Published: October 25, 2013

The Lost Decade?

Rahul K. Shah, MD George Washington University School of Medicine, Children’s National Medical Center, Washington, DC Many recognize the catch phrase above as referring to the economic times of Japan over the last two decades, when the country experienced a collapse in its economic bubble. Unfortunately, some economists believe that our country is in a situation that may lead to a lost decade as well. Only time will tell. The phrase “lost decade” came to mind when reading the astutely designed study by Landrigan, et al. titled, “Temporal Trends in Rates of Patient Harm Resulting from Medical Care.”1 The authors had internal and external reviewers perform random audits of hospitals in North Carolina to assess for trends in patient harm over the last decade. The premise is that with the significant attention from the Institute of Medicine report in 1999 and the subsequent attention and resources committed to the patient safety and quality improvement movement, we should be seeing tangible returns on our investments a decade later. Unfortunately, the study in the New England Journal of Medicine by Dr. Landrigan and his group shows that there has not been significant improvement in harms reduction over the past decade. For the study, they chose to look only at North Carolina, as this state has been a leader in committing to patient safety and quality improvement efforts. This study is worth reading for all Academy members, as it echoes what many have commented to the Patient Safety and Quality Improvement Committee in the past year. As the decade comes to an end, we are found asking ourselves what has been gained in terms of tangible results for patient safety. Although I am not surprised by the findings in the Landrigan study, there are certainly some thoughts that can be presented as opposing viewpoints. Perhaps states other than North Carolina have shown a statistical improvement in outcomes over the last decade, or perhaps on a macro-level this would have been shown to be true. It may be that the returns on the patient safety and quality improvement investment are lagging returns, in the sense that pilot initiatives and a culture change take time to manifest. But I ask myself, would I rather be a patient now or 15 years ago? We all should ask ourselves this question, because on a very granular level we can see tangible results of the benefits of patient safety and quality improvement initiatives. Furthermore, we are all privy to anecdotal stories regarding good catches and harm that has been prevented. It just may take a few more years for these anecdotes to amount to statistical significance. The Institute of Medicine had an ambitious target of a 50-percent reduction over the ensuing five-year period. Unfortunately, that window has passed, but hopefully we will see some concrete results soon. The Patient Safety and Quality Improvement Committee is driven by iterative and incremental changes which we believe in hindsight will demonstrate a composite improvement in outcomes and the quality for otolaryngology patients. In the last decade, our specialty has continued to lead and pave the path among surgical specialties on patient safety and quality improvement efforts. Academy members have been busy and instrumental on efforts such as participating on myriad national quality organizations, taking a role in the continued expansion of the American College of Surgeon’s National Surgical Quality Improvement Program (NSQIP). We also have begun contemplating the role of data registries for members, conducting studies on medication and device safety, and looking at areas of vulnerability for our members. As noted by the Landrigan team, there are similar successes in the general body of medicine, although some of the adoption is limited. It does not benefit the patient at all that the literature is becoming populated with studies about safety and errors in otolaryngology. What benefits the patient is that individual practitioners and national organizations heed the results from these articles and attempt to put some of these findings into use on a patient level. It is important to ask whether we will see statistically significant outcomes from the patient safety and quality improvement measures that are in place and continue to be implemented. It may be best to stop the debate for now and agree that only time will tell. The healthy dose of realism provided by the Landrigan article helps align our perspectives and further studies to ensure that we actually do provide a return on the significant investments we are making—to simply have better outcomes for patients from each intervention. Reference Landrigan CP, Parry GJ, Bones CB. Temporal Trends in Rates of Patient Harm Resulting from Medical Care. N Engl J Med. 2010 Nov 25;363(22):2124-34. We encourage members to write to us with any topic of interest and we will try to research and discuss the issue. Members’ names are published only after they have been contacted directly by Academy staff and have given consent to the use of their names. Please email the Academy at qualityimprovement@entnet.org to engage us in a patient safety and quality discussion that is pertinent to your practice.

Rahul K. Shah, MD
George Washington University School of Medicine, Children’s National Medical Center, Washington, DC

Many recognize the catch phrase above as referring to the economic times of Japan over the last two decades, when the country experienced a collapse in its economic bubble. Unfortunately, some economists believe that our country is in a situation that may lead to a lost decade as well. Only time will tell.

The phrase “lost decade” came to mind when reading the astutely designed study by Landrigan, et al. titled, “Temporal Trends in Rates of Patient Harm Resulting from Medical Care.”1 The authors had internal and external reviewers perform random audits of hospitals in North Carolina to assess for trends in patient harm over the last decade. The premise is that with the significant attention from the Institute of Medicine report in 1999 and the subsequent attention and resources committed to the patient safety and quality improvement movement, we should be seeing tangible returns on our investments a decade later.

Unfortunately, the study in the New England Journal of Medicine by Dr. Landrigan and his group shows that there has not been significant improvement in harms reduction over the past decade. For the study, they chose to look only at North Carolina, as this state has been a leader in committing to patient safety and quality improvement efforts.

This study is worth reading for all Academy members, as it echoes what many have commented to the Patient Safety and Quality Improvement Committee in the past year. As the decade comes to an end, we are found asking ourselves what has been gained in terms of tangible results for patient safety.

Although I am not surprised by the findings in the Landrigan study, there are certainly some thoughts that can be presented as opposing viewpoints. Perhaps states other than North Carolina have shown a statistical improvement in outcomes over the last decade, or perhaps on a macro-level this would have been shown to be true. It may be that the returns on the patient safety and quality improvement investment are lagging returns, in the sense that pilot initiatives and a culture change take time to manifest.

But I ask myself, would I rather be a patient now or 15 years ago? We all should ask ourselves this question, because on a very granular level we can see tangible results of the benefits of patient safety and quality improvement initiatives. Furthermore, we are all privy to anecdotal stories regarding good catches and harm that has been prevented. It just may take a few more years for these anecdotes to amount to statistical significance. The Institute of Medicine had an ambitious target of a 50-percent reduction over the ensuing five-year period. Unfortunately, that window has passed, but hopefully we will see some concrete results soon.

The Patient Safety and Quality Improvement Committee is driven by iterative and incremental changes which we believe in hindsight will demonstrate a composite improvement in outcomes and the quality for otolaryngology patients. In the last decade, our specialty has continued to lead and pave the path among surgical specialties on patient safety and quality improvement efforts. Academy members have been busy and instrumental on efforts such as participating on myriad national quality organizations, taking a role in the continued expansion of the American College of Surgeon’s National Surgical Quality Improvement Program (NSQIP). We also have begun contemplating the role of data registries for members, conducting studies on medication and device safety, and looking at areas of vulnerability for our members.

As noted by the Landrigan team, there are similar successes in the general body of medicine, although some of the adoption is limited. It does not benefit the patient at all that the literature is becoming populated with studies about safety and errors in otolaryngology. What benefits the patient is that individual practitioners and national organizations heed the results from these articles and attempt to put some of these findings into use on a patient level.

It is important to ask whether we will see statistically significant outcomes from the patient safety and quality improvement measures that are in place and continue to be implemented. It may be best to stop the debate for now and agree that only time will tell. The healthy dose of realism provided by the Landrigan article helps align our perspectives and further studies to ensure that we actually do provide a return on the significant investments we are making—to simply have better outcomes for patients from each intervention.

Reference

  1. Landrigan CP, Parry GJ, Bones CB. Temporal Trends in Rates of Patient Harm Resulting from Medical Care. N Engl J Med. 2010 Nov 25;363(22):2124-34.

We encourage members to write to us with any topic of interest and we will try to research and discuss the issue. Members’ names are published only after they have been contacted directly by Academy staff and have given consent to the use of their names. Please email the Academy at qualityimprovement@entnet.org to engage us in a patient safety and quality discussion that is pertinent to your practice.

More from February 2011 - Vol. 30 No. 02
Outreach to Egypt, Lebanon, and Turkey
On a recent tour of the Near East, Eugene N. Myers, MD, the Regional Advisor for the Balkans, Greece, and Turkey on the AAO-HNSF International Steering Committee, was guest of honor at the Annual Educational Conference of the University of Cairo’s Department of Otolaryngology. The meeting took place October 13-15, 2010, in Porto Marina, Egypt. Dr. Myers gave the opening lecture titled, “Defining the Role of the Surgeon in the Era of Chemoradiation.” He also delivered lectures on “Management of Congenital Cysts and Sinuses of the Head and Neck” and “Management of Tumors of the Parapharyngeal Space,” and presented an instructional course on “Selective Neck Dissection.” Dr. Myers also served as a visiting professor at the University of Alexandria, Egypt, and on October 17, 2010, lectured on “Selective Neck Dissection” at the American University of Beirut Department of Otolaryngology in Lebanon. At the 32nd Turkish National Congress of Otorhinolaryngology and Head and Neck Surgery, October 27-31, Antalya, Dr. Myers was the guest of honor. This was the fifth joint meeting between the American Academy and the Turkish National Society. Professor Asim Kaytaz, the Turkish Congress president, welcomed 1,940 attendees, including 80 foreign participants from 32 countries. Academy speakers on the program were Ramon A. Franco Jr., MD, Stilianos E. Kountakis, MD, PhD, Eugene N. Myers, MD, FRCS Ed (Hon); Jeffrey N. Myers, MD, PhD, Joseph B. Nadol Jr. , MD, Laura J. Orvidas, MD, Edmund A. Pribitkin, MD, Ralph P. Tufano, MD, and Mike Yao, MD. During the Turkish Congress, the Balkan Society of Otolaryngology—Head and Neck Surgery elected Dr. Myers as its Honorary President.
Zimbabwean boy patient, post-op.
Cleft Mission to Zimbabwe
David A. Shaye, MD Sacramento, CA As a University of California (UC) Davis resident, I participated in a five-week volunteer rotation in Zimbabwe, Central Africa. There, I worked with Operation of Hope, a U.S.-based non-profit organization that focuses on helping children with cleft lips and palates in countries where there is a large, unmet need. Along with Academy Fellows Travis T. Tollefson, MD, and Christopher J. Tolan, MD, both facial plastic surgery graduates of UC Davis, we performed 45 surgeries for children with cleft lips, cleft palates, burns, and other facial deformities. The first day in Zimbabwe was screening day, where we evaluated, screened, saw in follow-up, or scheduled for surgery nearly 100 patients at Harare Central Hospital. The patients had heard of Operation of Hope through a word-of-mouth referral network and national radio advertisements that air the month prior to the program. In parts of Zimbabwe, some view a cleft deformity as a punishment for parental wrongdoings. Community acceptance of the children is poor, which adds to their difficulties. One family sold a goat to finance the 14-hour bus ride to the capital so that their son, Calvin, could undergo surgery. His parent’s thank-you note hangs in the hall of Harare Central Hospital: “Thank you for what you have done to our child Calvin. May God bless you and give you more blessings. Calvin has a small mouth now, with a round face. Thank you all!” I stayed for an additional three weeks of volunteering at Howard Hospital, a rural mission hospital in the northern part of Zimbabwe. There I performed and assisted in a variety of surgeries with other volunteers. Despite the ravages of TB, malnutrition, and AIDS that permeate the healthcare system, there is an enormous sense of hope and appreciation in the Zimbabwean people. In the future, I hope to make international volunteer work a focus in my career. I want to thank the Humanitarian Efforts Committee for making my mission possible through a resident humanitarian travel grant.
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Consensus Opinion: How to Code Balloon Sinus Dilation
Richard W. Waguespack, MD; Michael Setzen, MD; Michael J. Sillers, MD; Scott P. Stringer, MD The AAO-HNS submitted three new code requests in October 2009 to the American Medical Association (AMA) for Category I CPT codes for the use of stand-alone balloon sinus dilation technology during endoscopic sinus surgery. The AMA has accepted these new code proposals and has recommended work and practice expense relative value units (RVUs) to CMS for the new codes. These codes incorporated into CPT 2011 as follows: 31295 Nasal/sinus endoscopy, surgical; with dilation of maxillary sinus ostium (e.g., balloon dilation), transnasal or via canine fossa (Do not report 31295 in conjunction with 31233, 31256, 31267 when performed on the same sinus) 31296  with dilation of frontal sinus ostium (e.g., balloon dilation) (Do not report 31296 in conjunction with 31276 when performed on the same sinus) 31297  with dilation of sphenoid sinus ostium (e.g., balloon dilation) (Do not report 31297 in conjunction with 31235, 31287, 31288 when performed on the same sinus) The relative work values of these codes as adopted by CMS are 2.70 for 31295, 3.29 for 31296 and 2.64 for 31297. There are changes in the introductory language and new parenthetical notes related to existing endoscopic sinus surgery codes to account for these additions. Revised introductory guidelines A surgical sinus endoscopy includes a sinusotomy (when appropriate) and diagnostic endoscopy. Codes 31295-31297 describe dilation of sinus ostia by displacement of tissue, any method, and include fluoroscopy if performed. Codes 31233-31297 are used to report unilateral procedures unless otherwise specified. The parenthetical notes define which codes can be reported together. Dilation codes cannot be reported for the same sinus as existing corresponding resection codes. New exclusionary parenthetical notes 31233 Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus or canine fossa puncture) (Do not report 31233 in conjunction with 31295 when on the same sinus) 31235 Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of sphenoidal face or cannulation of ostium) (Do not report 31235 in conjunction with 31297 when performed on the same sinus) 31256 Nasal/sinus endoscopy, surgical, with maxillary antrostomy; 31267 with removal of tissue from maxillary sinus (Do not report 31256, 31267 in conjunction with 31295 when performed on the same sinus) 31276 Nasal/sinus endoscopy, surgical with frontal sinus exploration, with or without removal of tissue from frontal sinus (Do not report 31276 in conjunction with 31296 when performed on the same sinus) 31287 Nasal/sinus endoscopy, surgical, with sphenoidotomy; 31288 with removal of tissue from the sphenoid sinus (Do not report 31287, 31288 in conjunction with 31297 when performed on the same sinus) The CPT Assistant article published in January 2010 will be largely superseded by the new codes. As always, if a service is not accurately described by an existing CPT code, the unlisted 31299 should be reported. The primary goal of endoscopic sinus surgery is relieving obstruction and re-establishing sinus ventilation and drainage. This is a generally accepted surgical principle that applies to all of the paranasal sinuses regardless of what instrumentation is used. With the introduction of balloon dilation technology, there is a recognized difference in the physician work involved between traditional endoscopic sinus surgery with tissue removal (bone, mucosa, polyps, tumor, and/or scar) and endoscopic sinus surgery when the balloon, or any device, is employed as a dilation tool only and no tissue is removed. When a balloon or other device is used to dilate a sinus ostium under endoscopic visualization as a standalone procedure and no tissue is removed, the correct reporting is the new corresponding dilation code. Fluoroscopy, if performed, is not reported separately. Balloon dilation of the maxillary ostium performed via the canine fossa approach with removal of tissue from the interior of the antrum is reported with 31299. If performed in a bilateral fashion, 31299, without modifier 50, is reported; this unlisted code should only be reported once per surgical session. Similar logic applies to the sphenoid sinus. This does not apply to endoscopic surgery of the ethmoid sinus as there is no current balloon technology for use in the ethmoid sinus. If ethmoidectomy is performed in conjunction with balloon dilation of the frontal, maxillary, and/or sphenoid (no tissue being removed), the appropriate ethmoid code should be reported in addition to the corresponding dilation code: 31254 Nasal/sinus endoscopy, surgical; with ethmoidectomy, partial (anterior), or 31255 Nasal/sinus endoscopy, surgical; with ethmoidectomy, total (anterior and posterior). Removal of ethmoid tissue as part of ethmoidectomy does not constitute tissue removal from the frontal, maxillary, and/or sphenoid sinuses if the balloon is used for dilation of these sinus ostia alone. The majority of endoscopic frontal sinus procedures focus on relieving obstruction in the frontal recess, the inferior aspect of the frontal sinus outflow tract, while others focus on enlarging the ostium. The goal of frontal sinus surgery, as with the other paranasal sinuses, is to relieve obstruction and re-establish ventilation and drainage. CPT code 31276 Nasal/sinus endoscopy, surgical with frontal sinus exploration, with or without removal of tissue from the frontal sinus describes the work performed as follows: Obstructing frontal recess cells, polyps, or scar tissue and intersinus septae from the dome of the ethmoid and skull base are delicately removed. It also may include removal of osteitic bone between the frontal sinus and a supraorbital ethmoid cell. The skull base is at significant risk for perforation resulting in CSF leak or intracranial bleeding. The following examples satisfy the criteria for reporting this code such that at the completion of a Draf I/IIA-B/III procedure, one can visualize the frontal sinus for exploration and proceed with removal of tissue from the frontal sinus, if performed: A Draf I frontal sinusotomy would include removing the posterior wall of the Agger nasi cells, the superior attachment of the bulla lamella of the ethmoid bulla, and/or Type I and II frontal cells. This removes tissue obstructing the frontal sinus and is not part of the typical ethmoidectomy. A Draf IIA frontal sinusotomy would include removal of a Type III frontal cell reaching into the frontal sinus. A Draf IIB/III (endoscopic modified Lothrop) frontal sinusotomy not only reaches the ostium but enlarges it with punches, drills, etc. There are instances in which the balloon is used to establish a pathway, through the frontal recess to the frontal sinus followed by tissue removal (mucosa, polyps, scar, tumor and/or bony partitions) with traditional instrumentation such as forceps and/or the microdebrider. In this instance, the balloon is used as an adjunct to traditional instrumentation. When the result is a frontal sinusotomy and tissue has been removed, the appropriate code is 31276 and the dilation is not separately reported. Similar rationale would apply to surgery involving the maxillary and sphenoid sinuses. If the balloon is used to dilate the sinus ostium and subsequently tissue is removed relative to that sinus, the appropriate maxillary sinus and/or sphenoid sinus codes is/are utilized. For example, if an endoscopic balloon dilation of the maxillary sinus is performed with a 6 mm balloon and the uncinate process is fractured and subsequently removed and/or peri-ostial polypoid mucosa is excised to create a sinuostomy, the appropriate code that describes the work performed is 31256 (Nasal/sinus endoscopy, surgical; with maxillary antrostomy). If 31256 is performed and mucosa is subsequently removed from the interior of the maxillary sinus, 31267 Nasal/sinus endoscopy, surgical; with removal of tissue from the maxillary sinus is utilized. Similarly, if the sphenoid sinus ostium is dilated with a balloon under endoscopic visualization and subsequently a portion of the superior turbinate, bone and/or peri-ostial polypoid mucosa is removed from the sphenoethmoid recess to further re-establish ventilation and drainage from the sphenoid sinus, 31287 Nasal/sinus endoscopy, surgical, with sphenoidotomy describes the work performed. Once the sphenoidotomy has been performed and if tissue is removed from the interior of the sphenoid sinus, 31288 Nasal/sinus endoscopy, surgical, with sphenoidotomy; with removal of tissue from the sphenoid sinus is reported. Unfortunately, having Category I CPT codes for sinus ostial dilation does not guarantee payment by all carriers as some designate the procedures “investigational” or “experimental.” This is a carrier determination, largely based on its internal interpretation of existing literature and current usage. The Academy periodically reviews the literature relating to levels of evidence to help demonstrate when new technologies, such as dilation, meet or exceed generally accepted criteria for reimbursement. If one must report 31299 for a service not described by existing codes, it is critical to accurately document all elements of the procedure. In order for the carrier to understand what was done surgically, a full and detailed explanation of the surgery needs to be documented in the accompanying letter of explanation appeal that should be sent to the carrier with a copy of the operative report. Both documents (as well as any communications needed to precertify the procedure) should explain in detail for each site what was done with respect to the unlisted procedure. If members have problems with respect to coding and reimbursement for these procedures, please contact the Academy’s Health Policy department at healthpolicy@entnet.org. To access this article, visit http://www.entnet.org/Practice/Coding-for-Balloon-Sinus-Dilation-2010.cfm.
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Health Policy
Q: What is stereotactic computer-assisted navigation (SCAN), and how can I bill for it (beginning January 1, 2011) when I perform FESS? A: SCAN, also known as image guidance, is typically used by otolaryngologist—head and neck surgeons when performing functional endoscopic sinus surgery (FESS) and skull base approaches. Image guidance provides surgeons with a more detailed view of intra-cranial and extra-cranial structures such as areas near the eyes, brain, and major veins, arteries, and nerves that they may encounter during FESS. Image guidance is commonly used when performing revision FESS procedures where significant scarring may be present and usual anatomical landmarks are no longer in place, or on complex sinus cases where the anatomy may be distorted. Complications are better avoided when the surgeon has improved ability to judge the location of instruments during sinus surgery. To find out more indications for image guidance, view our policy statement “Intra-Operative Use of Computer Aided Surgery” (http://www.entnet.org/Practice/policyIntraOperativeSurgery.cfm). You can bill a SCAN procedure if you can show its medical necessity in your operative notes. The decision to use image guidance is the surgeon’s, but obtaining reimbursement is more likely to occur when medical necessity is clearly documented. Effective January 1, 2011, the appropriate CPT codes for billing image guided FESS are +61781 – stereotactic computer-assisted (navigational) procedure; cranial, intradural (list separately in addition to code for primary procedure) or +61782 – cranial, extradural (list separately in addition to code for primary procedure in addition to the appropriate FESS code). The final physician work relative value units (RVUs) for 61781 and 61782 are 3.75 and 3.18, respectively. Generally, otolaryngologist— head and neck surgeons would use the second code, +61782. CPT code +61795 – Stereotactic computer assisted volumetric (navigational) procedure, intracranial, extracranial, or spinal (List separately in addition to code for primary procedure), which was previously used to report this service has been deleted. The reason for this is the CPT Editorial Panel split it into three separate codes (61781, 61782, and 61783) to differentiate distinct anatomic regions. After CMS releases the final correct coding initiative (CCI) edits pertaining to the SCAN procedure, we will post them on our website (http://www.entnet.org/Practice/NCCI-Advocacy-Updates.cfm), and update this article. There may be local coverage determinations (LCDs) which restrict the circumstances for which you can obtain reimbursement for the SCAN procedure.  If you have difficulty with reimbursement, exhaust the carrier’s appeals process. If you are unsuccessful at overturning this decision, contact Healthpolicy@entnet.org. If you have further questions on how to bill this procedure and others, contact the coding hotline at 1-800-584-7773. To access this article, visit http://www.entnet.org/Practice/Coding-for-Stereotactic-Computer-Assisted-Navigatione.cfm. Revised by the Physician Payment Policy Workgroup (December 2010)
Impact of Final Rule CY 2011, MPFS for Otolaryngology—Head and Neck Surgery
The Calendar Year (CY) 2011 final rule for the Medicare physician fee schedule (MPFS) was published in the November 29, 2010, issue of the Federal Register. The Academy strongly advocated (http://www.entnet.org/Practice/upload/AAO-HNS_Comment_Letter_NPRM_MPFS_Aug2010.pdf) for several policy changes which were accepted by the Centers for Medicare and Medicaid (CMS) and are effective January 1, 2011. They include: Separate payment for Canalith repositioning procedure; Physician work and Practice Expense (PE) for 3 new Nasal/sinus endoscopy codes procedure codes, and 1 stereotactic computer-assisted (navigational) procedure code; Continued use of the Physician Practice Information Survey (PPIS) data, which results in overall higher PE values and payment for office-based procedures; and Maintenance of the current work relative value units (wRVU) for Excision of parotid tumor or gland procedures (CPT codes 42415 and 42420). We asked CMS to take additional administrative actions to reduce the cost of eliminating the flawed sustainable growth rate (SGR). Although we urged CMS to restore the consultation codes, they denied this request because they did not believe there was enough evidence to prove any negative consequences of eliminating consults. We recommended that CMS withdraw the proposal to apply the multiple payment procedure reduction (MPPR) policy to therapy codes, but they did not accept our recommendation. A summary of these policies and other issues of importance are below. Stay tuned to the Academy’s website (http://www.entnet.org/Practice/members/Advocacy.cfm) and The News for the most up-to-date information regarding Congressional action on the SGR. Canalith repositioning  Effective January 1, 2011, CMS will separately reimburse canalith repositioning (CPT 95992), at the American Medical Association Specialty Society Relative Value Scale Update Committee’s (AMA RUC) previously recommended wRVU of 0.75 and practice expense (PE) inputs. Because CPT 95992 can be furnished by physicians or therapists as therapy services under a therapy plan of care or by physicians as physicians’ services outside of a therapy plan of care, the agency will add CPT 95992 to the “sometimes therapy” list. Medicare will not reimburse audiologists for performing canalith repositioning because it is not a diagnostic test. Establishment of interim final RVUs for CY 2011 CMS accepted 71 percent of the 291 work RVU recommendations made by the AMA RUC, and provided alternative values for the remaining recommendations. Over the last several years, the acceptance rate of the AMA RUC recommendations has been higher, at 90 percent or greater. However, in response to concerns expressed by Congress, Medicare Payment Advisory Commission, and other stakeholders regarding the accurate valuation of services under the MPFS, CMS has intensified its scrutiny of the work valuations of new, revised, and potentially misvalued codes. The final RVUs for the new balloon dilation and stereotactic computer-assisted procedure codes are (CMS accepted the AMA RUC’s values for these codes): 31295  Nasal/sinus endoscopy, surgical; with dilation of maxillary sinus ostium (e.g., balloon dilation), transnasal or via canine fossa  – work RVU 2.70 31296 with dilation of frontal sinus ostium (e.g., balloon dilation) – work RVU 3.29 31297 with dilation of sphenoid sinus ostium (e.g., balloon dilation) – work RVU 2.64 61782 Sterotactic computer-assisted (navigational) procedure: cranial, extradural (List separately in addition to code for primary procedure – work RVU 3.18; facility PE RVU 1.81) For additional information, see pages 41-43. Resource-based PE RVUs  CY 2011 is the second year of a four-year transition to the PE RVUs calculated using the AMA’s Physician Practice Information Survey (PPIS) data. Therefore, the CY 2011 PE RVUs are a 50/50 blend of the previous PE RVUs from the Socioeconomic Monitoring System (SMS), supplemental survey data, and newer PPIS data. All new CPT codes will be paid based on the fully implemented PE RVUs in CY 2011. Also, existing CPT codes for which the global period has changed in CY 2011 will not be subject to the PPIS PE RVU transition. Equipment utilization rate CMS will apply a 75 percent utilization rate for expensive imaging equipment (i.e., equipment valued over $1 million) in a non-budget neutral process for CY 2011. These changes to the PE RVUs will not be transitioned over a period of years. (Note: the previous rate was 90%). Disclosure requirements for in-office ancillary services exception  For advanced imaging service (only MRI, CT and PET services), CMS finalized that the referring physician must provide written disclosure to the presenting patient that he or she may obtain the service from another provider. CMS requires this notification to include a list of at least five suppliers within a 25-mile radius of the referring physician’s practice. CMS will not require patients to sign this disclosure statement but the referring provider must record proof of the patient’s acknowledgement of the disclosure in the medical record. Malpractice RVUs for new and revised services  CMS will continue its current method of updating malpractice RVUs by determining the malpractice RVUs for new and revised codes through a direct crosswalk to a similar “source” code or a modified crosswalk to account for differences in work RVUs between the new or revised code and the source code. Electronic prescribing (eRX) For e-prescribers in 2011, the eRX incentive is 1 percent. Penalties begin in 2012 at 1 percent for eligible professionals who are not successful e-prescribers. 12-month maximum submission period for Medicare claims CMS will decrease the time threshold for providers to submit claims to Medicare from 18-27 months after the date of service (DOS) to 12 months. Providers will need to submit claims for services performed in the last three months of 2009 by December 31, 2010. For those services furnished on or after January 1, 2010, providers must submit the claims for these services before the end of one CY after the DOS. Expansion of the MPPR policy Imaging: CMS will apply the MPPR to the Technical Component (TC) of multiple imaging services (includes CT and CTA, MRI and MRA, and ultrasound) performed within a family of codes or across families. This will apply to the aforementioned services when performed on a patient in one session irrespective of modality and contiguity of the body parts. Therapy Services: CMS will reduce by 50 percent the Practice Expense (PE) component for subsequent “always therapy” services performed by the same provider on patients in a single day. (Medicare will fully reimburse the code with the highest RVU but will reduce the PE input for the subsequent codes by 50 percent.) To view the final rule, visit http://www.ofr.gov/OFRUpload/OFRData/2010-27969_PI.pdf. To view a more detailed summary of the final rule and its impact on otolaryngology—head and neck surgery, visit http://www.entnet.org/Practice/CY2011-MPFS.cfm.
Drs. Chandrasekhar, Edelstein, and Hammerschlag with Assemblyman Micah Kellner.
Dispensing Hearing Aids in New York
Sujana S. Chandrasekhar, MD, Chair-Elect, BOG New York is the only state in the U.S. that enforces an arcane law by which the only professional NOT permitted to profit more than 10 percent from hearing aid sales is a physician. Independent audiologists and hearing aid dispensers, with their limited years of education and ability to offer solutions for hearing loss, can and do profit enormously from the sale of hearing instruments. Because they cannot offer medical or surgical care for the individual’s hearing loss, their advice is likely skewed toward a sale. New York otolaryngologists, led forcefully by Hayes H. Wanamaker, MD, Gavin Setzen, MD, Paul E. Hammerschlag, MD, and Steven M. Parnes, MD, with strong backing by the Medical Society of the State of New York (MSSNY), and the guidance of AAO-HNS Government Affairs staff, have been remarkably effective at unearthing the background of this old legislation. They brought the matter before legislators, built a coalition, and even had a bill to repeal the current law introduced during the last legislative session. It is unusual to achieve such success in such a short period of time. The Patient Access to Hearing Aids (PAHA) Coalition, comprised of state and national medical and specialty organizations and others, continues its work to educate legislators, both in their district offices and in Albany, about the need for a change. I had a wonderful experience going to Albany with one of my residents, Gregg Goldstein, MD, whom I was able to mentor through the nuances of effective lobbying. For his part, Dr. Goldstein was able to see that so many physicians took time out of their practices to make their voices heard at the state capitol. Dr. Hammerschlag, David M. Edelstein, MD, and I hosted a successful fundraising evening in November 2010 for Assemblyman Micah Kellner, a strong champion for patients’ rights who has been a vocal supporter of this issue.  A second fundraiser in December allowed physicians to meet with State Senator Liz Krueger, giving her a chance to learn more about physician and practice issues. Getting involved with PAHA has opened my eyes to the power and possibilities of grass-roots advocacy. I strongly urge other otolaryngologists, in private practice, academics, or the military, to explore their options in advocacy. At the least, I encourage you to sign up for the ENT Advocacy Network, which you can do easily by emailing govtaffairs@entnet.org. When you receive notifications of action alerts, they are easy to act upon within two to three minutes, even in the middle of busy office hours. I also urge you to attend your state society meetings and get more involved in the BOG. I look forward to seeing more new faces at the BOG Spring Meeting, March 26-27, 2011.
Tools You Can Use for State Advocacy
In 2011, every state legislature in the country will convene in general session to consider a variety of measures, many of which will be aimed at closing ongoing budget holes and implementing federal healthcare reforms. StateNet estimates a total of 140,000 bills will be introduced this year, eligible for consideration, in addition to those bills held over from 2010 in New Jersey and Virginia. Each year, AAO-HNS State Legislative Affairs staff reviews thousands of bills using its bill-tracking software, CQ StateTrack, which employs keyword searches to identify bills of potential interest. In 2010, the AAO-HNS made these reports available on its website, accessible at www.entnet.org/practice/members/stateadvocacy.cfm, enabling members to review all bills being tracked – over 450 – by state and issue. Due to publication deadlines, many legislative activities cannot be reported on in a timely manner in AAO-HNS publications. Since state legislation can move rapidly and be amended at any time, these reports allow you to follow important bills as they develop. To take further advantage of the features of the product, several state society leaders are now receiving customized state reports, reviewing bills, and strategizing with Academy staff about legislation as it moves through the process. This year, the AAO-HNS is using a new service that can also benefit members and state otolaryngology societies, StateConnect. Offered by the National Conference of State Legislatures, this interactive program allows access to real-time legislator data, including committee assignments and contact and biographical information. It also allows users to download legislator lists based on committee, party, and position, saving significant staff time when a letter or email needs to be sent to a group of legislators on a particular bill. The Surgery State Legislative Action Center, hosted by the American College of Surgeons, allows you to find out who represents you and send email directly to those legislators. In addition, when a state bill requires involvement by our members, staff can offer pre-written emails or talking points to provide you the necessary tools to communicate with legislators with minimal time commitment. State and national societies are invited to work with Government Affairs staff to use this helpful program. Finally, in addition to state bill-tracking reports, the State Advocacy section of the AAO-HNS website, accessible at www.entnet.org/practice/members/stateadvocacy.cfm, provides numerous other resources, including Academy letters, position statements, articles, and testimony. If you have not signed up already, be sure to join the ENT Advocacy Network, which provides members with bi-weekly email updates of key state and federal legislative and political developments, and enhancements to our already extensive list of service offerings. This is a free member benefit, and joining is simple: email govtaffairs@entnet.org. Contact us at legstate@entnet.org with questions or to discuss how you might take advantage of any of these services.
Meet Your ENT PAC Board of Advisors
ENT PAC, the political action committee of the AAO-HNS, is a critical component of the Academy’s advocacy efforts. By pooling the voluntary contributions of our U.S. members, the AAO-HNS is able to financially support Members of Congress and candidates for federal office to champion the issues important to otolaryngology—head and neck surgery. The ENT PAC Board of Advisors is a non-partisan, nine-person committee, charged with overseeing both fundraising and disbursement strategies. By carefully considering each disbursement, the Board of Advisors ensures that ENT PAC funds are used to best support the priorities of the AAO-HNS and to strengthen new and existing relationships on Capitol Hill. Members of the ENT PAC Board serve two-year terms and are eligible for three consecutive terms. If you would like more information regarding the roles and responsibilities associated with the ENT PAC Board of Advisers, or to learn more about AAO-HNS political activities, please contact entpac@entnet.org. 2011 ENT PAC Board of Advisors – Listed Alphabetically Marcella R. Bothwell, MD, Chair University of California San Diego Scott R. Chaiet, MD, Resident Representative University of Wisconsin Hospital and Clinics Steven B. Levine, MD ENT and Allergy Associates, LLC, Connecticut Thomas B. Logan, MD Midwest Ear, Nose and Throat, PSC Methodist Hospital and St. Mary’s Hospital, Kentucky/Indiana William J. McMillan, MD, Vice Chair Munson Healthcare, Michigan Ira D. Papel, MD Facial Plastic Surgicenter The Johns Hopkins University, Maryland Liana Puscas, MD, Young Physician Representative Duke University, North Carolina Peter A. Selz, MD Ear, Nose and Throat Centers of North Texas Texoma Medical Center Texas Health Presbyterian Foundation Surgical Hospital of Grayson County, Texas Gavin Setzen, MD Albany ENT & Allergy Services, PC Clinical Associate Professor of Otolaryngology, Albany Medical College, New York 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.
ENT PAC Thanks 2010 Donors, Announces Record-Breaking Year
Thanks to the generous contributions of U.S. AAO-HNS members and staff, ENT PAC, the Academy’s political action committee, exceeded its fundraising goal for the 2009/2010 election cycle and set a new fundraising record since the PAC’s inception in 1995.As we continue our efforts to influence the implementation of healthcare reform and fight for improvements for your practices and your patients, it is particularly important that advocacy tools, such as the ENT PAC, are used fully. The strength of ENT PAC, specifically the number of donors and size of our coffers, helps determine the strength of our voice on Capitol Hill. The ENT PAC Board of Advisors recognizes and thanks all U.S. AAO-HNS members and staff who supported ENT PAC in 2010. $1,000 – $5,000 Contribution Mark Baldree, MD Daniel Berner, MD Marcella Bothwell, MD Richard Brauer, MD Leonard Brown, MD Sujana Chandrasekhar, MD C Y Joseph Chang, MD Scott Dempewolf, MD Linda Dindzans, MD Lee Eisenberg, MD MPH Robert Finch, MD Paul Gaudet, MD Samuel Girgis, MD Cameron Godfrey, MD James Gould, MD Paul Imber, DO Ronald Kirkland, MD Mark Klingensmith, MD Alice Kuntz, MD Ronald Kuppersmith, MD MBA Dennis Lee, MD MPH Steven Levine, MD Philip Liu, MD J Scott Magnuson, MD Kathleen McDonald, MD William McMillan, MD William Merwin, MD Philip Miller, MD Samantha Mucha, MD Michael Nathan, MD David Nielsen, MD, Staff Daniel Ortiz, DO Simon Parisier, MD George Parras, MD Robert Puchalski, MD Richard Rosenfeld, MD MPH Peter Selz, MD Gavin Setzen, MD Frank Shagets, MD Diane Shirley-Davis, MD J Pablo Stolovitzky, MD John Taylor, MD Wesley Vander Ark, MD Jan Youssef, MD Todd Zachs, MD   $500 – $999 Contribution Michael Alexiou, MD David Beal, MD Leslie Berghash, MD Jeffrey Brown, MD William Bruce, MD Frank Burton, MD Henry Butehorn, MD Richard Caldwell, MD Giulio Cavalli, MD Stephen Chadwick, MD Douglas Chen, MD James Cinberg, MD Lawrence Clarke, MD Ryan Cmejrek, MD Richard Collie, DO Mark Connelly, MD Susan Cordes, MD Agnes Czibulka, MD Michael De Vito, MD Richard DeMaio, MD Eduardo Diaz, MD Elizabeth Dinces, MD Robert Dolan, MD John Donovan, MD B Kelly Ence, MD Christopher Eriksen, MD Patrick Farrell, MD G Glen Fincher, MD Newton Fischer, MD Sidney Fishman, MD Lisa Galati, MD Enrique Garcia, MD Terry Garfinkle, MD MBA James Geraghty, MD Jeffrey Ginsburg, MD Frederick Godley, MD Jay Goland, MD Ravi Gorav, MD MS Nancy Griner, MD Steven Horwitz, MD John Houck, MD P David Hunter, MD Stacey Ishman, MD Chandra Ivey, MD Barry Jacobs, MD Madan Kandula, MD Kanhaiyalal Kantu, MD Matthew Kates, MD Lawrence Kaufman, MD Umang Khetarpal, MD Helen Kim, MD Timothy Knudsen, MD Frank Koranda, MD Greg Krempl, MD John Krouse, MD PhD Siobhan Kuhar, MD PhD Jeffery Kuhn, MD Denis Lafreniere, MD Amy Lazar, MD David Litman, MD Thomas Logan, MD Joel Lubritz, MD Sonya Malekzadeh, MD Marc Maslov, MD Phillip Massengill, MD Douglas Mattox, MD Scott McNamara, MD Jason Mouzakes, MD Thomas Nabity, MD V Rama Nathan, MD Laxmeesh Nayak, MD Dominick Paonessa, MD Ira Papel, MD William Parell, MD Thomas Paulson, MD Todd Proctor, MD Liana Puscas, MD Andrew Reid, MD Patrick Reidy, MD Sara Scheid, MD Jerry Schreibstein, MD Michael Seidman, MD Bruce Selden, MD Adam Shapiro, MD Paul Shea, MD Jack Shohet, MD Lawrence Simon, MD Abraham Sinnreich, MD William Slattery, MD Jonathan Smith, MD Keith Soderberg, MD Neil Sperling, MD Joseph Spiegel, MD Michael Stewart, MD MPH Robert Strominger, MD Chester Strunk, MD Brian Szwarc, MD Charles Tesar, MD Wyatt To, MD Joy Trimmer, Staff William Turner, MD Keith Ulnick, DO Ira Uretzky, MD Michael Vidas, MD Richard Waguespack, MD W Juan Watkins, MD Michael Widick, MD Donald Wilson, MD Terrance Wood, MD Ken Yanagisawa, MD   $250 – $499 Contribution Peter Abramson, MD Jeffrey Adams, MD Robert Adham, MD Ravi Agarwal, MD Sudhir Agarwal, MD Michael Agostino, MD J Noble Anderson, MD Sanford Archer, MD Jeffrey Aroesty, MD Jose Arsuaga, MD Seilesh Babu, MD Larry Bailey, MD Christopher Baranano, MD Jeffrey Barber, MD James Bartels, MD Robert Baumgartner, MD Robert Bechard, MD Carlos Benavides, MD Thomas Benda, MD David Bennhoff, MD Shelley Berson, MD David Bianchi, MD James Blotter, MD William Bond, MD K Paul Boyev, MD James Brawner, MD John Brockenbrough, MD James Brooks, MD Karla Brown, MD Steven Buck, MD Michael Byrd, MD Gregory Carnevale, MD Mark Carney, MD Kevin Cavanaugh, MD Scott Chaiet, MD Ajay Chitkara, MD Richard Chole, MD PhD Clifford Chu, MD Alen Cohen, MD Noel Cohen, MD Kent Cox, MD Donald Crawley, MD David Cross, MD Michael Cunningham, MD Subinoy Das, MD C. Phillip Daspit, MD Junior De Freitas, MD Nathan Deckard, MD John DelGaudio, MD Edward Dickerson, MD Jayme Dowdall, MD Lloyd Dropkin, MD Melinda Duncan, DO David Edelstein, MD Wayne Eisman, MD Moshe Ephrat, MD Paul Fass, MD Theodore Fetter, MD Frederick Fiber, MD David Foyt, MD Ramon Franco, MD Peter Friedensohn, MD Stephen Froman, MD Michael Fucci, MD Philip Garcia, MD Scott Gayner, MD Jonathan George, MD David Gitler, MD Jacquelyn Going, MD Steven Gold, MD Howard Goldberg, MD Mark Goldstein, MD Suman Golla, MD Mark Gutowski, MD Yoav Hahn, MD Paul Hammerschlag, MD Ronald Hanson, MD Tom Harlow, CAE, Staff Joseph Hart, MD MS Michael Haupert, DO Heidi Heras, MD Karen Hermansen, MD Neil Hockstein, MD Drew Horlbeck, MD John House, MD Robert Hughes, MD Joseph Hutchison, MD Thomas Irwin, MD Jon Isaacson, MD Alexis Jackman, MD Ofer Jacobowitz, MD PhD Andrew Jacono, MD Geun Jahng, MD Bruce Johnson, MD Calvin Johnson, MD Jonas Johnson, MD James Jones, MD Kenneth Kaplan, MD David Kennedy, MD Sungjoo Kim, MD John Kirchner, MD Steven Kmucha, MD JD Liesl Knottingham, MD Brett Koder, MD Jeffrey Koempel, MD MBA Helen Krause, MD Bryan Krol, MD John Kveton, MD Estella Laguna, Staff Christopher Larsen, MD Miguel Lasalle, MD Pierre Lavertu, MD Joel Lehrer, MD Joseph Leonard, MD Donald Leopold, MD Douglas Liepert, MD Fred Lindsay, DO Ray Lousteau, MD Rick Love, MD Jay Luft, MD Rodney Lusk, MD Robert MacDonald, MD Barry Maisel, MD James Manning, MD Megan Marcinko, Staff Andrew Marlowe, MD Felipe Martinez, MD James Masdon, MD Clement McDonald, MD Peter McKernan, MD Robert McLean, MD PhD Michael Menachof, MD Michael Mendelsohn, MD Ralph Metson, MD Todd Miller, MD Brian Mitchell, MD Foy Mitchell, MD Richard Miyamoto, MD MS David Moore, MD J Cary Moorhead, MD Philip Morgan, MD Warren Morgan, MD Craig Murakami, MD Kent Murphy, MD Ednan Mushtaq, MD Paul Neis, MD Courtney Noell, MD John Nurre, MD Rick Odland, MD PhD J David Osguthorpe, MD R Glen Owen, MD Rajiv Pandit, MD Kourosh Parham, MD PhD Steven Parnes, MD Michael Patete, MD Spencer Payne, MD George Pazos, MD Philip Perlman, MD Kim Pershall, MD Jennifer Ann Pesola, DO Guy Petruzzelli, MD MBA PhD Scott Phillips, MD Michael Platt, MD David Poetker, MD MA Christopher Poje, MD Saurin Popat, MD Juan Portela, MD William Portnoy, MD Robert Prehn, MD David Randall, MD Frederick Rayne, MD John Resser, MD James Restrepo, MD Bryan Richards, MD Justin Roberts, DO Grayson Rodgers, MD David Rosi, DO Greg Rowin, DO Mark Rubinstein, MD Jose Sanchez-Mendiola, MD Michael Scherl, MD Scott Schoem, MD Matthew Schwarz, MD John Scott, MD Samuel Selesnick, MD Merritt Seshul, MD Michael Setzen, MD William Sheppard, MD Mark Sheridan, MD Paul Sherrerd, MD Michael Shohet, MD Gary Snyder, MD Derek Soohoo, MD Robert Stachler, MD James Stankiewicz, MD C Richard Stasney, MD Jamie Stern, MD Wendy Stern, MD Rebecca Stone, MD Jason Surow, MD Thomas Takoudes, MD Oscar Tamez, MD Karen Tan, MD Cynthia Tarver, MD J Regan Thomas, MD Willard Thompson, MD Richard Tibbals, MD A D Toland, DO Roger Traxel, MD Theodore Truitt, MD Debara Tucci, MD John Ulrich, DO J Nicholas Vandemoer, MD Steven Vetter, MD P Ashley Wackym, MD E Earl Walker, MD Hayes Wanamaker, MD Pell Ann Wardrop, MD Mark Weigel, MD Jeffrey Weingarten, MD Michael Weiss, MD Samuel Welch, MD PhD Phillip Wells, MD Josh Werber, MD John Werning, MD DMD Steve West, MD Ralph Wetmore, MD Christopher White, DO Richard Wiet, MD Neil Williams, MD Raymond Winicki, MD David Witsell, MD MHS Arthur Wood, MD Mark Yanta, MD Kathleen Yaremchuk, MD Mario Yco, MD Mathew Yetter, MD Glen Yoshida, MD John Zappia, MD Lauren Zaretsky, MD Warren Zelman, MD Jan Zemplenyi, MD Kevin Ziffra, MD Lee Zimmer, MD PhD   $1 – $249 Contribution David Abraham, MD Allan Abramson, MD Karen Ahlstrom, MD Mohammad Akbar, MD Keith Alexander, MD Nathan Alexander, MD Eugene Alford, MD Jeremiah Alt, MD Kurt Anderson, MD Lauren Anderson, MD David Armstrong, MD Gregory Ator, MD Andrew Azer, MD Christopher Bald, MD Vishal Banthia, MD John Barlow, MD Jeffrey Beall, MD Charles Beatty, MD Russell Beckhardt, MD Mark Bell, MD Paul Bell, MD Karen Bellapianta, MD Michael Benninger, MD James Benson, MD Simon Best, MD Janice Birney, MD Elizabeth Blair, MD Joel Blumin, MD William Blythe, MD Robert Bonham, MD Alexis Bouteneff, MD Derald Brackmann, MD Lawrence Braud, MD Maury Bray, MD Jean Brereton, Staff Megan Bronson, Staff James Bryant, MD Roman Bukachevsky, MD Lawrence Burgess, MD Emily Burke, MD Michael Burnett, MD Scott Busch, DO James Bush, MD Arkadiush Byskosh, MD Joseph Califano, MD Joseph Campanelli, MD Rodney Caniglia, MD Norman Cantor, MD Daniel Carothers, MD Michael Carter, MD John Cevera, MD Fayez Chahfe, MD Parker Chamberlin, MD MBA Socorro Chamblee, MD Christopher Chang, MD Louis Chanin, DO Daniel Chelius, MD Theodore Chen, MD Bradford Chevrin, MD Stanley Chia, MD Dev Chitkara, MD Baishakhi Choudhury, MD William Clark, MD Mark Clemons, MD Burton Cohen, MD Donald Cote, MD Dale Cox, MD Devin Cunning, MD Cormac DePan, MD Craig Derkay, MD Devang Desai, MD Brian Dodds, MD Jeffrey Driben, MD Norman Druck, MD Carl Drucker, MD Stephen C Duffy E Scott Elledge, MD Niklaus Eriksen, MD Carl B Ermshar, MD Alexander Farag, MD Dennis Feider, MD Berrylin Ferguson, MD Richard Ferraro, MD Roy Fleniken, MD Randy Folker, MD Paul Fortgang, MD D Scott Fortune, MD Paul Frake, MD Michael Fritsch, MD Beverly Fulcher, MD Shane Gailushas, MD Daniel Ganc, MD Martin Garcia, MD William Gartner, MD Gavin Gassen, MD Michael Gatto, MD Clarence Gehris, MD Mark Gerber, MD Paul Gittelman, MD Lindsay Golden, MD Elliot Goldofsky, MD Michael Goldrich, MD Rebecca Golgert, MD Mariano Gonzalez-Diez, MD Joseph Goodman, MD Gary Goodnight, DO Michael A Gordon, MD Gregg Govett, MD Samuel Gubbels, MD Lowell Gurey, MD Joseph Haas, MD Howard Hammer, DO Avraham Hampel, MD Steven Handler, MD Brenda Hargett, Staff Charles Harkins, MD John Harris, MD Michael Harris, MD Philip Harris, MD Scott Harrison, MD Anna Kristina Hart, MD Robert Hazen, MD Graves Hearnsberger, MD Webb Hersperger, MD Arlis Hibbard, MD Peter Hillsamer, MD David Hilton, MD Barry Hirsch, MD James Holt, MD Susan Holzer, CAE, Staff Rebecca Howell, MD Kenneth Hughes, MD Charles Hurbis, MD Charles Hutchins, MD Zaven Jabourian, MD David Jakubowicz, MD Scharukh Jalisi, MD Bennie Jarvis, MD Pardis Javadi, MD Michael Kaplan, MD Lawrence Katin, MD Karim Katrib, MD Nader Kayal, MD James Kelly, MD Katherine Kendall, MD Richard Kersch, MD Joshua Kessler, MD Philip Scott Key, MD Sultan Khan, MD Raymond Komray, MD Charles Koopmann, MD MHSA Michael Kortbus, MD Stephen Kramer, MD Brian Kulbersh, MD Timothy Kuo, MD Donald Lanza, MD MS Derek Lee, MD Harrison Lin, MD Jeffrey Liu, MD Lee Loftin, MD Seth Lowell, MD PhD Frank Lucente, MD Adam Luginbuhl, MD Amber Luong, MD PhD Steven Lyon, MD James Magnussen, MD Eileen Mahoney, MD Creed Mamikunian, MD David Mandell, MD Alexander Mandych, MD Vartan Mardirossian, MD Susan Marenda-King, MD Herbert Marks, MD Frank Marlowe, MD Ralph Marrero, MD Wm Stephen Martin, MD Christopher Mawn, MD Mark  McClinton, MD Michael Mccormick, MD Edith McFadden, MD MA Jeanne McIntyre, CAE, Staff Megan McLellan Abbott, MD Nancy Mellin, MD David Melon, MD Valentin Mersol, MD Aaron Moberly, MD Ali Moghtader, MD Edwin Monsell, MD PhD William Morgan, MD Garrison Morin, MD MBA Michael Morris, MD Brett Moses, MD Homan Mostafavi, DO James Murdocco, MD Brandon Musgrave, MD Douglas Nadel, MD Jeffrey Nau, MD James Netterville, MD Grace Nimmons, MD James Oddie, MD Joseph Olekszyk, DO John O’Neill, MD Michael Orsini, MD Alissa Parady, Staff Sanjay Parikh, MD Norman Pastorek, MD Nilesh Patel, MD Ilya Perepelitsyn, MD Nora Perkins, MD Lisa Perry-Gilkes, MD Stanley Peters, MD Linnea Peterson, MD Anna Petropoulos Weissleder, MD Joseph Petrusek, MD Thomas Pfennig, DO Timothy Pingree, MD Geoffery Pitzer, MD Daniel Plosky, MD Adam Prawzinsky, MD Eric Purdom, DO Mary Kendall Rago, MD Christopher Rassekh, MD Michael Reilly, MD Reginald Rice, MD Jason Roberts, MD Neal Rogers, MD Louis Rondinella, MD Allan Rosenbaum, MD Eben Rosenthal, MD Mark Royer, MD Emily Rudnick Boss, MD Justin Rufener, MD Konstantin Salkinder, MD Robert Sataloff, MD DMA Megan Schagrin, CAE, Staff Gordon Schaye, MD Stuart Scherr, MD Peter Schilt, MD Christopher Schmidt, MD Richard Schmidt, MD Richard Schultz, MD Kristine Schulz, Staff Kenneth Scott, MD Merry Sebelik, MD Curtis Seitz, MD Armen Serebrakian, MD Majid Shafiei, MD Eve Shank, MD Nima Shemirani, MD Steven Shimotakahara, MD Abraham Shulman, MD William Silver, MD Leslie Silverstein, MD John Simmons, MD Michael Simmons, MD Jesse Smith, MD Lee Smith, MD Robert Somerville, MD Aaron Spingarn, MD Frederick Sporck, MD Monroe Sprague, MD Samuel Sprehe, MD Michael Srodes, MD Alden Stock, MD Harry Stone, MD George Stoneman, MD Mariel Stroschein, MD Monica Tadros, MD Rafael Tarnopolsky, MD Duane Taylor, MD Kiran Tipirneni, MD Wilfredo Tiu, MD Lenhanh Tran, MD Atul Vaidya, MD Emilio Valdes, MD Jeanne Vedder, MD Ronald Vidal, MD Valerie Vitale, MD David Walner, MD Marilene Wang, MD Debra Weinberger, MD Adam Weisstuch, MD Liane Westerman, MA David White, MD John White, MD Brian Wiatrak, MD Glenn Williams, MD Norman Woldorf, MD John Wood, MD Murray Woolf, MD Zhenqing Wu, MD Rhoda Wynn, MD Eiji Yanagisawa, MD C Alan Yates, MD Anthony Yonkers, MD Estelle Yoo, MD Jay Youngerman, MD K John Yun, MD Philip Zapanta, MD Michael Zoller, MD Seth  Zwillenberg, MD   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.
Save the Date
American Society of Geriatric Otolaryngology ASGO 2011 Annual Meeting Tuesday, April 26, 2011, 1-5 pm (one day prior to COSM) Chicago Sheraton Hotel and Towers The Guest of Honor is J. Regan Thomas, MD, President of AAO-HNS/F and chairman of the department of Otolaryngology-HNS at the University of Illinois at Chicago. The keynote speaker will be Gregory Allan Sachs, MD, renowned geriatrician and division chief of geriatrics at the University of Indiana. For more information, go to www.geriatricotolaryngology.org.
Founding Partners for Progress groups: (back row, L-R) B. Todd Schaeffer, MD; Robert A. Glazer, MPA; Marc J. Levine, MD; I. David Bough, Jr., MD; Steven H. Sacks, MD; John J. Grosso, MD; Jay S. Youngerman, MD; (front row, L-R) R. Tyson Deal, MD; Edward A. Porubsky, MD; Patrick E. Brookhouser, MD; Rodney P. Lusk, MD; Sujana S. Chandrasekhar, MD; Richard W. Waguespack, MD; Michael Setzen, MD. Not pictured: J. Noble Anderson, MD; A. Craig Chapman, MD; Moshe Ephrat, MD; Howard S. Kotler, MD; Michael A. Rothschild, MD; Pell Ann Wardrop, MD.
Partners for Progress
The AAO-HNS works diligently to enhance medical services, advance science, improve patient care, and serve our members—from medical students and residents to established physicians, surgeons, clinicians, and academicians. A special group of institutions and practices, the AAO-HNS Partners for Progress, believes so strongly in this mission that it has chosen to dedicate its philanthropy to ensure that the work of the AAO-HNS continues to thrive. Special thanks to the 2010 Partners for Progress The AAO-HNS is pleased to acknowledge the commitment and dedication exhibited by each Founding Member of Partners for Progress. Together, these 11 groups pledged more than $110,000—providing essential funding for member programs. The Partners were honored in many ways during the annual meeting in Boston. As attendees traveled to the OTO EXPO exhibits, they could not miss the gigantic logos and practice names displayed on Partners for Progress banners hanging prominently from the rafters of the Boston Convention Center. As attendees awaited the beginning of the Opening Ceremony, they learned of the important ways these groups had come together to support activities that benefit all members. The Donor Wall of Honor also caught the attention of many members who stopped to learn more about Partners for Progress. Many Partners also enjoyed visiting the Millennium Society Donor Lounge, compliments of their group’s participation in the program. Join Partners for Progress in 2011 Philanthropic participation of members plays a significant role in our ability to provide the highest standard of care worldwide. Your annual support is critical to ensuring the future of the specialty. During 2011, your group can make a tremendous impact on the specialty’s advancement and on patient care. You can choose to support the area that is most important to your group. Whether your donation is used to fund research, education, resident resources, humanitarian and international outreach, or advocacy and practice management, you can trust that it will go far to advance the specialty’s mission. Your practice will enjoy tremendous Partners for Progress recognition We are pleased to recognize your group in many ways, including: Recognition as a partner in highly visible signage, on the Donor Wall of Honor, and other special donor recognition at AAO-HNS/F meetings throughout the year. Acknowledgement in popular AAO-HNS/F communications, through a special listing on the AAO-HNS website; and in the AAO-HNSF Annual Report, The News, and the Bulletin. Promotion of your partnership by award of a special recognition plaque to be displayed in your waiting room; use of a special press release to alert your community media of your significant support of patient care. Privilege of using the AAO-HNS Partners for Progress logo on letterhead, business cards, practice website, and practice promotion materials. Millennium Society recognition for members of your practice and exclusive benefits, including access to the Millennium Society Donor Lounge during the annual meeting (based on level of participation) and early notice for hotel and registration for the meeting. It’s easy to join the growing number of Partners for Progress It’s easy to become a partner and to show your practice’s support of your specialty. Your group will be recognized when: Your institution’s or practice’s corporate entity gives $10,000 or more during the calendar year, or Several individuals in your practice collaborate to provide individual gifts totaling $10,000 or more during the calendar year. The AAO-HNSF is a 501 (c)(3) organization, so Partners for Progress gifts to the AAO-HNSF are tax-deductible to the extent permitted by current IRS regulations. Gifts in support of advocacy and certain other AAO-HNS programs are given directly to the AAO-HNS, a 501 (c)(6), and are not tax-deductible donations. Practices should consult with their tax advisors to discuss advantages associated with giving a charitable gift through their corporate entity. Four categories of annual giving enable organizations of all sizes to support the AAO-HNS (pledges are welcomed): Champion $50,000 Investor $25,000 Partner $10,000 Associate* *Practices with two or fewer physicians should contact Development staff to discuss Associate-level participation. Many academicians are already giving to the AAO-HNSF. Department chairs, please consider speaking with your institution about creating a matching gift program that will double the impact of the individual giving and provide valuable recognition for your institution. Development is here to help by discussing the concept with the appropriate individual at your institution. To become a Partner for Progress Contact Julie Wolfe, Senior Development Associate, at 1-703-535-3717 or jwolfe@entnet.org. Special Thanks to Our 2010 Partners for Progress Founding Members Partners Otosleep Associates Chicago Otolaryngology Associates Howard S. Kotler, MD ENT Associates of Alabama J. Noble Anderson, MD, and A. Craig Chapman, MD Island ENT/NY Facial Plastics B. Todd Schaeffer, MD, and Moshe Ephrat, MD Long Island ENT Associates, PC Jay S. Youngerman, MD, and John J. Grosso, MD Michael Rothschild, MD Michael Setzen, MD, Otolaryngology PC New York Otology Sujana S. Chandrasekhar, MD Richard W. Waguespack, MD, Ear, Nose, and Throat List as of December 7, 2010   Join or renew by February 18, 2011, and be recognized at the Spring BOG Meeting – www.entnet.org/partners or 1-703-535-3717.
AMA Adopts Principles on Accountable Care Organizations
Liana Puscas, MD Chair, AAO-HNS Delegation The American Medical Association (AMA) held its interim meeting in November 2010. Our Academy was represented by Liana Puscas, MD, delegation chair; delegates Michael S. Goldrich, MD, Shannon Pryor, MD, and Robert Puchalski, MD; alternate delegate David R. Nielsen, MD, AAO-HNS EVP/CEO; and Academy staff. The AMA debated at length the issue of federally mandated individual purchase of health insurance, ultimately deciding to study the problem further before agreeing to a specific policy. While a mandate with palpable penalties for non-compliance would have the benefit of increasing the number of Americans with health insurance and is a necessary element of broader health insurance reforms, the principle of individual federal mandates rankled many delegates because of the accompanying  increased involvement of government in medicine and the reality that insurance coverage alone does not guarantee access to healthcare (e.g., paucity of physicians who accept Medicaid). A significant portion of the debate revolved around the concept of using tax credits or tax penalties as a more palatable way of encouraging individuals to obtain health insurance. The House of Delegates also voted to study the use of tax credits and other mechanisms to aid physicians who provide un- or under-compensated care. Of specific importance to our specialty, the AMA supported the addition of interpreters for hearing-impaired patients to its study on the impact of any federal mandate that requires an interpreter to be present for patients who cannot communicate proficiently in English. One of the most significant actions was the adoption of principles that should guide the development of accountable care organizations (ACOs). According to CMS’s definition, an ACO is an organization of healthcare providers that agrees to be accountable for the quality, cost, and overall care of Medicare beneficiaries enrolled in the traditional fee-for-service program who are assigned to it. (“Assigned” means those beneficiaries for whom the professionals in the ACO provide the bulk of primary care services.) Assignment will not affect the beneficiaries’ guaranteed benefits or choice of doctor. Overall, the AMA’s principles emphasize that ACOs must be physician-led, place patients’ interests first, ensure voluntary physician and patient participation, and enable independent physicians to participate. The following is an edited version of the principles: Guiding Principle – The goal of an ACO is to increase access to care, improve the quality of care, and ensure the efficient delivery of care. Within an ACO, a physician’s primary ethical and professional obligation is the well-being and safety of the patient. ACO Governance – ACOs must be physician-led and encourage an environment of collaboration among physicians. Physician and patient participation in an ACO should be voluntary. Physicians should not be required to join an ACO as a condition of contracting with Medicare, Medicaid, or a private payer or being admitted to a hospital medical staff. The savings and revenues of an ACO should be retained for patient care services and distributed to ACO participants. Flexibility is necessary in patient referral and antitrust laws to allow physicians to collaborate with hospitals in forming ACOs without being employed by the hospitals or ACOs. Additional resources (grants) should be provided up-front in order to encourage ACO development. The ACO spending benchmark, which will be based on historical spending patterns in the ACO’s service area and negotiated between Medicare and the ACO, should be adjusted for differences in geographic practice costs and risk adjusted for individual patient risk factors. The quality performance standards required to be established by the Secretary of HHS must be consistent with existing AMA policy regarding quality, including the use of nationally accepted, physician specialty-validated clinical measures developed by the AMA-specialty society quality consortium (of which our Academy is a part). An ACO must be afforded due process with respect to the Secretary of HHS’s discretion to terminate an agreement with an ACO for failure to meet the quality performance standards. ACOs should be allowed to use different payment models, including fee-for-service, capitation, partial capitation, medical homes, care management fees, and shared savings plans. The Consumer Assessment of Healthcare Providers and Systems (CAHPS) Patient Satisfaction Survey should be used as a tool to determine patient satisfaction and whether an ACO meets the patient-centeredness criteria required by the ACO law. Interoperable Health Information Technology and Electronic Health Record Systems are keys to the success of ACOs. The ACO must abide by the financial solvency standards pertaining to risk-bearing organizations.
vaccine
Pneumococcal Vaccination: Updated CDC Recommendations for Cochlear Implant Patients
Highlights of the CDC Recommendations The CDC has issued new pneumococcal vaccination recommendations for individuals with cochlear implants. These recommendations can be viewed in detail on the CDC website (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5909a2.htm). • Children who have cochlear implants or are candidates for cochlear implants should receive PCV13. PCV13 is now recommended routinely for all infants and children. (See Table 2 in the March 12, 2010, MMWR at the above website for the number of doses and dosing schedule.) • Older children with cochlear implants (from age 2 years through age 5) should receive two doses of PCV13 if they have not received any doses of PCV7 or PCV13 previously. If they have already completed the four-dose PCV7 series, they should receive one dose of PCV13 through age 71 months. • Children 6 through 18 years of age with cochlear implants may receive a single dose of PCV13 regardless of whether they have previously received PCV7 or the pneumococcal polysaccharide vaccine (PPSV) (Pneumovax®). • In addition to receiving PCV13, children with cochlear implants should receive one dose of PPSV at age 2 years or older and after completing all recommended doses of PCV13. • Adult patients (19 years of age and older) who are candidates for a cochlear implant and those who have received a cochlear implant should be given a single dose of PPSV • For both children and adults, the vaccination schedule should be completed at least two weeks before surgery. Jeffery J. Kuhn, MD Chair, Implantable Hearing Devices Subcommittee In February 2010, the Food and Drug Administration (FDA)  licensed a 13-valent pneumococcal conjugate vaccine, PCV13, (Prevnar 13® [Pfizer]) for prevention of invasive pneumococcal disease caused by the 13 pneumococcal serotypes covered by the vaccine and for prevention of otitis media caused by serotypes in the 7-valent pneuomococcal conjugate vaccine formulation, PCV7, (Prevnar 7® [Wyeth]). PCV13 succeeds PCV7, which was licensed by the FDA in 2000. PCV 13 is approved for use in children aged 6 weeks to 71 months. Recommendations for use in children were established by the Advisory Committee on Immunization Practices (ACIP) and reported by the Centers for Disease Control and Prevention (CDC) on March 12, 2010.               Because children with cochlear implants are at increased risk for pneumococcal meningitis, the CDC recommends that they receive pneumococcal vaccination on the same schedule that is recommended for other groups at increased risk for invasive pneumococcal disease. Recommendations for the timing and type of pneumococcal vaccination vary with age and vaccination history. Specific recommendations can be viewed in detail on the CDC website: (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5909a2.htm). The American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS), supported by the cochlear implant manufacturers, launched a vaccination campaign in October 2009 in an effort to stress the importance of pneumococcal vaccinations for cochlear implant patients. The AAO-HNS Cochlear Implant Vaccination Campaign Task Force, headed by Barry E. Hirsch, MD, and John K. Niparko, MD, with representation from the CDC, developed educational materials (posters, flyers, vaccination record stickers, and CDC Fact Sheet for Professionals) that were distributed to cochlear implant centers throughout the United States. Information regarding vaccination recommendations for cochlear implant patients, links to CDC vaccination schedules, and downloadable patient educational materials were provided on the Academy’s website (http://www.entnet.org/CIHealth). In addition, the cochlear implant manufacturers included reminders in their programming software to discuss and record the vaccination status of cochlear implant candidates and recipients. Despite the new vaccination recommendations for invasive pneumococcal disease, the educational materials developed previously by the AAO-HNS remain relevant and are still available through the Academy’s website. The website has been updated to reflect the most recent CDC recommendations for pneumococcal vaccination in cochlear implant patients, and the appropriate links to current CDC vaccination schedules are provided. Furthermore, all three cochlear implant manufacturers have agreed to assume the responsibility of launching a second vaccination awareness campaign in order to reinforce the importance of pneumococcal vaccination to healthcare professionals who are involved in the care of cochlear implant patients. We encourage you to familiarize yourself with the current CDC guidelines and to routinely recommend age-appropriate vaccinations for all cochlear implant patients. Most health insurance plans cover the cost of vaccinations for cochlear implant patients, and the cochlear implant manufacturers will provide payment to patients for any unreimbursed vaccination costs.
Participate in the 2011 Socioeconomic Survey
The Academy’s 2011 socioeconomic survey, an invaluable tool for otolaryngologist—head and neck surgeons to compare their practices’ productivity, revenue, operations, and other patterns, is ready to launch. The Townsend Group, the outside vendor the Academy has used for each survey, will disseminate the survey to members via email and/or fax in mid-February and work with the Academy to analyze the results. If you receive this survey, please complete it. As you know, a high survey response rate will provide more robust data, which will help provide AAO-HNS members with benchmarking tools for your practices. We plan to display the results and analysis of the survey at our 2011 annual meeting in San Francisco.  AAO-HNS members may access previous socioeconomic surveys on our website (log-in required) at http://www.entnet.org/Practice/members/socioeconomic.cfm. If you have questions, contact healthpolicy@entnet.org, or phone Udo Kaja at 1-703-535-3727.
Boards of Directors December 2010 Meeting Highlights
Before the December 2010 Boards of Directors meetings, Board members, key staff, and invited guests met to outline the 30-year vision of the Academy and its Foundation. Based on those discussions and feedback, Academy staff will begin to lay the blueprint for the future. On Saturday, December 4, 2010, the AAO-HNS/F Boards of Directors met in Alexandria, VA. In addition to hearing reports from Board members and key staff, the following motions and resolutions were approved: AAO-HNS (Academy) 1. Approved the September 25, 2010, minutes of the AAO-HNS Board of Directors meeting. 2. At the request of the Physician Resources Committee, approved the revision of their charge to the following: Committee Charge: The Physician Resources Committee is charged with studying both the availability of otolaryngological workforce and the projected needs for such workforce. The conclusions for these studies should be used in advising the Academy, government agencies, training programs, and medical students about the anticipated need for otolaryngologists. 3. At the request of the Plastic and Reconstructive Surgery Committee, approved the revision of their charge to the following: Committee Charge: The Committee on Plastic and Reconstructive Surgery is charged with the review of regulatory issues and third party payer policies. This Committee should also endeavor to develop a harmonious relationship with plastic surgeons and with oral and maxillofacial surgeons in order to aid in the development of multidisciplinary programs, and to provide an appropriate forum for the resolution of interdisciplinary problems. 4. Pursuant to its bylaws, approve the following nominations to the ENT PAC Board of Advisors: • Re-appointment of Marcella Bothwell, MD, for a two-year term to expire on September 30, 2012. Dr. Bothwell will be eligible for one additional two-year appointment. • Appointment of Marcella Bothwell, MD, as Chair of the ENT PAC Board of Advisors for a two-year term to expire on September 30, 2012. • Re-appointment of William McMillan, Jr., MD, for a two-year term to expire on September 30, 2012. Dr. McMillan will not be eligible for an additional term. • Appointment of William McMillan, Jr., MD, as Vice-Chair of the ENT PAC Board of Advisors for a two-year term to expire on September 30, 2012. 5. Change the title for the policy statement, “Balloon Dilation,” to “Dilation of Sinuses, Any Method (e.g., Balloon, Etc.).” 6. At the recommendation of the Credentials and Membership Committee, accept 34 new candidates for membership for 2010 7. At the request of the AAO-HNS Executive Committee, ratification of the appointment of Alice H. Morgan, MD, PhD, to the Nominating Committee for the purpose of completing the term of Sujana Chandrasekhar, MD, and ending on September 30, 2011. 8. At the request of the Physician Payment Policy Workgroup (3P), ratification and support of an updated coding guidance regarding the new 2011 codes for balloon sinus ostial dilation, as approved by the AAO-HNS Executive Committee on November 4, 2010, and to be made available on the AAO-HNS website. 9. At the request of the Women in Otolaryngology, approved the formation of a Women in Otolaryngology (WIO) Section of the AAO-HNS to replace the WIO committee, in order to better meet the needs of AAO-HNS members, engage more women otolaryngologists, and support the strategic plan of the AAO-HNS. 10. Accept the motion of the Bylaws Committee and submit for vote by the membership the following amendment to the Academy bylaws authorizing the Board of Directors to make all appointments of Academy Delegates to the AMA House of Delegates. Note: Underlined Red Type indicates new language. Article VII. Delegates to the American Medical Association House of Delegates The Board of Directors shall elect a voting Fellow or Member to serve as the primary Academy Delegate or Chair to the American Medical Association House of Delegates every three years. The elected Delegate shall serve a three-year term, and may serve three additional terms, for a total of four successive three-year terms. The Executive Vice President shall serve, ex-officio, as the Alternate Delegate. In the event that additional seats become available, the Board of Directors shall appoint additional Delegates and Alternate Delegates. AAO-HNSF (Foundation) 1. Approved the September 25, 2010, minutes from the AAO-HNSF Board of Directors Meeting. 2. Revised Foundation CME Mission Statement: PURPOSE: The American Academy of Otolaryngology-Head & Neck Surgery Foundation’s CME program improves physician competence through lifelong learning by identifying and addressing the educational needs which underlie practice gaps in otolaryngology-head and neck surgery. CONTENT AREAS: The scope of educational topics covered by the Foundation’s CME program shall be broad, but all activities must meet the ACCME and the AMA/PRA definitions of continuing medical education and be related to the specialty of otolaryngology-head and neck surgery. These topics include, but are not limited to: • business of medicine • clinical fundamentals • core competencies (ABMS, IOM) • ethics • facial plastic and reconstructive surgery • general otolaryngology • geriatric otolaryngology-head and neck surgery • head and neck surgery • laryngology/bronchoesophagology • otology/neurotology • patient safety and quality improvement • pediatric otolaryngology-head and neck surgery • rhinology and allergy • sleep medicine TARGET AUDIENCE: The target audiences for Foundation CME activities are physicians and physicians-in-training who specialize in otolaryngology-head and neck surgery. ACTIVITY TYPES: The Foundation’s CME program includes, but is not necessarily limited to: • Courses: scientific meetings, including the Annual Meeting which consists of a full program of • scientific seminars/papers, • instruction courses, and • business of medicine presentations. • Courses: smaller scientific meetings on a specific clinical topic. • Enduring Materials: self-assessment activities, such as: • Home Study Course (readings and exams), • Patient of the Month Program (clinical patient simulation exercises), • Physician individualized learning. • Education Steering Committee and/or the Board of Directors. • Internet (enduring materials): online (electronic) CME activities. • Other worthwhile educational activities as may be determined from time-to-time by the Education Steering Committee and/or the Board of Directors. EXPECTED RESULTS: The CME program: • Helps participants develop, maintain, or strengthen their application of: • accepted methods of diagnosis and treatment to provide services for patients; • skills, abilities, and strategies in practice. • Provides updates on new developments in the field. 3. At the recommendation of the Women in Otolaryngology Committee and the Young Physicians Committee, approve offering childcare services during the Annual Meeting & OTO EXPO. 4. Approved the nomination by the Coordinator for International Affairs to appoint Nancy L. Snyderman, MD, as an additional Adviser at Large to the International Steering Committee. 5. At the request of the History and Archives Committee, approve the revision of their charge to the following: Committee Charge: The History and Archives Committee shall serve as an advocate for the preservation, conduct of research, and development of educational programs in the history of otolaryngology—head and neck surgery. This mission will be accomplished by undertaking or sponsoring historical projects such as exhibits, publications, and seminars, and by providing advice and undertaking projects in support of medical professionals and the lay public. 6. Approved the request from the Coordinator for International Affairs to hold a joint meeting of the Academy and the Colombian Association of ORL-HNS May 18-21, 2011, in Cartagena, Colombia. 7. The AAO-HNS/F shall distinguish Sleep Medicine as an easily identified category in all AAO-HNSF educational offerings, including but not limited to Annual Meeting content and AcademyU, and appropriately identify Sleep Disorders and Snoring as a distinct area of otolaryngology-head and neck surgery in AAO-HNS/F publications, and in particular, patient/public areas of the website. 8. Approved Bradley W. Kesser, MD, as Chair of the Otolaryngology Neurotology Education Committee effective October 1, 2011, and to serve as Chair-Elect prior to the start of the term. 9. Approved Catherine J. Rees, MD, as Chair of the Laryngology Bronchoesophagology Education Committee effective October 1, 2011, and to serve as Chair-Elect prior to the start of the term. The next AAO-HNS/F Boards of Directors meetings will take place Monday, May 2, 2011, in Chicago, following the Combined Otolaryngology Spring Meeting (COSM).
Stacey L. Ishman, MD, MPH Vice Chair, BOG Legislative Representatives Committee
Kids E.N.T. Month and a Call to Action
February marks the ninth annual observation of Kids E.N.T. Health Month and an opportunity to educate our colleagues and patients about the appropriate diagnosis and management of pediatric ear, nose, and throat disorders. We are all aware that many consulting physicians see otolaryngic issues on a daily basis. Our perceptions are reinforced by recent national data that show that more than 40 percent of visits to primary care doctors involve a pediatric ENT complaint, and that ear infections rank as the top reason for a child to visit a doctor. The Kids E.N.T. campaign was created, therefore, to increase knowledge of pediatric ENT health issues to our consulting doctors and the public, to advocate for the health of our patients, and to market our practices to referring doctors. As part of this campaign, the Academy provides numerous resources (http://www.entnet.org/kidsent), including: Facts sheets on more than 20 common disorders such as hearing loss, sleep apnea, allergies, obesity, and reflux; Customizable posters and postcards; Online videos and video news releases; A PowerPoint slideshow (useful when speaking with community groups or at grand rounds); and Sample outreach letters to the media. While the Academy continues to increase the number of tools we have to treat and educate patients, none of them are effective unless they are used. As you may remember, the Academy did a survey of the general public last year and found that they still have a hard time understanding what an otolaryngologist does and what training we have undergone. The results of the survey showed that “ENT” surgeons were considered highly skilled and trained, while “otolaryngologists” were considered to have a lower level of training and were perceived to have the same level of specialized expertise as general practitioners. These findings suggest that we need to take every opportunity to promote otolaryngology—head and neck surgery. Kids E.N.T. month is an easy occasion for us to promote both children’s health and our specialty, and the best part is, the Academy has really done most of the work. Many of these tools are adaptable and can be customized to market your practice or address local and topical issues. Please consider using these resources in your practices, on your websites, and for your patients. The need for advocacy In addition to February’s Kids E.N.T. campaign, the Academy continues to work with our legislators at both the state and federal level through our excellent legislative staff, action networks, and the Joint Surgical Advocacy Conference (JSAC). All of these efforts are intended to focus on the issues important to us, including scope of practice, healthcare reform (both through legislation and regulation), and funding and legislation that help our practices and ultimately our patients. JSAC is a great opportunity to receive training in effective advocacy. In addition, its goal is to educate participants about the legislative efforts of the Academy and explain the issues that are affecting healthcare. Last year, issues highlighted at JSAC included: fixing the Medicare physician reimbursement system, reforming medical liability at a federal level, improving quality, and obtaining greater access for pediatric reconstructive surgery. JSAC is co-sponsored by the AAO-HNS, along with a number of other surgical societies, and requires only a small amount of time and commitment from you. The staff puts together all the handouts and summaries you need to discuss the most important issues, trains you on strategies to get our perspective across effectively, and will set up face-to-face visits with legislators if you can commit a morning to do this. (For more information, see www.entnet.org/JSAC.) As the future for healthcare becomes murkier, there is no question that our involvement is critical for the health of our practices and of our patients. As physicians, we advocate every day—for patients to use a prescribed medicine, for a parent to consider surgery to resolve a child’s illness, and for reasonable reimbursement. It is our responsibility to extend our advocacy to our local and federal representatives so that they understand who we are. They need to know what great value otolaryngology brings to the lives of our patients, and why is it critical to continue to fund for new innovation, while assuring quality in all that we do. Please join me in doing something good for your practice and your patients; participate in the Kids E.N.T. campaign and JSAC.
David R. Nielsen, MD, AAO-HNS/F EVP/CEO
A Closer Look at the ACA
By January 2011, the Secretary for Health and Human Services (HHS), Kathleen Sebelius, was required to present to Congress her plan for the National Quality Strategy, in compliance with the implementation of the Patient Protection and Affordable Care Act (ACA). Last summer and fall, key elements were proposed, and with the requirement for transparency in implementing ACA, HHS solicited input into the final draft of the plan from a wide range of individuals and entities, including physicians and their organizations. The Academy sought input from its Boards of Directors and elected leaders and collated those comments into our response. Through a series of statements interspersed with 10 carefully phrased questions, the priorities of the HHS strategy and their implications were dissected and challenged. These statements and questions addressed: 1) the principles guiding the strategy; 2) the framework for it; 3) the priorities of the strategy; 4) its goals; 5) the measures of progress for both the goals and priorities; and 6) stakeholder engagement and participation, including feedback in developing the elements of the plan. As  I write this, the final plan by HHS had not yet been presented. An initial set of potential “core principles” were developed to serve as the foundation of the National Quality Strategy and influence the development of priorities, goals, and strategies. They include: Person-centeredness and family engagement will guide all strategies, goals, and improvement efforts. The strategy and goals will address all ages, populations, service locations, and sources of coverage. Eliminating disparities in care—including but not limited to those based on race, ethnicity, gender, age, disability, socioeconomic status, and geography—will be integral to all strategies and goals. The design and implementation of the strategy will consistently seek to align the efforts of public and private sectors.1 As you read about healthcare reform, and form your own opinion about the problems and solutions, ask yourself which of the elements of the National Quality Strategy you can support. Do you agree that we should: Make healthcare safer, by eliminating adverse preventable events that injure patients through the delivery of care? Increase the degree to which care is coordinated for patients, leading to demonstrably improved patient outcomes such as reduced preventable hospital readmissions and fewer medication errors due to poorly managed care transitions? Dramatically reduce the occurrence of, and improve management of chronic illnesses, through strong partnerships and clear accountability across healthcare providers, patients, and communities? If so, you are in alignment with the HHS goals for healthcare reform. The framework within which we can work to accomplish these goals could include: Better Care: Person-centered care that works for patients and providers. Better care should expressly address the quality, safety, access, and reliability of how care is delivered, as well as the experience of individuals in receiving that care; active engagement of patients and families; and the best possible care at all stages of health and disease; Affordable Care: Care that reins in unsustainable costs for families, government, and the private sector to make it more affordable; and Healthy People/Healthy Communities: The improvement of health and wellness at all levels through strong partnerships between healthcare providers, individuals, and community resources. If such a framework seems reasonable to you, agreement between physicians and HHS on what to do to move forward seems achievable. This is HHS’ stated framework. It is politically tempting to believe that with the results of the most recent election, more traction can be gained in reversing, overturning, or eliminating elements of the ACA. But at a recent meeting, the CEOs of many of the major medical associations were reminded that the drive to address quality improvement, and the absolute need to remedy the unsustainable costs of providing healthcare in the U.S., were strong and under way long before President Obama was elected, and prior to the passage of ACA. Even if elements of (or the entire) ACA were reversed, that drive would not only continue, but gain momentum. The stark reality is that unless physicians, patients, purchasers of healthcare, and related providers, systems, and managers find a way to improve quality and reduce costs, problems of access to care, worsening public health, and financial crises loom. As we work to remedy what we see as the negative elements and consequences of the ACA, we should do more than just be “against” what won’t work. We have an obligation to adopt and promote those principles that are in the best interest of our patients and that will address, effectively and relatively quickly, the inevitable healthcare and financial crises that face us if we are not proactive in managing the health of our nation. Be open-minded and give careful thought as to what we can DO (not just what we oppose), individually and collectively, to improve care and quality, and use resources wisely and judiciously. We have given an oath that we will do so, and our patients and nation deserve nothing less. Reference National Health Care Quality Strategy and Plan, September 9, 2010 http://www.hhs.gov/news/reports/quality/nationalhealthcarequalitystrategy.pdf [downloaded December 14, 2010]
J. Regan Thomas, MD, AAO-HNS/F President
Legislative and Regulatory Advocacy: What’s the Difference?
As a key component of my year as President, I want to stress and strengthen our advocacy activities. “How a bill becomes a law” is complicated, but can be broken into two main processes: development and implementation. Not surprisingly, many of our members are often confused by the difference between the roles of the Academy’s Government Affairs (GA) and Health Policy (HP) departments. Both are necessary, and collaboration is frequently required. To help simplify the roles, GA/Legislative Advocacy handles everything that happens until a bill is signed into law. They are the “shapers,” and the key players are the U.S. Congress and state legislators. Then, HP/Regulatory Advocacy monitors how a new law is executed or interpreted via rules and regulations. They are the “fine tuners,” and their key players are the Administration and related agencies (CMS, HHS, FDA, etc.). Healthcare reform and the Patient Protection and Affordable Care Act (ACA) give a perfect example of how the two areas must work together. GA handled all the legislative advocacy efforts until the ACA was passed by Congress. Now, HP is advocating for the appropriate implementation of the policies stipulated in the bill. However, attempts to modify the law in 2011 will require resumed legislative efforts, and the whole process starts again! The politics of it all The result of the contentious 2010 mid-term elections drastically altered the lawmaking process for the 112th Congress. A divided Congress (Republican control in the U.S. House of Representatives and slim Democratic control in the U.S. Senate) means that, theoretically, there is more opportunity to legislate from “the middle.” However, healthcare efforts are so ideologically charged that many new and/or recurring legislative efforts could stall. In 2011, Republican control in the House is expected to result in increased efforts to repeal and/or drastically modify the ACA. The GA team will continue to work independently and in collaboration with the Surgical Coalition to urge Congress to make necessary changes to the ACA. The top priority for the AAO-HNS is repeal and/or modifications to the Independent Payment Advisory Board (IPAB). Also, given the divided Congress, the Administration will ultimately be forced to abandon some of its more liberal agenda items if it expects to secure significant legislative achievements in the last two years of the President’s term. Of course, Republicans and Democrats also will begin publicizing their perceived victories as a platform for the 2012 elections. The election cycle never ends. Like politicking, advocacy never really stops. Although the GA and HP teams handle different aspects of the law-making process, collaboration is a daily event. Many issues require legislative action each year in order to ensure appropriate funding. As examples, NIH and other research funding, and Medicare physician payment and applicable rule-making are re-occurring “staples” of the AAO-HNS advocacy priorities. Accomplishments Here’s another way to distinguish the complementary, yet distinct, roles of GA and HP. For 2010, the top five GA federal and state legislative accomplishments were: Prevented direct access legislation from advancing in Congress, and successfully opposed/negotiated scope-of-practice bills in New York, Pennsylvania, Virginia, and Wisconsin. Halted a 25-percent cut in Medicare physician payments scheduled for January 1, 2011. Defeated a federal proposal to tax hearing aids. Stopped a federal tax on elective cosmetic procedures, and defeated proposals to tax medical services in Georgia, Oregon, and Washington. Secured introduction of “truth in advertising” legislation at the federal level. Under HP, the top five socioeconomic and federal regulatory accomplishments for 2010 were: Received CMS approval for separate payment for Canalith repositioning (Epley Maneuver) procedure beginning January 1, 2011. Obtained CMS approval for three new nasal/sinus endoscopy codes for January 1, 2011. Secured Aetna coverage of therapeutic fracture of nasal inferior turbinates when performed on the same date as septoplasty without a modifier. Reversed Humana coverage policy limiting use of miniCT scans for most sinusitis indications as of November 5, 2010. Overturned AMA and CMS decision to bundle payment of vestibular function test codes performed on the same patient on the same day. This year is expected to be another period of heightened activity for our GA and HP advocacy teams. We are very fortunate to have dedicated, knowledgeable, and effective advocacy staff in the Academy, and we would not be able to function as effectively without their expertise. Our successes are contingent upon the active involvement and engagement of AAO-HNS members in our advocacy initiatives. Help us to help you. Be an advocacy leader and make your voice heard.
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JSAC: No Excuses, Just a Great Meeting
Susan R. Cordes, MD Board of Governors Member-at-Large   With spring just around the corner, thoughts go to longer days, warmer weather, and the Joint Surgical Advocacy Conference (JSAC), which takes place March 27-29, 2011, immediately following the BOG Spring Meeting. I still remember the first time I attended the meeting and how surprised I was that I enjoyed it so much. Before attending my first JSAC, I thought it was a meeting for people “into” politics or “political junkies.” I quickly discovered that this is false; it is truly a political meeting for surgeons.  The meeting begins with a review of the political issues facing otolaryngologists, after which even the most politically naïve feel comfortable discussing the issues. Subsequent talks cover the basics of advocacy (or advanced advocacy for JSAC veterans). Additional topics ensure that attendees are completely ready to storm Capitol  Hill and be heard. Prior to that first JSAC, I was intimidated by the prospect of meeting with legislators or their staffs. It was a huge relief that we visited their offices in groups. Being in a group allows each person to talk as much or as little as he or she is comfortable. Between appointments, it’s just fun to go trooping around Capitol Hill with your surgical colleagues. And I recall thinking how fortunate I am to live in a country where I can go to the nation’s capital and meet with our leaders to discuss issues and express concerns. With a couple hundred surgeons attending the meeting, I believed there were plenty of others to get the word to Congress and that I didn’t really need to go. But it only takes a day on Capitol Hill to see that numbers matter. Various groups swarm the Hill to voice their concerns, and the larger the group, the better the chance of getting noticed. Leaders in our specialty have challenged us to show we care by meeting with legislators, and JSAC is a chance to do just that. Times are tough and everyone is really busy, but JSAC is time well-spent. It takes just two weekdays away from work to have the opportunity to impact the future of healthcare. Decisions made by Congress now will not only affect the way we practice medicine, but will influence the healthcare that is available to us and our families when we get sick. That is certainly worth two days. JSAC is a much smaller meeting than many others. This is beneficial in that it is just “us surgeons,” and it’s a great opportunity to connect with colleagues, to network, and even get to know the other surgeons in your community and state. After meeting at JSAC, surgeons in my state have kept in touch regarding political issues and have collaborated on local activities and meetings. JSAC is attended by Academy leaders, including BOG leaders and current and past Academy presidents; it is a great opportunity to get to know them as well. I was hesitant to attend my first JSAC meeting. I was worried that I wouldn’t know what to say or that I couldn’t answer a question, but I was surprised to find what a well-planned and enjoyable meeting it is.  I came home well-informed and energized to stay on top of the issues. And at the risk of sounding like a cliché, I was proud to be an American. It is a privilege that we live in a country where we can visit our leaders, and it is exciting to take advantage of that privilege. I have been to every JSAC since my first one, and I am looking forward to this year’s meeting just as eagerly. I hope to see you there!
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We Asked…They Answered!
Read why your colleagues think you should attend the Fourth Annual Joint Surgical Advocacy Conference (JSAC) March 27-29, 2011, in Washington, DC. What is the most important thing you learned from attending JSAC? What is the most compelling reason to come to the JSAC? We know the devil is in the details, and the writing of the regulations for the new healthcare law is now beginning. What better way to influence policy than becoming informed and involved through JSAC? Rodney P. Lusk, MD, President-Elect, AAO-HNS The most important thing I have learned from JSAC is that we MUST stick together. While we have our individual and society issues, focusing on them can be detrimental to the overall outcome of medical reform. We must quit arguing among ourselves and fight together for fair compensation for our hard work that we perform every day on the front lines of patient care. Otolaryngology is a small specialty society, but we make our presence known to the surgical community at this conference. Marcella R. Bothwell, MD, Chair, ENT PAC Board of Advisors I was initially hesitant about diluting our experience by eliminating our traditional otolaryngology conference in Washington, DC, by joining with other surgeons. However, when I experienced the first JSAC, I saw that not only would the ENT influence not be diluted, it was actually strengthened by the greater numbers and visibility of all surgeons at JSAC. By advocating together with our surgical siblings, our voice is stronger, and our positions are solidified. If we are not sitting at the table, we run a real risk of being a main course. Sujana S. Chandrasekhar, MD, Chair-Elect, Board of Governors Having attended JSAC and its predecessor (AAO-HNS Washington Advocacy Conference), I have a multi-year perspective. It is important to understand the legislative process, and appreciate that change usually takes years of ongoing advocacy. Do not be frustrated that the same issues arise each year. The battles are won in small steps, and hopefully we can look back and be proud of the impact we have made. As President John F. Kennedy once said, “Ask not what your country can do for you, but what you can do for your country!”–an appropriate statement for today’s medical and legislative environment. Paul M. Imber, DO, Chair, Board of Governors Legislative Representatives Committee Surgeons from all over the country really do have similar concerns, despite being from different specialties. The primary reasons I find it helpful to attend JSAC every year are: up-to-date briefings on healthcare policy to better understand how changes to legislation impact our patients; a community of concerned physicians keeps you from feeling overwhelmed while trying to make a difference; and a great opportunity for residents interested in advocacy to be mentored. Jayme R. Dowdall, MD, Vice Chair, SRF Governing Council  By attending JSAC, I have learned how important it is to present a unified face of surgery on Capitol Hill. The meeting demonstrates unity amongst surgeons on issues involving our patients, access to care, and our practices. The most compelling reason to attend JSAC is to advocate for our patients and ourselves. It also helps us develop and maintain relationships with those in Congress and their staffs. Lee D. Eisenberg, MD MPH, Board Coordinator for Governmental Relations Many of us in academia seem to miss out on the day-to-day operations of running a practice. JSAC, in many ways, really addresses the challenges facing the overwhelming majority of private practice otolaryngologists that make up 80 to 90 percent of the OTO-HNS workforce. If you are nervous that you are not sure what you would want to say to our elected representatives, AAO-HNS provides outstanding bullet points and outstanding educational opportunities to help us intelligently represent our pressing needs. Michael D. Seidman, MD, Chair, Board of Governors  I have attended advocacy conferences for over a decade now, and I have learned that it is absolutely critical to show up, bring a colleague, and passionately advocate to legislators on Capitol Hill on behalf of our specialty and our patients. There is NO substitute for ENT doctors making their case in person regarding the many issues facing otolaryngology and the House of Medicine. We have to personalize and humanize each issue and “bring it home” to the legislator with stories of patient problems in their district, to try and get them and their staffs to understand our position on the issue, and what impact that issue may have on their constituent, who also happens to be a voter (and a patient)! Gavin Setzen, MD, Immediate Past Chair, Board of Governors By attending JSAC, I have learned how to engage more effectively with other surgical subspecialties and how to advocate with my Congressional delegation for meaningful change. Of course, longstanding unresolved issues, such as professional liability reform and the flawed Sustainable Growth Rate (SGR) formula, continue to plague surgeons and must be continually communicated to Congress for remedy. Congress must hear directly from those of us who, along with the patients we serve, are most directly affected by healthcare reform and flawed Medicare reimbursement policies. Failing to be engaged on a personal level allows others with different agendas to potentially push theirs, which can adversely impact our practices. Richard W. Waguespack, MD, Board Coordinator for Socioeconomic Affairs  I have been attending the Academy’s advocacy meetings since 1984. In those 26 years, I have only missed twice, due to weather or illness. The most compelling reason for continued attendance is to stay current with the issues affecting us and our patients. The program is always well-organized and extremely informative, and I have become a more effective advocate both at the federal and state levels. F. Thomas Sporck, MD, West Virginia Academy of Otolaryngology – HNS For me, the most compelling reason to attend JSAC is because I care about the future of medicine and our specialty, and know that as physicians, we must be seen and heard to make a difference. It is a more critical time than ever before to be involved. If you don’t get involved in the process and wait for someone else to speak on your behalf on critical issues that affect our patients and our practices, you should not complain. I was so impressed by the number of residents and young physicians that have attended in the past and we (not so young physicians) must continue to inspire their involvement by also being in attendance. Duane J. Taylor, MD, Chair, Diversity Committee
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JSAC 2011: If Not Now, When?
SAVE THE DATE – Joint Surgical Advocacy Conference – 2012 Dates Announced! In 2012, the Joint Surgical Advocacy Conference (JSAC) will retain its popular March schedule to coincide with the AAO-HNS BOG Spring Meeting. Mark your calendars – the 2012 JSAC is scheduled for Sunday, March 25, through Tuesday, March 27. The conference venue will be the ideally located Hyatt Regency Washington on Capitol Hill. To learn more about JSAC, visit www.entnet.org/jsac.           The political climate in Washington, DC, was drastically altered by the contentious 2010 mid-term elections, and Congress now has one of the largest classes of freshman legislators in decades. Attending the 2011 Joint Surgical Advocacy Conference (JSAC) is the perfect way for AAO-HNS members to become familiar with the 112th Congress’ new legislators and begin developing or strengthening your advocacy skills. Relationships formed with members of Congress at this year’s JSAC will make a difference and help strengthen AAO-HNS advocacy efforts in the future. The three-day conference, sponsored by the AAO-HNS, the American College of Surgeons, and numerous other surgical groups, provides residents, fellows, and practicing physicians the opportunity to join your peers in a collaborative advocacy effort. The conference program offers attendees advocacy training, detailed issue briefings, pre-scheduled meetings on Capitol Hill with Members of Congress and their staffers, networking opportunities, and timely reports from Washington politicos. JSAC 2011 will continue to feature programs that were new to the conference’s agenda in 2010, including a CME course at no additional cost on Accountable Care Organizations (ACOs). In addition, the experience-based training that received rave reviews in 2010 will again be included. Attendees will have two options: “Advocacy 101” for beginners (mandatory for first-time attendees), or “Advanced Advocacy.” The concurrent training sessions will help prepare attendees for meetings with Members of Congress or their staffs. “Advocacy 101” provides attendees with the basics on how the legislative process works and best practices for Congressional meetings. “Advanced Advocacy” delves deeper into tactics for building and maintaining relationships with Members of Congress. This year, advocacy training will also include a new “role-playing” exercise to prepare members for their Capitol Hill visits. JSAC is also a great experience for AAO-HNS resident members, and program directors are encouraged to support conference attendance. Resident-specific opportunities, including travel grants, specialized advocacy training, and an individualized briefing, are available. And what is a visit to Washington, DC, without a political fundraiser? AAO-HNS attendees will have the unique opportunity to participate in a VIP reception supporting the Academy’s political action committee, ENT PAC. Now is the time to be heard on Capitol Hill. Although the Patient Protection and Affordable Care Act (ACA) is law, the healthcare reform process is far from over. Regulatory efforts to implement the ACA are under way, and legislative efforts to modify the law are expected in 2011. Please consider taking a few days away from your practice to join your colleagues at JSAC 2011. Not only will you learn more about how federal legislation and the implementation of healthcare reform will impact your practices and patients, but you can personally convey your concerns and recommendations to your legislators. AAO-HNS members cannot afford to miss this timely conference – it’s worth the investment! For more information, please visit www.entnet.org/jsac.