherly, MD Randal S. Weber, MD Stephen Kenneth Wolfe, MD Members David A. Abraham, MD Peter Abramson, MD Ronald G. Amedee, MD Finn R. Amble, MD J. Noble Anderson, Jr, MD James E. Arnold, Sr, MD Moises A. Arriaga, MD Herbert J. Ashe, Jr, MD William E. Barfield III, MD William R. Bond Jr., MD Peter C. Bondy, MD Phyllis B. Bouvier, MD Derald E. Brackmann, MD Carol R. Bradford, MD Jean Brereton, MBA Patrick E. Brookhouser, MD Jimmy J. Brown, DDS, MD Neil E. Brown, MD Lani Cadow Roberta M. Case, MD Ralph Cepero, MD C. Y. Joseph Chang, MD A. Craig Chapman, MD Khalid Chowdhury, MD, MBA Susan R. Cordes, MD Mary Pat Cornett, CAE, CMP Anthony J Cornetta, MD Stephen P. Cragle, MD Donald E. Crawley, MD R. Tyson Deal, MD Daniel G. Deschler, MD Eduardo M. Diaz, Jr, MD Elizabeth A. Dinces, MD Linda J. Dindzans, MD J. Douglas Harmon, MD Wayne B. Eisman, MD Moshe Ephrat, MD M. Bradley Evans, MD Jose N. Fayad, MD Ilana Feinerman, MD Alberto D. Fernandez, MD Enrique T. Garcia, MD Robert Glazer David A. Godin, MD Steven M. Gold, MD Robert P. Green, MD John J. Grosso, MD Benjamin Gruber, MD, PhD Steven D. Handler, MD Brenda Hargett, CPA, CAE Jacques A. Herzog, MD Barry Hirsch, MD Lauren D. Holinger, MD G. Richard Holt, MD, MSE, MPH John R. Houck Jr., MD Paul M. Imber, DO Barry R. Jacobs, MD Gina D. Jefferson, MD Hung J. Kim, MD James F. Kimbrough, MD Matthew T. Kirby, MD Howard S. Kotler, MD John H. Krouse, MD, PhD Denis C. Lafreniere, MD Estella Laguna Pierre Lavertu, MD Patty Lee, MD Marc J. Levine, MD Steven B. Levine, MD Alan F. Lipkin, MD Rodney P. Lusk, MD William M. Luxford, MD Ellie Maghami, MD Laurie E. Markowitz Spence, MD Edith A. McFadden, MD, MA Jeanne McIntyre, CAE Claude A. McLelland, MD Richard T. Miyamoto, MD, MS J. David Osguthorpe, MD R. Glen Owen, Jr. MD John F. Pallanch, MD Lisa Perry-Gilkes, MD James K. Pitcock, MD Christopher P. Poje, MD Jennifer P. Porter, MD Edward A. Porubsky, MD Robert Puchalski, MD Gregory W. Randolph, MD Elisabeth H. Rareshide, MD John S. Rhee, MD, MPH Richard A. Rosenberg, MD Michael A. Rothschild, MD Thomas A. Salzer, MD B. Todd Schaeffer, MD Megan Schagrin, CAE, CFRE Robinson W. Schilling, MD Mitchell K. Schwaber, MD C. Willy Schwenzfeier III, MD Samuel H. Selesnick, MD Michael Setzen, MD Clough Shelton, MD Gary M. Snyder, MD Robert J. Stachler, MD Wendy B. Stern, MD Fred J. Stucker, MD Marcelle Sulek, MD Duane J. Taylor, MD David J. Terris, MD Debara L. Tucci, MD Christopher L. Vickery, MD Richard W. Waguespack, MD Marilene B. Wang, MD Mark K. Wax, MD Samuel C. Weber, MD Brian H. Weeks, MD Samuel B. Welch, MD, PhD W. Andrew Wells, MD Benjamin White, MD Alan B. Whitehouse, MD John D. Witherspoon, MD Julie Wolfe Gayle E. Woodson, MD Eiji Yanagisawa, MD Ken Yanagisawa, MD Bevan Yueh, MD, MPH Randall S. Zane, MD Lee M. Shangold, MD, and Lauren S. Zaretsky, MD Lee A.Zimmer, MD, PhD Young Physician Members Ronda E. Alexander, MD Margo M. Benoit, MD James T. Brawner, MD Gabriel Calzada, MD Tamer Abdel-Halim Ghanem, MD, PhD Heather J. Gomes, MD, MPH Stacey L. Ishman, MD Ayesha N. Khalid, MD Oleg V. Kravtchenko, MD Amber U. Luong, MD, PhD Michael G. Moore, MD Spencer C. Payne, MD Daniel I. Plosky, MD Liana Puscas, MD Nikhila Raol, MD Lawrence M. Simon, MD Lee P. Smith, MD Angela K. Sturm-O’Brien, MD Mark E. Zafereo, Jr, MD Philp B. Zald, MD Gifts and pledges as of April 6, 2011.
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Don’t Forget These Dates!
May 1 Monthly Mini-Campaign: Facial Plastic & Reconstructive Surgery and more at www.entnet.org/Community/outreach.cfm May 2 Registration and Housing opens for the 2011 AAO-HNSF Annual Meeting & OTO EXPO at www.entnet.org May 26 Otolaryngology History Society call for papers for 2011 meeting; contact museum@entnet.org May 31 Humanitarian Resident Travel Grants application deadline for missions July 1-December 31, 2011; contact humanitarian@entnet.org May 31 Humanitarian Post-Residency travel grant application deadline; contact humanitarian@entnet.org
Diversity Committee Recognizes the Changing Face of Otolaryngology
Duane J. Taylor, MD Chair, Diversity Committee “Now is the accepted time, not tomorrow, not some more convenient season. It is today that our best work can be done and not some future day or future year. It is today that we fit ourselves for the greater usefulness of tomorrow.”  – W.E.B. DuBois The Diversity Committee is charged with educating and promoting diversity and inclusion in all its forms. This includes gender, race, religion, socioeconomic status, disability, geographic location, sexual orientation, age, and culture within our membership, and especially in our leadership. It also is charged with promoting cultural sensitivity and competence in concert with other committees—first to the membership and medical schools, and then to the public for the best treatment of ear, nose, throat, head, and neck disease. We are committed to establishing programs that support these goals of inclusion in an effort to build a culture that will attract the best and brightest physicians to our specialty, increase research being conducted by a diverse population of researchers, foster the best educational exchange, and enhance patient care. The Diversity Committee has been given a great opportunity to fulfill some of the goals outlined above, and I thank all those involved for their hard work and efforts. We must acknowledge our past and present Academy leaders Ronald B. Kuppersmith, MD, MBA, and J. Regan Thomas, MD, for their support and insight into the value of such efforts. Also I would like to thank our previous liaison staff, Jeanne McIntyre, CAE, for her efforts in helping to get this committee off the ground and moving, and welcome our new staff liaison Rudy Anderson. Currently, the Academy and Foundation are undertaking a monumental campaign, The Changing Face of Otolaryngology – Head and Neck Surgery. The Diversity Committee, along with other components of our organization, will be at the forefront of this endeavor. As chair of the Diversity Committee, I feel fortunate to have the opportunity to share with you, the membership, some of the aspirations we hope to make a reality: • Annual grant awards for medical rotations in otolaryngology • Medical student grants for the Annual Meeting & OTO EXPO and the Board of Governors (BOG) spring meeting • Resident leadership grants for the annual meeting, BOG spring meeting, and the Joint Surgical Advocacy Conference • Distinguished Research prizes for meritorious medical student or resident papers from underrepresented minority researchers • Centralized Otolaryngology Research Efforts (CORE) grant funding for research in areas related to healthcare disparities that have an impact on underrepresented patient populations, and/or to support projects of young investigators from underrepresented minorities • Increased marketing outreach to training program directors and to medical programs to encourage awareness of the specialty, its commitment to diversity, and the AAO-HNS/F. These goals we have set are just a few of the building blocks to progress, and they keep our specialty in line with acknowledging the diversity of our society. This endowment will enhance our ability to provide the best ENT care to all of our patients. The Changing Face of Otolaryngology – Head and Neck Surgery campaign is certainly progress, and the Diversity Committee is proud to help lead the way in these efforts. The Diversity Committee and I are truly excited, ready, and prepared to meet this tremendous challenge, but we need your assistance. For more information, please visit www.entnet.org/change. To donate online, go to www.entnet.org/donate. “Every day you may make progress. Every step may be fruitful. Yet there will stretch out before you an ever-lengthening, ever-ascending, ever-improving path. You know you will never get to the end of the journey. But this, so far from discouraging, only adds to the joy and glory of the climb.” – Winston Churchill
The Changing Face of Otolaryngology— Head and Neck Surgery Campaign
As an organization representing all otolaryngologists, we strive to encourage an atmosphere of inclusion for all. The AAO-HNS and its Foundation are charged with educating and promoting diversity and inclusion in all forms. This includes gender, race, religion, socioeconomic status, disability, geographic location, sexual orientation, age, and culture, within our membership and especially in our leadership. The AAO-HNS/F is committed to establishing programs that support these goals in an effort to build a culture that will attract the best and brightest physicians to our specialty. This ultimately will increase the research being conducted by a diverse population of researchers, foster the best educational exchange, and enhance patient care. As our world and our community change and evolve, our specialty continues to grow and progress. We recognize and celebrate our diversity. Beginning this year, our development efforts will reflect the changing face of Otolaryngology—Head and Neck Surgery. This new campaign, The Changing Face of Otolaryngology—Head and Neck Surgery, will allow us to “fund” our charge of inclusion and create the financial infrastructure for establishing the programs that support and attract the best and the brightest. Four areas will be highlighted in the campaign, and programs under each will be endowed. Diversity  The Diversity Endowment will provide a critical base of funding for underserved minorities to create programs that facilitate education about inclusion and encourage exploration of our specialty. The endowment will offer: • Annual grant awards for medical rotations in otolaryngology • Medical student and resident leadership grants for the annual meeting, Board of Governors (BOG) meeting, and Joint Surgical Advocacy Conference (JSAC) • Distinguished research prizes for meritorious medical student or resident papers from underrepresented minority researchers • Centralized Otolaryngology Research Efforts (CORE) grant funding for research in areas related to healthcare disparities that have an impact on underrepresented patient populations, and/or to support projects of young investigators from underrepresented minorities • Increased marketing outreach to training program directors and to medical programs to encourage awareness of the specialty, its commitment to diversity, and the AAO-HNS/F Women in Otolaryngology The Women in Otolaryngology Endowment will continue efforts to support five key areas identified as vitally important to women in otolaryngology: • Career development of women otolaryngologists—head and neck surgeons, whether private, academic, or military; • Actionable research that affects how women are integrated into mainstream otolaryngology; • Promotion of work/life integration (an issue facing all ORLs, of concern especially to our younger female members); • Leadership development and recognition; • Engagement of notable speakers relevant to women’s needs and interests for AAO-HNSF WIO Section activities. Residents and Young Physicians Young physicians and residents are the future of the otolaryngology community. The Future Leaders Endowment will provide programs that enhance leadership development for young otolaryngologists and cultivate future AAO-HNS/F leaders, including: • An annual BOG Leadership Institute Scholarship to facilitate young physicians’ engagement in AAO-HNS/F leadership training programs • Award annual Resident Leadership Grants to the annual meeting and/or BOG spring meetings and JSAC International Building on the momentum of 2010, International Visiting Scholarships (IVS) will continue to be endowed. These grants provide meritorious international otolaryngologists the opportunity to: • Participate in the Annual Meeting & OTO EXPO • Take part in a two-week observership at a U.S. Center of Excellence • Build meaningful, ongoing relations with U.S. counterparts • Receive a one-year complimentary subscription to Otolaryngology—Head and Neck Surgery These endowments will provide a critical base of funding for programs to facilitate education and research and place greater emphasis on inclusion. As a specialty, we face many future workforce challenges, including inadequately growing physician workforce, an aging population, and increased demands for otolaryngologic care. These all underscore the importance of ensuring a specialty that is welcoming to all through programs that support The Changing Face of Otolaryngology—Head and Neck Surgery. For more information or to become involved with The Changing Face of Otolaryngology—Head and Neck Surgery campaign, visit www.entnet.org/change or email development@entnet.org.
Gavin Setzen, MD, Chair of the Imaging Committee
The World’s Otolaryngology Fair: The AAO-HNSF Annual Meeting & OTO EXPO
Otolaryngologists from around the world will convene September 11-14, 2011, in California, for the premier educational and professional development opportunity. The Board of Governors (BOG) welcomes you to San Francisco, the “Golden Gate City,” and this program promises a comprehensive schedule covering a variety of issues critical to our specialty. This year has been filled with many challenges for otolaryngology and the house of medicine, with the introduction of healthcare reform implementation. The evolution continues. The BOG and our Academy will continue to push for meaningful reform of Medicare physician reimbursement, medical liability reform, and watch closely a plethora of other threats to medicine and our ability to provide optimal care to our patients. We must remain viable as the small business entities that each of our practices represents, both in academia and private practice. We also must prepare for new paradigms such as Accountable Care Organizations (ACOs) and Medical Homes, as well as the frenzy of mergers and hospital acquisitions of practices around the country. We continue to fight many battles at the state level regarding inappropriate expansion of scope of practice by allied medical providers and misleading advertising by non-physicians attempting to practice medicine without a license. There will be extensive discourse regarding these and many other topics at the BOG meeting to best prepare the membership for the “new realities” of contemporary medical practice. The AAO-HNS and BOG work diligently with the talented and committed BOG and Government Affairs staff to monitor and proactively address the ever-increasing landscape of challenges we face as individuals and as a profession. The annual meeting is a wonderful opportunity to observe the BOG in action. I invite you to join us and explore diverse opportunities for formal participation through your regional and state otolaryngological societies. Get involved, stay involved, and help make a difference. Also, from a social perspective, the annual meeting is always a wonderful way to reconnect with colleagues and old friends, to network, and to make new friends. The BOG activities begin Saturday, September 10, with committee meetings, including the Legislative Representatives Committee and Socioeconomic & Grassroots Committee. These committee meetings are filled with cutting-edge discussions relating to legislative, practice management, and socioeconomic factors affecting our specialty. You are guaranteed to walk away with important information that will make you more secure and successful in your practice. There will be a dynamic BOG Miniseminar Monday, September 12, titled “Hot Topics in Otolaryngology: 2011.” It will focus on the changing landscape of the practice of medicine in the era of healthcare reform—hospital/physician joint ventures, ACOs, reimbursement for Emergency Department (ED) coverage, and updates on payments for implementation of electronic health records (EHR). Lawrence Geller, vice president of consulting services for the Group Medical Management Associates, will focus on how the otolaryngologist can be positioned to be successful in the new ACO model of healthcare delivery. Raymund King, MD, JD, is a board-certified otolaryngologist and practicing attorney who will present on the implications of such alliances. Rick G. Love, MD, headed the BOG Legislative Committee task force on pay for ED call, and he will recommend how to successfully merge the feeling of obligation to care for hospital emergency room patients in light of increasing overhead, liability, and decreasing physician reimbursement. Michael J. Koriwchak, MD, an Atlanta-based otolaryngologist, is a noted lecturer and consultant on matters of EHR design, implementation, and “meaningful use,” and he will update attendees on the progress of the EHR initiatives. No doubt, this will be a blockbuster event. Beginning at 5 p.m. on September 12, plan to attend the BOG General Assembly Meeting. It will feature the election of BOG officers and awards recognition and will review all BOG activities and progress reports. For a full schedule of BOG-related events, please visit the Academy’s website. I urge you to get involved with your local, state, and regional societies, and make the BOG and advocacy integral to your professional otolaryngology life. Also, contribute to ENT PAC every year, participate to learn about the issues, become an advocate for your patients, your practice, your Academy, and your profession. These activities are not a “luxury,” something that someone else will take care of for you, but are a required part of practicing medicine today. We need to continue to facilitate the shift to this becoming “standard practice.” For more information on how to become active in the Board of Governors, visit the Academy’s website or contact Richard Carson, senior manager, Component Relations, at 1-703-535-3726 or at bog@entnet.org. Thank you for your commitment to the Academy and our specialty.
David R. Nielsen, MD, AAO-HNS/F EVP/CEO
Your Role in Electing Leadership
One of your most important membership privileges is choosing the Academy’s Nominating Committee. This committee, in accordance with our bylaws, is elected directly by you, the members of the Academy. In oversimplified terms, its charge is to select candidates for available offices. But in reality, its work is very complex and demanding, and requires a great deal of thoughtful preparation, discussion, and collaboration. Over the last decade, there has been a steady increase in the solemnity, determination, and desire of this group to better understand the strategic direction of the Academy and its Foundation. This group also endeavors to pair candidates with roles on the basis of preparation, dedication, and appropriate concern for the welfare of all of otolaryngology. It looks at demonstrated leadership on Academy committees, the Board of Governors and the Board of Directors. The committee weighs contributions to the annual meeting through both the Program Advisory Committee and the Instruction Course Advisory Committee and their sub-groups; work in basic science, translational, and health services research of both academic and community-based practitioners; work done on the various Education faculties and committees; contributions to the Millennium Society, Hal Foster, MD, Endowment, and the Political Action Committee; attendance at our surgical advocacy conferences; and many other related contributions. Further, the committee reviews the many other important venues for major contributions to the specialties that do not necessarily show up within the Academy structure. Many of our members are active in state legislative and regulatory oversight and advocacy in an informal manner. Others have developed great skill and expertise in health policy and physician payment policy through the CPT panel and the RUC committee. They work tirelessly behind the scenes to advocate for fairness in physician payment, coding, and billing policies with which we all must comply. Some members have worked closely with AADO, ARO, IOM, NIH/NIDCD, SUO, and other organizations whose actions and missions may parallel or intersect ours at many points. Academy members have represented our specialty in quality forums (NCQA, NQF, PCPI, SQA), government entities (military members and associations, DoD, VA), humanitarian missions (both domestic and abroad), and inter-specialty medical associations such as the ACS, AMA, CMSS, and NMA. Others make invaluable contributions through our certifying board, ABOto, or ABMS; accrediting bodies such as ACCME, ACGME, and its otolaryngology RRC; and in private enterprise through entrepreneurial business development, inventions, and device manufacturing. And as we have pointed out before, otolaryngologists are disproportionately well-represented in leadership in their communities. This is evidenced by several who have served as state and county medical association presidents, board members, and political appointees. In short, the pool of qualified candidates is both deep and wide. By pairing candidates’ strengths with our organizational strategy and our current need, the committee’s endurance, perseverance, and wisdom coalesce in the official leadership slate for your final choice. So, I want to honor the many, whose names we as members will never hear about, who are considered each year for nomination to Academy office. Every one of these individuals is an exceptional leader and deserves the honor of being nominated for office. Because the Nominating Committee keeps its conversations and deliberations private, we don’t have a public mechanism for naming and thanking all who are considered. Some of them may not even know that their names have been discussed. But I can assure all of our members that these individuals, including those who do not appear on your ballot, are great women and men dedicated to the medical profession, to otolaryngology, and to their patients, and are great models of the type of leaders we need to address the demands of the future of medicine. Last year, for the first time in a decade, the number of votes cast by our members for Academy offices increased significantly. Let’s do it again. If you save your email voting notice, put aside your ballot, or plan to come back at a later time to review the candidate statements and issues, don’t forget to come back. We need the vote, the voice, the energy, and the commitment of each member to manage successfully the transition to change that we see all around us. Thank you for doing your part. Commit now to study the issues, share your opinions, and work together to strengthen our specialty.
J. Regan Thomas, MD, AAO-HNS/F President
Our “Big Tent” Meeting
As we look ahead to September, I encourage you all to join us at—and bring your colleagues to—our Annual Meeting & OTO EXPO in San Francisco. I eagerly look forward to the most exhilarating, energizing meeting of our specialty in one of my favorite cities. We will welcome thousands of our members, specialists, allied health professionals, and exhibitors from across the United States and around the world. Please help us greet international colleagues from more than 90 countries. These colleagues spend significant time, trouble, and treasure to attend the world’s largest gathering of otolaryngologists—and the largest exposition of products and services for our specialty. Above all, our vision is that these exchanges of ideas will result in better care for all our patients. At our Opening Ceremony, we recognize those Academy leaders and members who make unrivaled contributions in many spheres, and we honor delegates from our five 2011 guest countries—Australia, France, Germany, Japan, and Switzerland—as well as distinguished leaders from our 48 International Corresponding Societies. Globalization is accelerating at a rapid pace, and it’s vital to stay aware of new trends in clinical and surgical techniques, currents in practice management, and breakthroughs in research. To that end, our meeting is a “big tent” where you can exchange views, information, and opinions, with attendees from all over, from Idaho to India, Kansas to Korea, and Minnesota to Mexico…and beyond. Thanks to Scientific Program Coordinator John H. Krouse, MD, PhD, this year, we offer two mornings of international tracking. On Monday, September 12, our unique Global Health 2011 symposium, building on last year’s successful Global Health 2010, showcases renowned experts from around the globe, introduced by Gregory W. Randolph, MD, our Foundation Coordinator for International Affairs, and the 12 Regional Advisors from our International Steering Committee. On Tuesday, September 13, Professor Karl Hormann, president of the European Academy of ORL-HNS, will deliver the Myers International Lecture on Head and Neck Cancer, followed by a miniseminar on “ethnic rhinoplasty” sponsored by the International Federation of Plastic Surgery Societies. Our meeting is probably unique in the world in offering dedicated programming to female issues. Our Women in Otolaryngology, newly elevated to Section status, will hold an exciting session for women Academy members. Many female otolaryngologists from around the world will want to take part in discussions on issues of concern to women. In addition, a miniseminar addresses humanitarian outreach by and for women and special considerations that arise with female patients and caregivers. We will further celebrate the strength that comes from our diverse background and skills in special programming focusing on cultural competencies that builds on our commitment to deliver quality patient care. (See Diversity Committee on page 14.) Past president G. Richard Holt, MD, MSE, MPH, our Regional Advisor for the Middle East, will convene a special Middle East Caucus for delegates from the Middle East and North Africa to discuss ways our Academy can collaborate with otolaryngology communities there. Similarly, our two Regional Advisors for Africa, James E. Saunders, MD, and James L. Netterville, MD, will repeat the popular Africa Caucus which brought visitors from Sub-Saharan Africa together with U.S. members eager to make connections. There also will be opportunities to meet on the IFOS Hearing for All initiative, to gather with international editors of society and subspecialty journals, and to hear about our newly retooled, redesigned International Speakers Bureau whose members are available to go to overseas conferences. On Tuesday, September 13, at the International Reception, I will honor our guest countries with a special toast and recognize our talented and deserving International Visiting Scholars. I want to thank our many volunteer members who are working hard to offer you a feast of ideas to help you give better care to your patients. Our meeting is unrivalled in the world for the rigorous peer-review of our scientific program and instruction courses. My goal is that you will leave our meeting—after catching up with friends, making new connections, and sharing real-life stories—with a head full of fresh ideas and knowledge to equip you to deliver the best ear, nose, and throat care.
Social Media and Networking at the Annual Meeting
Continually looking for new ways to enhance our members’ meeting experience, the Academy will again be using social media at the 2011 Annual Meeting & OTO EXPO in San Francisco. Giving attendees real-time access to new information during the meeting, social media and networking sites are additional tools that will help make your annual meeting experience memorable. In addition to helping those in attendance, these tools will allow colleagues who can’t make it to San Francisco, as well as the general public, to actively participate in particular sessions through video, tweets, and quick polls. Twitter  On Twitter, we will post live tweets of important news and updates daily to keep attendees on track during the meeting. We also will post relevant quotes from key sessions on the annual meeting’s Twitter account (http://twitter.com/aaohns), which now boasts more than 1,009 followers. To follow the meeting events, be sure to use the 2011 hashtag, #otomeeting2011. Facebook If you are already on Facebook, chances are you are a fan of the Academy Facebook page, www.entnet.org/facebook. Before the meeting, we will be posting updates, photos, and deadlines. During the meeting, our Facebook page is a great resource to find the latest media coverage of new research proceedings. It’s also a place to touch base with your colleagues and get the latest scoop on social events during your stay. YouTube You have probably visited YouTube to watch clinical videos of new surgical techniques (or maybe just to see videos of your favorite old shows). But for the 2011 Annual Meeting & OTO EXPO, the Academy staff will be filming short clips of various meeting sessions to give everyone a taste of what’s new and exciting at the meeting. Flickr Some of the best pictures taken at the annual meeting by the attendees themselves will be available free of charge on Flickr. We encourage all members to take photos of the convention center, opening ceremony, sessions, and social events, and share them each day. As an incentive, we will highlight your photos on our website for other members to view. Find more information about the AAO-HNSF 2011 Annual Meeting OTO EXPO at www.entnet.org/annual_meeting. Keep checking your Bulletin and the Academy Facebook and Twitter pages for updates.
Dr. Diaz
2011 AAO-HNSF Annual Meeting & OTO EXPO: Get with the Program
M. Steele Brown, special to the Bulletin The 2011 AAO-HNSF Annual Meeting & OTO EXPO is changing the face of otolaryngology by improving once again upon a familiar script. The AAO-HNSF Program Advisory Committee (PAC) and Instruction Course Advisory Committee (ICAC) is giving Academy members that for which they’re asking. The world’s largest gathering of otolaryngologists, this year’s meeting will be held from September 11-14, at the Moscone Center in San Francisco, CA. The event, which is expected to bring together 9,000-plus attendees and more than 300 exhibiting companies, will educate otolaryngologist—head and neck surgeons about the newest in leading-edge tools and techniques, present groundbreaking discoveries, and provide an opportunity to renew old friendships and meet new colleagues. “I think the most important thing I can stress about this meeting and the planning that goes into it each year is that the content continues to evolve,” said Instruction Course Coordinator Eduardo M. Diaz, Jr., MD. “We continue to check with the membership and work to give them what they are asking for. So I think people are going to be pleased with what they find at the meeting this year in San Francisco.” Scientific Program Expands, Deepens According to Scientific Program Coordinator John H. Krouse, MD, PhD, this year’s scientific program will again be integrated across all areas of the specialty — from basic and translational science to clinical research and practice — featuring approximately 86 miniseminars, 300 oral presentations, and 450 poster presentations, similar to last year’s Annual Meeting & OTO EXPO in Boston. MA. “The number of submissions we got this year was up significantly, from 120 in 2010 to 150 this year,” Dr. Krouse said. “So we continue to see a steady increase in the quantity and quality of submissions going into our programming pool and attendees at the Annual Meeting & OTO EXPO are reaping the benefits of all that good work.” Dr. Krouse said Academy members continue to demand a greater depth and breadth of content at the Annual Meeting & OTO EXPO and the program committees are dedicated to providing it. “I think the meeting is becoming more and more comprehensive, as we are able to focus in a bit more each year on areas of real interest for all the various groups of members and guests attending the event. Rather than just a few broad areas of focus, we really can offer a variety of interesting topics to all of the segments of our membership.” The Academy once again invited specialty societies to submit miniseminars for presentation at the Annual Meeting & OTO EXPO. The specialty program, which began in 2009 with 10 co-sponsored presentations, is offering 18 such miniseminars in San Francisco. Dr. Krouse said that the content for these presentations originates from across the specialty and allows the Academy, along with its specialty societies, to deliver content that will sharpen and enhance the attendees’ expertise. “Clearly the demand for these presentations is there, because the number and quality of the submissions continues to rise,” he said. “The pool is both deeper and richer every year. Unfortunately, that also means we have to reject really high-quality work because we saw such a rich interest this year.” Dr. Krouse said he is looking forward to the program, particularly the sessions on robotic head and neck surgery. “That is a really cutting-edge topic and one that should excite the membership,” he said. All of the miniseminars are peer-reviewed by the Program Advisory Committee. Dr. Krouse said that the Maintenance of Certification (MOC) process continues to be of utmost importance and that the program committee is committed to helping those physicians prepping for MOC now and in the future. On the basic and translational front, the 2011 Neel Distinguished Research Lecture will highlight the basic and translational work by James Christopher Post, MD, PhD, Medical Director at the Center for Genomic Sciences at the Allegheny-Singer Research Institute in Pittsburgh, PA. The 2011 Basic and Translational Research mini-program will cover various topics, including “Otitis Media: Evidence-Based Reviews to Change Practice,” “Genetics in Otolaryngology: Translational Research,” “Updates in Pediatric Obstructive Sleep Apnea,” and “Biofilms in Otolaryngology: What Does this Mean to the Clinician?” Instruction Courses Instruction Courses are one- or two-hour sessions lead by experts in the field of otolaryngology and other healthcare professionals that address current diagnostic, therapeutic, and practice management topics, presented by both Academy members and non-members. Early registration for Instruction Courses increases your possibility of receiving your first-choice selections and saves you money. The 2011 Instruction Course Program is again packed with great educational opportunities. Dr. Diaz said that, as submissions increase in number, the Instruction Course Advisory Committee (ICAC) continues to raise the bar for inclusions in the Annual Meeting & OTO EXPO. “We used to have so many courses that we started separating the wheat from the chaff, making the standards a fair amount higher and increasing the number of eyes on each submission,” he said. “We are working hard to tailor the curriculum to what we hear Academy members asking for. We are giving them what they want.” “The ICAC looked at a ton of abstracts this year,” he said. “There used to be two or three committee members looking at everything, but now we take a look at which courses and topics are getting the highest rating by the attendees at past meetings and applying that filter. Then the whole 20-member committee takes a look at the abstracts and decides what makes it in and what gets passed over.” Dr. Diaz said the San Francisco courses offers more than 400 hours of quality instruction on a variety of topics, including robotics and its various uses in Otolaryngology. Instruction course fees are $50 per hour and $70 per hour for hands-on courses, if you register in advance. Instruction course fees increase after the advance registration deadline, to $70 per hour and to $90 per hour for hands-on courses. There are three sub-groups outside the regular courses: • Hands-on—These courses allow each attendee to participate in the presentation. • Mini-Course—Limited to 25 participants, mini-courses promote informal discussion and the exchange of information. • Interactive—These courses will use an Audience Response System, allowing audience members to respond to the presenter during the course. As with the Scientific Program, the Instruction Courses are a valuable tool for members preparing for examinations. “The Instruction Course tracks, like the Scientific Program, are aligned with the specialty areas defined by the American Board of Otolaryngology,” according to Dr. Diaz. “These categories make it easier for members to select Courses and maximize the Annual Meeting’s benefit to them.” Once again, CME stations will be available in the convention center and accessible online, allowing attendees to go to a station or their laptop to review a course immediately after attending it. For physicians attending the meeting, the CME credits earned will be included in the official transcript sent in January. Certificates of Attendance will also be available for printing at certain points in the convention center. International Flavor Once again, the Academy is reaching out to the international otolaryngology-head and neck surgery community, presenting a joint venture with the International Otolaryngology Committee. According to Dr. Krouse, the purpose of the ongoing focus on international cooperation rests on the good that comes from the cross-fertilization of ideas. “We continue to expand our International Program, with two full mornings of programming dedicated to this area on Monday and Tuesday,” he said. “Not everything is developed or discovered by Americans, so it only makes sense that we extend the invitation to our international colleagues to share their expertise with us. We all benefit when we share our ideas.” The 2011 Annual Meeting & OTO EXPO will honor Australia, France, Germany, Japan, and Switzerland, with delegations from each of these countries being honored at the Opening Ceremony. Networking Opportunities The Academy will again make a list of events and places available for networking. As always, the alumni events will be held on Tuesday, allowing former colleages to rekindle their professional relationship and catch up with old friends. “The Millennium Lounge will be up and running again,” Dr. Krouse said. “It really provides a great opportunity for networking, giving members a venue to sit, talk and relax. And it is important to note that the Foundation sees a direct financial benefit as well.” Eligible visitors may take advantage of the business services available in the lounge, which include telephones, fax machines and computers for checking email and browsing the Internet. Millennium Society members can also get help with course registrations and the submission of CME evaluations, as well as information about local events and meeting activities and even a complimentary luggage check. For those attendees whose goal it is to find a new job, employee, or research partner, ENT Careers Live! will be there for you too. The Academy will again also offer an online itinerary planner with a downloadable appointment scheduler. It includes all education, scientific, and instruction course programming; social functions, committee meetings, and other special meetings taking place at the Annual Meeting & OTO EXPO.
Michael S. Benninger, MD
Meet the Candidates for President-Elect of the Academy
At the Board of Governors Spring Meeting in March 2011, Gavin Setzen, MD, immediate past chair of BOG, and chair of the BOG Nominating Committee/Nominee Platform Work Group, provided an overview of the Candidates Forum session. Because of prior international speaking commitments, neither candidate for president-elect was available to be in attendance at the BOG Spring Meeting. In advance of the meeting, both candidates were provided with questions developed by the BOG Nominee Platform Work Group, and each candidate’s responses were videotaped and shown to the attendees. The following transcripts were made from the videos especially for this Bulletin. Links to the video clips can also be accessed at www.entnet.org/Community/public/Presidents-Elect-Forum.cfm. The entire slate of candidates’ official statements will appear in the June Bulletin and be posted on the Academy’s website for review. Note: Both candidates were given the same treatment and instruction in the preparation of the following forum materials. QUESTION 1: Choosing two elements of the Academy’s Strategic Plan, how would you propose to advance them over the next three years while in the influential positions of president-elect, president, and immediate past president. Michael S. Benninger, MD: I’m Mike Benninger, and I’m the chairman of the Head Neck Institute of the Cleveland Clinic. I would like to begin by thanking the Nominating Committee for proposing me to be the candidate for the presidency of the American Academy of Otolaryngology—Head and Neck Surgery. The opportunity to run for this office is a remarkable honor and, frankly, it is a bit humbling. I would also like to congratulate my good friend, Jim Netterville, on his well-deserved nomination. I strongly believe that the future of our specialty should be built on the foundations of professionalism, the pursuit of excellence, and improving the patient care, quality, safety, and experience. I believe that I have the experience and the fortitude to take on this most important position and to represent and advocate for you, our membership. I’ve dedicated most of my professional career to the Academy, and there is no organization that is more important to both the practices of but also the academic growth of otolaryngologists, and not only in the United States but worldwide. I believe that my efforts have helped to strengthen the mission of the Academy in supporting members through education, through research, and advocacy. I have served in many capacities for the Academy and Foundation. I have been the chairman of the Board of Governors. I’ve been the vice president, and I served as the editor of the White Journal. I spent four years on the Executive and Finance Committee, and 11 consecutive years on the Board of Directors. I believe that these experiences have provided me not only with a strong background and familiarity with governance but also the foundation to lead this remarkable organization. I have also been a delegate to the AMA on behalf of the Academy. I’ve been a member of a number of different committees, two of them as chairman, and I’ve served on the Taskforce for New Materials and the Home Study Course. I have a strong administrative background and a strong budgetary background, having chaired a large ENT department and now a large institute and having been the treasurer of the American Laryngological Association. I’ve been president of the American Rhinologic Society and will soon be president of the American Laryngological Association (ALA). I really feel that I represent both town and gown. I’m an academic ENT but still have part of my practice in a suburban general ENT practice. I was a member of the House of Delegates both to the AMA and the Michigan State Medical Society. Although I have a strong research and publication background and I’ve served both on the Residency Review Committee and as a Senior Board Examiner, I believe that I represent all of otolaryngology, particularly in my many years on the Board of Governors. The American Academy of Otolaryngology—Head and Neck Surgery is a remarkable organization that empowers otolaryngologists to deliver the best patient care and is critical to the future of our specialty. I love this organization, and I’m grateful that I’ve been a part of it. I believe that my experiences both within the Academy and without have helped to prepare me to be able to lead this amazing organization; and I know that with the support and participation of you, our members, the elective leadership, the Board of Governors, and our terrific staff that I will be able to promote our specialty, advocate for our members, and tackle our key strategic issues. Over the next few years, the challenges that our members will have to meet will be great and likely increasing. Not only do we have diminished payments, rising healthcare costs, and increasing self- and non-pay patients, the implementation of the Healthcare Reform Act will require renewed emphasis on healthcare advocacy, health policy, and education. The provisions of the reform are confusing, and the necessary actions for physicians are still nebulous. Most busy otolaryngologists have neither the time nor the resources to figure out the fine details of what they will be required to do, and continued assistance from our Academy is critical. We, as an organization, believe that any healthcare reform must be built on a solid foundation and in the best interest of our patients. Although advocacy and representation are the keys to defining the future of otolaryngology, education will serve to ease those transitions and strengthen our responses. We will continue to be challenged by governmental rules and regulations and by other payers and regulators, so our Academy should continue to strengthen our advocacy for all otolaryngologists and help us to navigate the myriad regulations and definitions. The overall shortage of otolaryngologists and maldistribution has been well-shown through work done through the Academy and spearheaded by Rick Pillsbury. We need to take on a more proactive role in evaluating the long-term threats to our practices and in finding solutions to improve distribution of ENT care, assuring access, and protecting our critical roles. There is no specialty that can do what we can, and there’s no organization that represents all of otolaryngology like the Academy. We may at times need support from other physicians and non-physician specialty providers, but the coordination of care for the management of patients with otolaryngologic disorders needs to remain with the otolaryngologists. Our challenge is to meet this demand and distribution while retaining the critical role of supporting the best quality, safety, and appropriate care for our patients. A clear part of this is protecting and growing our practices, our practices that define the highest quality of otolaryngology care. Finally, we must continue to advocate for meaningful tort reform. Our Academy has done much to support these changes, but we will need to do more and in a large part through the engagement and participation of our members. I’ve been active in organized medicine for most of my career, not only for the Academy but in many of our subspecialty societies, as president of the state ENT society and as a member of the House of Delegates both for the AMA and the Michigan State Medical Society. When I was chairman of the Board of Governors, we started the ENT PAC. I coordinate ENT care in an integrated system of multiple hospitals and a blend of high-intensity tertiary care along with regional general practice with employed physicians and with private practitioners and with academic and nonacademic practices. I have the experience and I will be dedicated to help provide leadership through these complex times and to advocate for the unique and essential role of all otolaryngologists in providing the highest quality of care for our patients. QUESTION 2: Diversity, specialty unity, and collaboration between our Academy and the specialty societies are very important to the stability and future success of our Academy. How do you propose promoting and securing these goals in an era of increased competition, fragmentation, and evolving healthcare reform? Michael Benninger, MD: The future of otolaryngology and the role of the Academy in designing that future will require that we come together as one specialty to represent the needs of our patients. One of the key objectives of the Academy is to promote specialty, strength, and unity. This will require building and sustaining an engaged membership, strengthening our development of future leaders and dedicated workers, and through collaboration between our sister societies. I feel that I have the strength and the experiences which can help meet this critical strategic goal. The otolaryngology community has many parts and organizations and with the Academy serving as the overreaching organization for each of these parts. Our remarkable subspecialty societies play an important role in educating their members, growing science, and improving critical care. Each of them has made a unique impact on otolaryngology and their size, independence, and more focused area of interest has led to important focused educational, research, and advocacy programs. As a group of otolaryngology organizations, our specialty is great. But as a coordinated cohesive group of organizations, our potential is unlimited. As the pressures of healthcare reform, decreasing payments, reductions in research and education financing, and growing regulations impact all of us, now is the time for our specialty societies in the Academy to continue our path to cohesiveness and unity. We need to do this with a focus of our patients always as the highest priority and with an outlook for promoting the legacy of otolaryngology for our future doctors. In addition to my career of involvement in the Academy, my background in organized medicine and our sister organizations is strong. I was president of the American Rhinologic Society and soon to be president of the ALA. I have served on the Triological Society Council and on the boards of the Voice Foundation, the Society of Head Neck Nurses, and the International Association of Phonosurgery. I also chaired the Sinus and Allergy Health Partnership, which was a joint venture between the Academy, the American Academy of Otolaryngic Allergy, and the American Rhinologic Society. These experiences have given me insight into the needs of our smaller organizations while still understanding and promoting issues that are important to all otolaryngologists. I also have spent much of my career developing future leaders. Although each of these people individually controls their own destiny, leaders help to develop other leaders. Many of the people that I have supported have gone on to become active leaders in their own right, with many of them in the Academy, including our current chairman of the Board of Governors, Mike Seidman. If elected President, it will be one of my highest priorities to continue the efforts to promote specialty, strength, and unity, to engage our membership, and to help cultivate the next generation of leaders in otolaryngology. James L. Netterville, MD: My friends, I am so sorry that I’m not with you this week in Washington. I cannot let this moment pass without thanking you again for honoring me with one of the most cherished awards of my career, the 2009 Board of Governors Practitioner of Excellence Award. I’m a full-time clinician just like most of you. I’m treating patients five to six days a week. Therefore, to receive the Practitioner Excellence Award from you, friends and peers who are actively treating patients daily, has been one of the highlights of my career. On this occasion, I’m extremely honored to be nominated for the presidency of our Academy. I would like to answer the two questions you forwarded to me and then end with some closing remarks. When you’re facing a massive shift in healthcare delivery that we have never seen before, we as doctors are facing a radical change in the way we practice medicine that we have never seen before; therefore, we need action that has never been delivered before. Our new Affordable Care Act presents two distinct reimbursement strategies, both with the purpose of broadening the unit of payment beyond fee-for-service and including quality into the payment system. This plan is an extensive experiment with the initiatives that include bundled payments, setting up of accountable care organizations. The Affordable Care Act also delegates to the Secretary of Health the implementation of payment reform. It has been totally removed from congressional oversight. In this same year, we are to change overnight from using 17,000 ICD-9 codes to 150,000 ICD-10 codes. In order for you to be paid, every form and every computer program will have to be updated. How will our advocacy deal with these radical changes in health policy? How will our educational programs prepare us for this coming flood? We at the Academy can play ostrich and hope these changes are never implemented or we can become proactive and develop tools to educate the Academy members on how to take advantage of this coming chaos. I propose setting up two specific advisory taskforces made up of both internal and external experts. The first would advise on how to structure our Academy’s advocacy to influence the implementation of the new program to our benefit. But equally important, and probably more relevant, this taskforce will give us direction on how to adjust of to what we cannot change. The second taskforce would be charged to work with the Academy’s educational program to set up a series of seminars at our Academy meeting specifically to address each of these potential changes. We desperately need education in organizational behavior of the policy, governance management, strategy, operations, so we can be prepared for involvement in value-based purchasing, bundled payments, and accountable care organizations. As we see these changes coming, questions loom in our mind: How will a small practice prepare for involvement in a large accountable care organization? How will we negotiate an equitable portion of a bundled payment for an entire patient visit? How will we measure and demonstrate quality in our practice? Our Academy must prepare to educate and advocate for us with this coming flood of healthcare. QUESTION 2: Diversity, specialty unity, and collaboration between our Academy and the specialty societies are very important to the stability and future success of our Academy. How do you propose promoting and securing these goals in an era of increased competition, fragmentation, and evolving healthcare reform? James L. Netterville, MD: First, we should not concentrate so much on our differences but on our common ground, for our common ground is far greater than our differences. At times, we have permitted the loud voices of a few doctors to create an illusion of divergence and fragmentation when in reality 98 percent of our needs we all hold in common. Although it is critically important to do everything possible to work toward unity, we must not allow an emphasis on this topic to create a perception of fragmentation that is far greater than reality. In spite of this vast common ground, enhancement in our communication and unity is needed. As I participated in our Board of Directors over the last three years, I’ve supported and voted for several initiatives toward this goal. An excellent example is the SSAC, a Specialty Society Advisory Council, which in its first one-and-a half years has made tremendous strides. With the strength of two voting seats on the Academy board, a position on the Executive Committee of the BOG, and multiple appointments to influential committees, this council has fully integrated into our academy fabric, bringing the voices of the specialty societies to the forefront of all discussions. Also this last year, I supported the creation of the new Women in Otolaryngology section. This was created in an effort to identify and represent the unique needs of our women colleagues. In Boston, our female partners raised over $400,000 in four days to found the Women in Otolaryngology Endowment through our Millennium Society. The majority of this money came from new donors demonstrating the power of this group to develop member loyalty and involvement in our Academy. I plan to use these as templates to create forums for any subset of our membership who may feel underrepresented by our Academy. When I was a child, I remember coming to blows as mortal enemies with my brother over a critical issue of what television channel we were going to watch. If we had parted ways over what seemed like such an important issue at that moment, I would have lost one of the most loyal friendships of my life. Through our unity as adults, we have survived many crises together. My major goal over the next three years is to help us all to see how actually united we are, how our goals and needs are truly the same, and how insignificant some of our differences really are. We are a small family that is being attacked from all directions. It is only through our unity that we will succeed. I work daily in a university setting surrounded by medical students, residents, and junior faculty who are constantly barraged with negative feelings about their future in medicine. A critical component of my role as their teacher, as their professor, is to encourage these young doctors so they don’t lose sight of the joy that a life of service to others offers to us all. I encourage them daily that they have made the right choice to be able to serve mankind in a way that no other profession can. The ability to lead with encouragement is an essential capacity that the leaders or our Academy need to possess. If we are not careful, our perception of our environment can often be tainted by a few factors that overshadow the real meaning to what we offer to our patients. We must never forget that we have been given a remarkable gift, the gift to be involved in the lives of our patients, to provide healing, to relieve suffering, to share joy with them when we return quality to their lives. If I’m so fortunate to represent you as a president of our Academy, my ambition is to listen to each of you and for us to work together to accomplish our goals, to work together to influence legislation that opposes our common objective of providing best quality and affordable care to our patients, to work to oppose all those who want to deliver this same care without the appropriate knowledge or training, to continue to improve the most remarkable otolaryngology educational program in the world with specific targets to prepare us for the changes in healthcare and maintenance of certification, to expand our joint research and quality outcome studies, to find new ways to expand our philanthropic base to create a powerful vibrant Academy for the next generation, and finally I plan to pray daily for peace and for wisdom for each of you, for the academy leaders, the academy staff as we struggle with the inevitable yet uncertain changes that lay ahead of us. Our Academy is a unique and remarkable society. It is by far the most premier and influential otolaryngology society in the world. I am passionate about the role of our Academy in our professional lives. It would be the singular honor of my life to be able to serve each of you through the presidency of our Academy.