Published: December 2, 2013

Support Millennium Society, Advance the Specialty

Thank you to all who support the Millennium Society. Your contribution provides a vital source of ongoing operational funding for programs and activities essential to supporting the success of today’s otolaryngologist-head and neck surgeons. Currently, costs related to producing the Foundation’s relevant, high-quality, and innovative programs to empower otolaryngologists to deliver the best patient care exceeds $19 million annually. As you may be aware, membership dues account for about 33 percent of our organization’s annual operations budget. Dues alone would not even provide funding for our annual educational programming, much less all the other highly respected, invaluable resources and programs that we produce for the otolaryngology community. Your gift provides the much needed source of funding to ensure that our popular and trusted programs continue to thrive and transform as required to keep pace with the needs of today’s otolaryngologists.Specifically, your gift will be instrumental in: Advancing the understanding and treatment of disease through research Creating high-quality educational opportunities for the otolaryngology workforce Educating the public and patients about the specialty Improving the quality of and access to healthcare and providing critical financial resources for otolaryngology Donate today by visiting www.entnet.org/donate. We also invite you to consider a monthly or quarterly pledge. Please contact Mary McMahon, director of development, at mmcmahon@entnet.org or phone 703-535-3717 for details.


New_Development_LogosThank you to all who support the Millennium Society. Your contribution provides a vital source of ongoing operational funding for programs and activities essential to supporting the success of today’s otolaryngologist-head and neck surgeons. Currently, costs related to producing the Foundation’s relevant, high-quality, and innovative programs to empower otolaryngologists to deliver the best patient care exceeds $19 million annually. As you may be aware, membership dues account for about 33 percent of our organization’s annual operations budget. Dues alone would not even provide funding for our annual educational programming, much less all the other highly respected, invaluable resources and programs that we produce for the otolaryngology community. Your gift provides the much needed source of funding to ensure that our popular and trusted programs continue to thrive and transform as required to keep pace with the needs of today’s otolaryngologists.Specifically, your gift will be instrumental in:

  • Advancing the understanding and treatment of disease through research
  • Creating high-quality educational opportunities for the otolaryngology workforce
  • Educating the public and patients about the specialty
  • Improving the quality of and access to healthcare and providing critical financial resources for otolaryngology

Donate today by visiting www.entnet.org/donate.

We also invite you to consider a monthly or quarterly pledge. Please contact Mary McMahon, director of development, at mmcmahon@entnet.org or phone 703-535-3717 for details.


More from December 2013 - Vol. 32 No.12

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2013 Annual Report: Sustainability – Information and Knowledge Management
The past 12 months have been ones of transition for Information Technology (IT). During the first part of 2013 an outside assessment and evaluation of IT infrastructure resources and staffing requirements was conducted. This study was robust and looked at all aspects of how Members are served through AAO-HNS/F technology. This full IT review resulted in new strategy and implementation plan. Structural Changes Ensure Strength for New Growth and Engagement Two major changes that were of the highest priority included the outsourcing of the helpdesk to free up skilled staffing resources and the move to a cloud-based Infrastructure-as-a-Service (IaaS) environment in answer to increased content and storage needs. These two moves enable the remaining technology staff to move from a platform of technology maintenance to that of engaging technology to forward member needs and resources. IT’s new focus on providing information and knowledge management is a much broader charge that sustains and supports AAO-HNS/F activities and collaborates with staff. This tectonic shift resulted in the renaming of the business unit to Information and Knowledge Management (IKM) and a new senior director last June. Improving the Member Experience With the change in the direction for IKM, focus could now be directed to improving the Academy’s online presence. This included two important projects with Member Engagement and Communications, respectively, to provide the vital integration of technology to member ROI. ★ The Member Portal: ENTConnect Based on a “best-of-breed” association-centric web platform, the new Member Engagement Portal, ENTConnect, will serve as a resource bank for chairs and committee members, and will enable Members to work more collaboratively, opening up full participation in online communities. Access to the Member Engagement Portal will be based on existing member login credentials. Since access will be restricted to members, this portal will be a place for dialog and discussion, content development and review, assessment and synthesis. ENTConnect is scheduled to go live in the spring of 2014. ★ A New and Responsive Website It was apparent from the technology assessment that the current website was not what we needed for the future. A new website that will better serve is being constructed and is on track for a roll-out in May 2014. Meanwhile, some improvements to the current site were undertaken. The results are substantive, and the analytics, since these revisions were introduced, reflect an increase in access and usability. Before selecting a partner to assist in the website redesign, there was an exhaustive review of Request for Proposal responses and in-depth candidate capability presentations. The website redesign project kicked off in Vancouver with member interviews.  Communications work in both areas adds an intuitive member experience through a visual taxonomy and branding. Two of the main focus areas for the redesign project are: 1) make our content easier to find and use, both on the site and from search engine results; and 2) have content automatically adjust to the screen size of whatever device is used to access our site. Whether you come to the site from a smartphone, tablet, or full size screen, content on the new website will automatically adjust.
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2013 Annual Report: Financial Report Fiscal Year 2013
The fiscal year July 1, 2012, through June 30, 2013, (FY13) closed with a positive (unaudited) $1.8 million variance from the break-even budget. Overall, revenues were within 1 percent of budget and operating expenses were approximately 10 percent under budget. With respect to non-operating activities, the return on the managed investment portfolio was nearly 8 percent for the fiscal year. Additionally, a gain of $1.7 million was recorded to adjust for the change in market value of the interest rate swap agreement related to the financing of the headquarters building. In combination, operating and non-operating FY13 activity increased reserves by $4.1 million. As of June 30, 2013, unrestricted and undesignated reserves were $12.5 million or roughly 65 percent of the operating budget, a level considered within best practices. The Hal Foster, MD, Endowment, started only three short years ago, now has net assets, pledged, received or to be received in the form of life insurance proceeds or bequests, of $10.3 million as of June 30, 2013. These funds are permanently restricted as endowment principal, the earnings on which are used as directed by the donor at the time the endowment gift was made. Endowment earnings funded almost $60,000 of AAO-HNS/F FY13 programming. For a copy of the independent audit of AAO-HNS/F’s FY13 financial statements email CHanlon@entnet.org. In May 2013, the Boards of Directors approved a balanced fiscal year 2014 (FY14) budget. The budgeted revenue is approximately the same as FY13, $19.6 million, reflecting realistic expectations about opportunities for revenue growth. Budgeted expenses reflect inflation adjustments for continuing programs and support expenses. Without additional revenue to meet these increases, the Board carefully analyzed how to maximize member benefits with the available resources and made critical decisions about programs to be carried out in FY14. The budgeting process involved a concerted effort from the elected leadership at every critical decision point, and included several sessions with the Boards of Directors, Executive Committee, and the FISC. The positive results of FY13 reflect good fiscal management, but AAO-HNS/F leadership and staff will continue to watch rising costs against flat revenue growth as strategies for the organization are developed going forward. -Gavin Setzen, MD, Secretary/Treasure
2013 Annual Report: Sustainability – Corporate Support Rebounds with Increase in Annual Meeting Support
Corporate Funding:            $826,000 We continue to work with companies and foundations to fund our mission through the Industry Roundtable (IRT) program, sponsorships, and royalties. We believe that the corporate area has been largely underworked and there is much more opportunity for growth. The Development staff is building relationships with companies and foundations to increase participation in our philanthropic activities. The 2013 Annual Meeting & OTO EXPOSM provided an excellent opportunity to engage corporate leaders in AAO-HNSF. A financial summary for each program is included with the updates below. Annual Meeting Sponsorships:   $237,000The good news story in the corporate world is the increased interest in annual meeting sponsorships and promotional opportunities. For FY13, we exceeded our budget mark by 63 percent ($236,500 vs. $150,000). Annual meeting sponsorship income is already well ahead of budget for FY14. Our plans include continuing to expand sponsorship opportunities for the 2014 Annual Meeting, as well as approaching potential sponsors earlier in their budget cycle for next year. Industry Roundtable (IRT):        $208,000 General funding for mission support continues to be a challenge for the organization. Due to recent changes in regulations, it is becoming increasingly difficult for industry to support general mission requests, annual meeting support, and educational efforts. Grant requests include the following funding areas: humanitarian aid travel grants, resident leadership grants, CORE, annual meeting educational support, and International Visiting Scholars. We continue to look at ways to revitalize the corporate giving program and are seeking to benchmark our program with programs from similar organizations. Academy Advantage Royalties:  $381,000 The Academy Advantage program continues to offer members select services at discounted rates. For FY13, we closed the year $57,000 (18 percent) over anticipated revenues. Our partnership with HealtheCareers is exceptionally strong and we are seeing good growth in the partnership. In an effort to bolster income, we are working to increase the number of Academy Advantage partners.
2013 Annual Report: Millenium Society
Life Members Peter J. Abramson, MD,¹  and Cara Abramson Kenneth W. Altman, MD, PhD, and Courtney Altman American Association of Otolaryngologists of Indian Heritage Vijay K. Anand, MD J. Noble Anderson, Jr., MD Seilesh Babu, MD,  and Abbey Crooks-Babu, MD Byron J. Bailey, MD,  and Margaret Bailey Robert W. Bastian, MD,  and Jan Bastian Neal S. Beckford, MD Leslie Bernstein, MD, DDS Nikhil J. Bhatt, MD,1*  and Anjali Bhatt, MD Neil Bhattacharyya, MD,  and Anjini Bhattacharyya, MD Andrew Blitzer, MD, DDS Mark E. Boston, MD Marcella R. Bothwell, MD I. David Bough, Jr., MD Linda S. Brodsky, MD Robert E. Butler, MD C. Ron Cannon, MD, and family Sujana S. Chandrasekhar, MD,*  and Krishnan Ramanathan Ajay E. Chitkara, MD Sukgi S. Choi, MD,1  and Charles F. Monk, Jr. Felix W. K. Chu, MD Noel L. Cohen, MD,  and Baukje Cohen Robin T. Cotton, MD James Croushore, MD James C. Denneny III, MD1 David R. Edelstein, MD,  and Ms. Eve Lesser David E. Eibling, MD Lee D. Eisenberg, MD*, MPH, and Nancy Eisenberg Janelle A. Y. Engel, MD,  and E. Rodney Engel, MD Deborah J. Freehling, MD Lisa T. Galati, MD Raghuvir B. Gelot, MD,  and Carolyn Gelot Samuel J. Girgis, MD Michael E. Glasscock III, MD Jack L. Gluckman, MD,  and Vickie Gluckman Steven M. Gold, MD Barbara Goldstein, PhD Rebecca D. Golgert, MD Mary E. Gorman, MD Thomas A. Graves, MD Anna Kristina Elise Hart, MD, and William Todd Harder Jack V. Hough, MD (decd.) John W. House, MD* Stacey L. Ishman, MD,*  and Jim McCarthy Barry Jacobs, MD,  and MaryLynn Jacobs Jonas T. Johnson, MD,  and Janis Johnson Srinivas R. Kaza, MD David W. Kennedy, MD Darius Kohan, MD Frank C. Koranda, MD Alan David Kornblut, AB, MS, MD, and Alfred Kornblut, CAPT MC USNR-RET (decd.) Jamie Koufman, MD Dennis H. Kraus, MD Helen F. Krause, MD (decd.) Vandana Kumra, MD Ronald B. Kuppersmith, MD, MBA, and Nicole Kuppersmith Rande H. Lazar, MD, FRCS Thomas B. Logan, MD,  and Jo Logan Rick G. Love, MD Frank E. Lucente, MD Rodney P. Lusk, MD, and  Constance C. Lusk, RN Sonya Malekzadeh, MD1 Martha Entenmann Tinnitus  Research Center, Inc. Phillip L. Massengill, MD* Pravina and Dinesh C. Mehta, MD Ralph B. Metson, MD James L. Netterville, MD1 David R. Nielsen, MD,1 and Rebecca C. Nielsen, RN Michael M. Paparella, MD,  and Treva Paparella Spencer C. Payne, MD* Angela M. Powell, MD Eileen M. Raynor, MD Richard M. Rosenfeld, MD, MPH¹ Steven H. Sacks, MD Harlene Ginsberg  and Jerry M. Schreibstein, MD¹ Michael D. Seidman, MD,  and Lynn Seidman Gavin Setzen, MD,¹  and Karen Setzen Donna E. Sharpe, MD Abraham Shulman, MD Herbert Silverstein, MD William H. Slattery III, MD Nancy L. Snyderman, MD James A. Stankiewicz, MD J. Pablo Stolovitzky, MD, and Silvia P. Stolovitzky Krishnamurthi Sundaram, MD Duane J. Taylor, MD¹ Dana M. Thompson, MD, MS Elizabeth H. Toh, MD Betty S. Tsai, MD Ira David Uretzky, MD,*  and Beth J. Uretzky P. Ashley Wackym, MD,  and Jeremy Wackym Pell Ann Wardrop, MD* Richard Alan Weinstock, DO, and Cheryl Weinstock Leslie K. Williamson, MD Lorraine M. Williams-Smith, MD, MPH, FACS David L. Witsell, MD, MHS Peak Woo, MD Geoffrey L. Wright, MD Ken Yanagisawa, MD,*  and Julia Shi, MD Jay S. Youngerman, MD*  and Toni Youngerman Mark E. Zafereo, Jr., MD Patron Members Phyllis B. Bouvier, MD Hung J. Kim, MD William M. Luxford, MD Eugene N. Myers, MD, FRCS,  Edin (Hon.) Rance W. Raney, MD Sustaining Members Reginald F. Baugh, MD William R. Bond, Jr., MD Peter C. Bondy, MD Amelia F. Drake, MD Marvin P. Fried, MD Michael Friedman, MD Clarence W. Gehris, Jr., MD Carlos Gonzalez Aquino, MD Joseph E. Hart, MD, MS Stephanie Joe, MD Alan J. Johnson, MD Romaine F. Johnson, MD Nedra H. Joyner, MD C. Ramadas Kamath, MD Timothy D. Knudsen, MD Lisa A. Liberatore, MD James A. Manning, MD Edith A. McFadden, MD, MA, Bert W. O’Malley, Jr., MD Robert B. Parke, Jr., MD, MBA Karen T. Pitman, MD¹ Lisa Perry-Gilkes, MD¹ Anna M. Pou, MD* Ravi N. Samy, MD Adam M. Shapiro, MD Carl H. Snyderman, MD, MBA Sanford C. Snyderman, MD Joseph R. Spiegel, MD Jamie Stern, MD Michael G. Stewart, MD, MPH¹ Mariel Stroschein, MD Debara L. Tucci, MD Sunil Ummat, MD, FRCSC Winston C. Vaughan, MD Randal S. Weber, MD Richard Alan Weinstock, DO Daniel L. Wohl, MD Stephen Kenneth Wolfe, MD Rhoda Wynn, MD Lauren S. Zaretsky, MD¹ Members Gregory M. Abbas, MD Daniel P. Akin, MD, PhD Patricia Allen Joel N. Anthis, MD Nancy H. Appelblatt, MD Richard G. Areen, MD Oneida A. Arosarena, MD James E. Arnold, Sr., MD Moises A. Arriaga, MD Jonathan E. Aviv, MD Douglas D. Backous, MD Sean B. Bailey, MD Dole P. Baker, Jr., MD James G. Barlow, MHA David M. Barrs, MD David D. Beal, MD Michael S. Benninger, MD Peter D. Berman, MD Philip Bernstein, MD Todd Blum, MHA, MBA, CMPE James H. Boyd, MD Derald E. Brackmann, MD Jean Brereton, MBA R. Bruce Buechler, MD Lawrence P. A. Burgess, MD Mark E. Carney, MD Eric S. Carter, MD Roy R. Casiano, MD Osmund T. Chan, MD C. Y. Joseph Chang, MD A. Craig Chapman, MD Khalid Chowdhury, MD, MBA Randall A. Clary, MD Donald J. Clutter, MD Stephanie Cordes, MD Susan R. Cordes, MD Anthony J. Cornetta, MD Stephen P. Cragle, MD Donald E. Crawley, MD Roberto A. Cueva, MD Lawrence J. Danna, MD Kent G. Davis, MD John M. DelGaudio, MD Jennifer Derebery, MD Craig S. Derkay, MD Daniel G. Deschler, MD David Devorkin, MD Elizabeth A. Dinces, MD Linda J. Dindzans, MD H. Peter Doble, II, MD Jeff Dudley Jolene Eicher Wayne B. Eisman, MD John R. Emmett, MD Moshe Ephrat, MD Stephanie J. Epperson, PA-C David A. Evans, MD Jose N. Fayad, MD Ilana Feinerman, MD Berrylin J. Ferguson, MD Valerie A. Flanary, MD James W. Forsen, MD Keith D. Forwith, MD Ramon A. Franco, Jr., MD Robert K. Gaughan, MD James Geraghty, MD Marion B. Gillespie, MD Douglas A. Girod, MD Robert A. Glazer, MPA Cameron D. Godfrey, MD David A. Godin, MD Mohammed A. Gomaa, MD Barbara Salmon Grandison, MBBS Iain L. Grant, MB ChB James C. Grant, MD Daniel Grinberg, MD Eli R. Groppo, MD John R. Gross, FHFMA John J. Grosso, MD Benjamin Gruber, MD, PhD Trevor G. Hackman, MD Steven D. Handler, MD, MBE Scott H. Hardeman, MD Brenda Hargett, CPA, CAE Willard C. Harrill, MD James M. Hartman, MD Ronald H. Hirokawa, MD Barry Hirsch, MD Kenneth M. Hodge, MD Richard S. Hodgson, MD G. Richard Holt, MD, MSE, MPH John R. Houck, Jr., MD Paul M. Imber, DO Lisa E. Ishii, MD, MHS¹ Tracy F. Jakob, MD Gina D. Jefferson, MD Garfield Johnson III, MD Daniel L. Jorgensen, MD V. Vasu Kakarlapudi, MD Michael J. Kearns, MD David J. Kiener, MD Haena Kim, MD James F. Kimbrough, MD Matthew T. Kirby, MD James J. Klemens, MD Mimi S. Kokoska, MD Howard S. Kotler, MD Greg Krempl, MD John H. Krouse, MD, PhD¹ Alice L. Kuntz, MD Denis C. Lafreniere, MD¹ Christopher D. Lansford, MD Pierre Lavertu, MD Amy D. Lazar, MD Patty Lee, MD Marc J. Levine, MD Steven B. Levine, MD Craig M. Litman, MD Richard S. Litman, MD James H. Liu, MD Philip G. Liu, MD Long Island Society  of Otolaryngology Howard W. Lowery, MD James D. Lowery, MD Keith Lynn Allen Mackley Robert H. Maisel, MD Laurie E. Markowitz Spence, MD Theodore P. Mason, MD Becky McGraw-Wall, MD Benjamin M. McGrew, MD Jeanne McIntyre, CAE Kevin X. McKennan, MD Claude A. McLelland, MD Brian J. McKinnon, MD, MBA Gorden T. McMurry, MD G. Walter McReynolds, MD Alan G. Micco, MD Donna J. Millay, MD Richard T. Miyamoto, MD, MS Walter P. Moore III, MD C. Elliott Morgan, MD, DMD John R. Morris, MD Samantha Marie Mucha, MD J. Gail Neely, MD Donald E. Newland, MD Mark L. Nichols, MD Brian Nussenbaum, MD Rick Odland, MD, PhD Randall A. Ow, MD John F. Pallanch, MD Bradford S. Patt, MD James K. Pitcock, MD Christopher P. Poje, MD Shannon P. Pryor, MD Robert Puchalski, MD Frederic A. Pugliano, MD Gregory W. Randolph, MD John S. Rhee, MD. MPH1 Brent E. Richardson, MD Eben L. Rosenthal, MD1 Michael A. Rothschild, MD Ron Sallerson Thomas A. Salzer, MD Robert T. Sataloff, MD, DMA James E. Saunders, MD¹ B. Todd Schaeffer, MD Cecelia E. Schmalbach, MD Seth R. Schwartz, MD, MPH Merry E. Sebelik, MD Michael Setzen, MD Ryan K. Sewell, MD Rahul K. Shah, MD Lee M. Shangold, MD John J. Shea, Jr., MD Paul F. Shea, MD Clough Shelton, MD William H. Sher, MD Michael R. Shohet Stanford M. Shoss, MD Steven D. Shotts, MD Richard V. Smith, MD Gary M. Snyder, MD Robert J. Stachler, MD J. Gregory Staffel, MD Wendy B. Stern, MD John P. Sugrue, MD Gerald D. Suh, MD Fred F. Telischi, MD David J. Terris, MD Charles B. Tesar, MD Evan J. Tobin, MD James S. Toung, MD Christopher L. Vickery, MD Michael C. Vidas, MD Eugenia M. Vining, MD Richard W. Waguespack, MD¹ Marilene B. Wang, MD Manish K. Wani, MD Mark K. Wax, MD* Julie L. Wei, MD Samuel B. Welch, MD, PhD W. Andrew Wells, MD Donald V. Welsh, MD Steve West, MD Stephen J. Wetmore, MD Gayle E. Woodson, MD Douglas L. Worden, MD¹ Eiji Yanagisawa, MD Stanley Yankelowitz, MD Kathleen Yaremchuk, MD¹ John K. Yoo, MD Bevan Yueh, MD, MPH Lauren S. Zaretsky, MD¹ Karen B. Zur, MD Young Physician  Members Meredith E. Adams, MD Nadir Ahmad, MD Kyle P. Allen, MD, MPH Christina Baldassari, MD Margo M. Benoit, MD Nathan A. Deckard, MD Jayme R. Dowdall, MD Charles S. Ebert, Jr., MD, MPH Tamer Abdel-Halim Ghanem, MD, PhD Ayesha N. Khalid, MD Oleg V. Kravtchenko, MD Alf Bjarne R. Lilleaas, MD Jeffrey C. Liu, MD Amber U. Luong, MD, PhD Kelly Michele Malloy, MD Nikhila P. Raol, MD Sarah L. Rohde, MD Marisa A. Ryan, MD Jennifer Setlur, MD Ryan K. Sewell, MD Lawrence M. Simon, MD Michael C. Singer, MD Lee P. Smith, MD Maria V. Suurna, MD Monica Tadros, MD Jonathan Y. Ting, MD Julie L. Wei, MD Eric P. Wilkinson, MD Erika A. Woodson, MD Jay A. Yates, MD Estelle S. Yoo, MD Nina S. Yoshpe, MD Philip B. Zald, MD Staff Members Anonymous Paul Bascomb Jean Brereton, MBA David Buckner Lani Cadow Mary Pat Cornett, CAE, CMP Nancy D’Agostino Brenda Hargett, CPA, CAE Jenna Kappel, MPH, MA Thomas Killam, CAE Estella Laguna Kathy Lewis Catherine R. Lincoln, CAE, MA (Oxon) Heather McGhee Jeanne McIntyre, CAE Mary McMahon, CFRE David R. Nielsen, MD¹ Ross Rollins Ron Sallerson Audrey E. Shively, MSHSE, MCHES, CCMEP Joy L. Trimmer, JD Pamela S. Wood, MBA, SPHR As of October 9, 2013 ¹ designates current Board of Director member * designates Development Committee member
Dr. Nikhil Bhatt introduces Dr. Eiji Yanagisawa during the reception.
2013 Annual Report: Sustainability
Individual Giving Hits New Heights Under the leadership of Nikhil J. Bhatt, MD, Coordinator for Development, the Development Unit has actively worked to increase individual giving to the Foundation. The members of the Development Committee have engaged in promoting the work of the Academy and Foundation and have been instrumental in opening doors and making introductions to potential new donors. The Unit instituted new activities in order to achieve its goals. Champagne Reception: A donor stewardship and cultivation event was held during the AAO-HNSF 2013 Annual Meeting & OTO EXPOSM. The purpose of the Champagne Reception was to thank donors giving at the highest levels and to encourage active Academy members to upgrade from general Millennium Society member donations ($1,000) and move into the ranks of those contributing at the highest tier of philanthropic giving. This inaugural event was successful with multiple participants donating to the Millennium Society. Plans are already under way for next year’s Annual Meeting. Young Physician Leadership Grants: The Development Committee determined that successfully obtaining Hal Foster, MD Endowment or Millennium Society Life Member gifts in the future requires engaging our young physician members now. This demographic is defined as those members eight years out of residency or fellowship training and up to 40 years old. To support this goal, three Young Physician Leadership Grants were provided for this year. Each were given as two $500 travel stipends to be applied equally to help with the expenses of attending the AAO-HNSF 2013 Annual Meeting & OTO EXPOSM and the 2014 Leadership Forum. The three grantees attended various committee meetings at the Annual Meeting and have plans to become more engaged in the Academy/Foundation. The plan is to expand upon this program for FY15. Gifts from Individuals: $323,000 Millennium Society: The Development staff has been engaged in an effort to secure Millennium Society giving in FY 2013. The focus continues to fully engage the Board, as well as the Development Committee, in soliciting Millennium Society support. Development Committee members have contacted donors who have lapsed in their giving and encouraged their renewed support. As we close the books on the AAO-HNSF 2013 Annual Meeting & OTO EXPOSM, we have 428 confirmed Millennium Society members. Partners for Progress Participation: The Partners for Progress program continues to be an important source of our annual fundraising success. See the current Partners for Progress partners listing. As a forum for the exchange of information, Partners for Progress members have participated in conference calls with members of the AAO-HNSF staff leadership on a bi-monthly basis. At the Partners for Progress Annual Roundtable, members are provided the opportunity to network in person. HAL FOSTER ENDOWMENT GROSS Hal Foster, MD Endowment: Hal Foster donations are still being actively pursued. We are working to increase the number of prospects in the pipeline and close on some of the potential donors who have expressed an interest in the last few years, but have not yet made a commitment. On September 1, Steve Church of Creative Financial Concepts, Inc., became our referring agent for planned giving. Total Hal Foster, MD  Endowment                      $10,340,000 Hal Foster, MD Endowment Significant Gifts Received This Year Planned Gifts-Life Policies $287,000 Planned Gifts-Bequests $614,000 Paparella  Distinguished Award  Endowment $160,000 Byron J. Bailey, MD and Margaret Bailey Humanitarian Travel Grant Endowment $50,000 Harry McCurdy, MD Resident Leadership Endowment $25,000 Women in Otolaryngology Endowment $14,600 Diversity Endowment $6,775 Harry Barnes  Society Endowment $6,050 Total Endowment Gifts FY13 $1,163,425
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2013 Annual Report: Getting Recognized For Your Academy Engagement
International Engagement Coordinator for International Affairs, Gregory W. Randolph, MD, reports that roughly 10 percent (and growing) of the Academy’s membership is from outside of the United States, with the largest representation from Canada, Brazil, Japan, Germany, Mexico, Portugal, and the United Kingdom. Engagement opportunities for our International members include writing opportunities for the Bulletin and Journal, as well as attending regional caucuses around the world. This past year saw enhanced communications between the Academy and its 54 International Corresponding Societies Network. The Academy welcomed its four guest countries to the Annual Meeting—Canada, Kenya, Nigeria, and Thailand. And for the first time, the Academy featured a popular Latin America Webcast at the Annual Meeting that attracted hundreds of participants from more than 16 countries, and convened its first International Assembly, which was well attended. Through the International Visiting Scholars (IVS), the Academy offers a limited number of scholarships to junior academics from developing countries.   In addition, there are scholarships from Indian ENTs (Indian IVS), a Latin American ENT (de la Cruz IVS) a woman ENT (Nancy L. Snyderman, MD, IVS), and others specifically designated. This year, 12 International Visiting Scholarships were awarded. Get Involved: Get the Recognition You Deserve! The Academy’s Honor Awards program is our way of recognizing meritorious service to members. These are earned through your engagement in Academy activities. Through this program, this year 54 members were recognized with an Honor Award, and 20 members were presented with the Distinguished Service Award. Many other awards and recognition are prevalent as you engage with the Academy. Our committees strive for excellence. This year, three committees were recognized for being “model committees” for their outstanding performance, leadership, and commitment to the goals and mission. Those committees were Allergy, Asthma, and Immunology Committee; Geriatric Otolaryngology Committee; and the Women in Otolaryngology Research and Survey Committee.
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2013 Annual Report: Special Interest and Standing Committees
With more than 70 special interest and Academy standing committees, there are hundreds of opportunities to become involved as has Board member and Ethics Committee Chair, Lauren Zaretsky, MD, for example. On November 1, the call for committees was made available to members. This allows all members an equal opportunity to indicate their desire to become involved in the future of the Academy for the 2014 committee year. New resources are being launched to make involvement easier and more effective. Development is under way for a new member engagement web portal to make involvement in committees and Academy activities much more convenient for everyone involved. Humanitarian Efforts Engaging in the Academy is not only done at home. Huge contributions can also be made abroad through surgical missions, visits to teach newer surgical technologies (e.g., endoscopic sinus surgery), or research efforts to understand the scope of ENT diseases in developing countries. Awards and recognition is well deserved through our members’ commitment to Humanitarian efforts. This year, the Academy’s Distinguished Award for Humanitarian Service was awarded to James E. Saunders, MD, in recognition of his exemplary life-long dedication to the otologic and hearing healthcare for patients worldwide, particularly those in Nicaragua, and for the education and training of a generation of otolaryngology staff and residents in ear surgery. In addition, 29 Humanitarian Travel Grants were awarded to residents and fellows-in-training in 2013 to offer services in 15 less-developed countries. In addition to the grants, this year the awardees had the opportunity to provide educational tools and other “members-only” materials from the Academy to train their colleagues in these countries. Women in Otolaryngology (WIO) Section Created in 2010, the WIO Section offers women otolaryngologists the opportunity to strengthen their career support systems and skills through networking events, professional development, and mentoring programs. As with the SRF Section, all women who are members of the Academy are automatically members of the WIO Section. Through its leadership infrastructure, there are ample opportunities for members to demonstrate their leadership abilities and influence the Academy’s future. This year, the Section initiated and increased networking for Women in Otolaryngology via electronic and written communications, programs and speakers. Christina Surawicz, MD, was well received as the guest speaker at the WIO General Assembly in Vancouver, addressing issues of importance to women in leadership positions. More than 250 members attended the event—a record crowd. Specialty Society Advisory  Council (SSAC) SSAC is vital to the Academy as it serves as a conduit for improved communication and identification of shared opportunities for the Academy and the otolaryngology specialty societies. This past year, SSAC, led by Albert L. Merati, MD, made some changes to its Governing Articles, now providing for a two-year term for its chair, which will enhance the effectiveness of the council and provide consistency in strategy.
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2013 Annual Report: Getting Involved Means Increased ROI
Maximize Your Membership: Increased Involvement        Last year, we reported on a new campaign to gain participation in Academy activities. The “Maximize Your Membership” campaign continues to be a strong umbrella and theme for all of our member engagement activities. By getting involved, members realize more ROI from their membership, while supporting the goals and strengthening the mission of the Academy. In 2013, more than 1,300 of our members served on education, clinically focused, or other committees of interest, including the Board of Directors (BOD), Board of Governors (BOG), Section for Residents and Fellows-in-Training (SRF), and the Women in Otolaryngology (WIO) Section. These opportunities to get involved are exclusive member benefits and are designed to fit any level of participation, from face-to-face networking opportunities to virtual activities. New! Young Physician’s Section (YPS) At its meeting in September, the Academy’s Board approved the application for section status presented by the Young Physician’s Committee. Recognizing that a physician leaving a residency program is in the “start-up” phase of his or her career with challenges unique to that period of career development, this newly created section will allow a multitude of opportunities for young physicians (defined as younger than 40 or within the first eight years of professional practice following a residency and fellowship training) to get involved in leadership. Three new Young Physician’s Leadership Grants were awarded this year—valued at $1,000 each! Watch for even more exciting new opportunities to become engaged in the Academy as this Section and its leadership infrastructure unfolds. Section for Residents  and Fellows-in-Training (SRF) All Academy resident members and fellows-in training are automatically members of this section. Its leadership infrastructure supports and provides a voice into the Academy’s strategy and programming. Additionally, the SRF provides its members with ample opportunities to get involved and receive grants and other financial assistance. In 2013 alone, 120 Resident Leadership Grants were awarded for the Academy’s 2013 Annual Meeting in Vancouver. Board of Governors (BOG) Chaired in 2013 by Denis C. Lafreniere, MD, the BOG serves as an advisory body to the Board of Directors (BOD) and the AAO-HNS membership. It consists of local, state, regional, and national otolaryngology–head and neck surgery societies, with a leadership infrastructure that advises the BOD. This year, the BOG created a regional infrastructure based on the 10 HHS regional areas to enhance its effectiveness and responses to legislative and advocacy needs, creating increased opportunities for involvement at the state and local level. In addition, the BOG has continued and strengthened its strong representation in all parts of the Academy’s Guidelines process, and has spearheaded an ongoing discussion regarding possible future sub-certification in Pediatric Otolaryngology.
These AcademyU® “elements” guide members to education options.
2013 Annual Meeting: AcademyU®: All the Elements for Easy Access to Education and Knowledge Resources
The AAO-HNS Foundation’s continuing professional development program has always offered rich and diverse resources covering a variety of topics organized by the eight specialties within otolaryngology-head and neck surgery. The diversity of offerings provided by the Foundation has made it challenging for busy practitioners to quickly find what they need. To meet this challenge, the program has been rebranded as AcademyU®, Your Otolaryngology Education Source. The resulting AcademyU periodic table provides an easy way for members to access all the Foundation’s education and knowledge products. The “elements” provide access to each learning resource. Similar to the chemical elements in the periodic table, each element is also grouped with others of a like type. In the case of the AcademyU periodic table, the groupings include live events, subscriptions, online courses and lectures, eBooks, and knowledge resources based on the formats that appeal to the diverse education needs and learning styles of members. AcademyU® is the window into all the education opportunities available to you as a member of the Academy. Visit www.entnet.org/academyu to view a complete description of all our education resources, whether they are online courses, eBooks, subscription products, live events, or knowledge products. You can easily subscribe, register, download, or log onto each of these activities through this single portal. AcademyU® brings you hundreds of education resources covering a variety of topics. In addition to improving online access, Education Opportunities, a special insert to the December 2012 Bulletin, offered an easily accessible and comprehensive look at all of these resources. Bulletin articles throughout 2013 provided more detailed descriptions of each of these products. Improving access to Annual Meeting & OTO EXPOSM resources received considerable focus this year.  The online Itinerary Planner allowed attendees to search and read details about the program, committee meetings, evening and satellite events, and much more in the months leading up to the event. The annual meeting website offered a robust amount of information on education offerings, networking, and exciting opportunities taking place during the meeting. The Final Program, provided in advance online, in addition to onsite, included color-coded education tracks. The annual meeting mobile app for the iPhone, Android, and iPad included detailed session information, your personal schedule, an interactive Vancouver Convention Centre map, an exhibitor list including booth number, a link to the OTO EXPO floor plan, instruction course handouts, CME/CE evaluation site, and the Otolaryngology-Head and Neck Surgery journal. The education and annual meeting leadership and staff see these improvements as just a step toward even greater accessibility in the future to the essential otolaryngology resources created by members for members.
Nancy L. Snyderman, MD, receives a plaque following her presentation of the John Conley, MD Lecture on Medical Ethics from James L. Netterville, MD 2012/2013 AAO-HNS/F President.
2013 Annual Report: Annual Meeting & OTO EXPOSM
The Annual Meeting & OTO EXPO℠ continues to be the largest otolaryngology meeting in the world and a significant destination for head and neck surgeons, researchers, healthcare providers, and educators worldwide. In its 117th year, the Annual Meeting remains the most influential and well-attended meeting for otolaryngologists. Attendance approached 8,000 and reached a high of more than 2,600 international attendees from more than 80 countries. The 2013 Annual Meeting & OTO EXPO focused on the latest basic and clinical science related to otolaryngology. Beginning with a heartfelt presentation by Nancy L. Snyderman, MD, presenter of the John Conley, MD Lecture on Medical Ethics, the conference included more than 1,100 speakers along with almost 500 original research poster presentations. The exhibit hall alone hosted more than 200 commercial companies. Beyond the tried and true, this year’s Scientific Program featured some new and exciting additions to its core evidence-based education programming including several new miniseminars on management of obstructive sleep apnea, new detection and imaging methods in otology and cancer, as well as important updates on healthcare legislation from the Board of Governors. Furthermore, this year attendees had the opportunity to view all scientific posters online at a kiosk located in the poster hall or through the annual meeting mobile app. Poster presenters and attendees also enjoyed breakfast Tuesday morning in the poster hall. The oral presentations received a face-lift this year. In response to comments we received from oral presenters and previous year attendees, select oral presentations were given in a new, accelerated format that consisted of a three-minute oral presentation and two-minute discussion. Capitalizing on the huge success of the two Clinical Fundamentals instruction courses presented at the 2012 Annual Meeting & OTO EXPOSM in Washington, DC, eight additional Clinical Fundamentals instruction courses were included on the 2013 program. These courses, along with a three-hour General Otolaryngology Review Course, were designed to meet the American Board of Otolaryngology’s Maintenance of Certification requirements for Clinical Fundamentals (Part II) and were also eligible for AMA PRA Category 1 Credit™. The AAO-HNSF would like to extend a special thanks to the Program Advisory Committee, led by Eben L. Rosenthal, MD, and the Instruction Course Advisory Committee, led by Sukgi S. Choi, MD, for their leadership, commitment to professional growth, and innovation. 2013 Annual Meeting & OTO EXPOSM 89                   Miniseminars 357                 Instruction Courses 322                 Oral Presentations 236                 Exhibiting Companies 1,070              First-time Attendees 27.5                Continuing Medical Education Credits available for each physician 30,698          Continuing Medical Education Certificates awarded to Annual Meeting Attendees 3,528             Installations of the Annual Meeting Mobile App
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2013 Annual Report: 2013 Continuing Professional Development Gap Analysis and Needs Assessment Initiative
Beginning in late 2012 and throughout 2013, the Foundation embarked on an ambitious initiative to collect and analyze gap analysis and needs assessment data to provide direction for the future of the Foundation’s continuing professional development function. Under the leadership of Sonya Malekzadeh, MD, and the Education Steering Committee, AAO-HNSF education committees, residency program directors, Academy members, and current residency education activity participants, and staff contributed to this Academy-wide effort. The assessment identified perceived practice gaps and education needs in order to plan more focused education activities. Data gathering included not only critical course topics, but also education design and format, as well as types of media best used to educate the members. This was an all-encompassing investigation that measured all Foundation education activities, including the Annual Meeting & OTO EXPOSM, on various levels to ascertain how the members need and want to engage in lifelong learning. The assessment is expected to become a biennial event. Members of the eight education committees examined current products and programs through a comprehensive needs assessment and SWOT analysis. Members furthered this effort by completing a member-wide education survey addressing their current continuous professional development needs and requirements. Additional surveys gathered data from program directors, medical school academic residency directors, and leaders in the use of simulation in otolaryngology residency training. Lastly, each education product was specifically evaluated by individuals who had directly participated in the activity. This robust data product will provide the AAO-HNS Foundation with the information and ability to revamp and revitalize its education offerings. The Foundation’s education leadership now has essential information for the next education planning cycle, valuable insight for longer-term planning, and required information for our 2015 ACCME reaccreditation preparation. The initiative is also a model for future years’ efforts to continually identify members’ gaps in practice, assess members’ education and training needs, and engage members in the ongoing initiative to impact lifelong learning and patient outcomes in a meaningful way. The outcome objectives of this initiative were to: Develop an action plan to improve the member education experience. Design education activities that meet the clinical needs of our members. Increase member involvement in and satisfaction with education offerings. Enhance member knowledge, competence, and skill in practice of otolaryngology-head and neck surgery. Through this initiative, three critical themes emerged:  Need for awareness of the breadth and depth  of the Foundation education offerings. Need for engagement to encourage  utilization and participation in education activities by both members and nonmembers. Need  for high quality of education activities.
2013 Annual Report: Education and Knowledge
The AAO-HNS Foundation enhances the quality of ENT patient care as the premier source of otolaryngology-head and neck surgery education and knowledge resources. Education activities address gaps in care and improve the knowledge and competence of otolaryngologist-head and neck surgeons, residents, medical students, non-otolaryngologist physicians, allied healthcare professionals, and the public. 2013 was a year of assessment and improvement—with a continued focus on essential education and knowledge resources—to ensure relevancy and value in the changing healthcare field. The ability to assess our current situation and measure future change is essential to strengthen the impact and effectiveness of the AAO-HNS Foundation’s continuing professional development (CPD) program. Significant progress was made in 2013 toward consolidating and enhancing the otolaryngology practice gap analysis and needs assessment process as enhancements to the Foundation’s data-driven education planning process. “2013 Continuing Professional Development Gap Analysis and Needs Assessment Initiative” highlights the results of a year-long, Academy-wide initiative to determine how members receive knowledge now, and how that will change in the future. The new survey will be a biennial event, so that member participation in the data collection process will provide an ongoing measure of member needs in regard to  education and performance improvement. The development of the next generation of otolaryngology education and knowledge resources requires a commitment to continuous assessment and redesign. In addition to the overall education needs assessment, the Foundation initiated a complete review of the scope and format of the Annual Meeting & OTO EXPOSM. Innovation and improvement continued in the short-term with more than 30 improvements launched at the 2013 annual meeting. “Annual Meeting & OTO EXPOSM” provides highlights of the highly successful event and the new opportunities included. Look for more innovation in the future as a result of feedback and benchmarking of other successful meetings. The measure of success of an education and knowledge resource is not only its quality, but also the degree to which it’s put to use to improve medical practice and patient outcomes. In 2013, the AAO-HNS and its Foundation worked together to increase member awareness and engagement in the generation and use of education and knowledge resources. “AcademyU®: All the Elements for Access to Education and Knowledge Resources” highlights the challenges and results of a complete rebranding, reorganization, and release of tools to support easy access to learning. While the comprehensive review and continuous improvement of all Foundation education and knowledge resources was underway, the Foundation continued to develop activities relating to topics critical to otolaryngology-head and neck surgery patient care. In addition, education resources continue to be developed to support participation in Maintenance of Certification®. The launch this year of 10 Clinical Fundamental live and online courses provided members with direct access to required MOC Part III activities. Supporting education to facilitate the use of Clinical Practice Guidelines in practice and the development of a comprehensive curriculum for otolaryngology are also top priorities already in progress. Always mindful of the importance of good stewardship, the Foundation has actively pursued opportunities to collaborate with others in the development and distribution of education resources that extend our capabilities to deliver high quality products. The revisioning of the Foundation’s education and knowledge resource offerings is always of key importance—but never more so than in this critical time of rapid and widespread change in healthcare, medical education, certification, licensure, and regulation. The Foundation’s Board, the members of the Board’s Science and Educational Committee, and the three board members directly charged with managing the education, scientific program, and instruction course program—Sonya Malekzadeh, MD, Eben L. Rosenthal, MD, and Sukgi S. Choi, MD—and members of their respective committees are reaching out to engage the membership in ensuring that the Foundation remains the premier source of otolaryngology-head and neck surgery education and knowledge resources.
2013 Annual Report: Filling the Research Gaps through CORE
Each of the AAO-HNSF clinical practice guidelines includes a section entitled “Research Needs.” Discussing topics with limited evidence allows guideline developers to highlight future research needs and suggest how to best fill existing gaps. In an effort to start studying gaps that have been identified, the AAO-HNSF Outcomes Research and Evidence-based Medicine Committee worked closely with a group of CORE grant program leaders during the past year to revise the Maureen Hannley Research Grant criteria. This grant mechanism now offers special consideration to investigators who target known evidence gaps within their project proposals. It also provides investigators the opportunity to utilize the CHEER network to engage both academic and community sites in their proposed study. Milan R. Amin, MD, of New York University was awarded the 2013 Maureen Hannley Research Grant. Dr. Amin’s application proposes a Level 1 study that will address the evaluation and treatment of hoarseness in patients. This evidence gap is referenced specifically by the Hoarseness (Dysphonia) Clinical Practice Guideline: “The recent Clinical Practice Guidelines (CPG) for Hoarseness put forward by the AAO-HNSF pointed out several major deficiencies in the evidence base related to the evaluation and treatment of patients complaining of hoarseness. One of these deficiencies is the use of steroids for the treatment of patients with these complaints.” Dr. Amin will study the comparative effectiveness of steroids in speeding and enhancing the recovery of non-surgically treated vocal fold lesions. He proposes a randomized clinical trial comparing patients who undergo traditional voice therapy for the treatment of phonotraumatic vocal fold lesions and those who undergo combined modality therapy incorporating the use of steroids prior to the initiation of voice therapy. He hypothesizes that the use of pre-therapy steroids will hasten and enhance the efficacy of traditional voice therapy and that steroid treatment alone will have a positive effect on voice outcomes.
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2013 Annual Report: AAO-HNSF Joins Choosing Wisely®
The Patient Safety Quality Improvement (PSQI) Committee led the AmericanAcademy of Otolaryngology—Head and Neck Surgery Foundation participation in the Choosing Wisely campaign to identify a list of “Five Things Physicians and Patients Should Question.” The AAO-HNSF and 16 other societies released their lists at a press conference on February 21, 2013. The AAO-HNSF‘s list of recommendations was carefully selected after a review of the current evidence that included AAO-HNSF clinical practice guidelines. Each list includes language communicating when a particular test or treatment may be appropriate based on the current clinical evidence. Consumer Reports, along with a coalition of consumer partner organizations, is also a part of the Choosing Wisely effort and is working with many of the societies to help patients understand the tests and treatments that are right for them. In addition to participating in the press conference, a commentary article on Choosing Wisely appeared in the April 2013 edition of Otolaryngology-Head and Neck Surgery. For more information visit http://www.entnet.org/choosingwisely. The AAO-HNSF’s List of Five Things Physicians and Patients Should Question: Don’t order computed tomography (CT) scan of the head/brain for sudden hearing loss. Don’t prescribe oral antibiotics for uncomplicated acute tympanostomy tube otorrhea. Don’t prescribe oral antibiotics for uncomplicated acute external otitis. Don’t routinely obtain radiographic imaging for patients who meet diagnostic criteria for uncomplicated acute rhinosinusitis. Don’t obtain computed tomography (CT) or magnetic resonance imaging (MRI) in patients with a primary complaint of hoarseness prior to examining the larynx.
The AAO-HNSF Guideline Task Force (GTF) met at the AAO-HNS/F last December in one of two in-person meetings held annually to present new products to the leadership and vet and prioritize new topics.
2013 Annual Report: Enhancing Dissemination, Education, and Implementation of Guidelines
With the increased interest in clinical practice guidelines, the AAO-HNSF made a commitment to incorporating dissemination, education, and implementation into our strategic plan this year. We have focused efforts on ensuring that the guidelines are widely disseminated, including development of tools to promote education about the guidelines and strategies to assist with the implementation of the new guidelines. Historically, the AAO-HNSF has published its guidelines in Otolaryngology—Head and Neck Surgery, working with Editor, Richard M. Rosenfeld, MD, MPH, and presented them to our members at the AAO-HNSF Annual Meeting & OTO EXPO℠. Thinking beyond our own specialty, we are now reaching out to external organizations to promote AAO-HNSF guidelines. For example, we are engaging in discussions with the AmericanAcademy of Pediatrics to present our pediatric focused guidelines at their 2014 annual meeting and on their website. The goal is to bring awareness to non-otolaryngologist physicians about our guidelines and ultimately improve the quality of care for the patients we treat. Two online lecture series were recorded at the AAO-HNSF 2013 Annual Meeting & OTO EXPO℠ for the Tympanostomy Tubes and Bell’s Palsy guidelines. These new learning modules are available to members and offer CME. Evidence-based healthcare is a combination of best research evidence and the expertise of the healthcare provider and also takes into account patient values. With this in mind, the AAO-HNSF began including consumers trained in evidence-based medicine on its guideline panels two years ago. This year, we have broadened efforts to engage consumers by developing plain language summaries for our guidelines. Using the expertise of the AmericanAcademy of Neurology and the Cochrane Colloquium, our first plain language summary targeted to consumers was released alongside the Clinical Practice Guideline: Bell’s Palsy in November 2013. Through the Creating Healthcare Excellence through Education and Research (CHEER) network, based at the Duke Clinical Research Institute and funded by the National Institute on Deafness and Other Communication Disorders (NIDCD), we are assessing awareness of and barriers to implementation of the clinical practice guidelines. Results from these studies will help us understand what tools will need to be developed in the future to assist our members and non-otolaryngologist practitioners with implementing clinical practice guidelines.
Drs. Reginal Baugh, Lisa Ishii, and Gregory Basura presented during the 2013 Annual Meeting.
2013 Annual Report: Research and Quality
To further research and quality improvement in the field of otolaryngology, our goal is to empower physicians to provide the best patient care through the development of evidence-based clinical practice guidelines. We look to identify, promote, and address the key research questions and disseminate discoveries for advancement in our field and to fundamentally improve patient outcomes. This year, with coordinator John S. Rhee, MD, MPH, we have progressed to meet these strategies: Build a sustainable infrastructure to test, pilot, and promote adoption of research and quality products such as guidelines, measures, and evidence-based medicine to promote translational research. Build and promote a strong research-granting program for the specialty. In addition, the first clinical practice guideline developed by the AAO-HNSF, Acute Otitis Externa, has been updated and will be published in February 2014. The AAO-HNSF has spent the past two years working to update its processes to ensure compliance to the 2011 Institute of Medicine report entitled Clinical Practice Guidelines We Can Trust and the 2012 publication of the Guidelines International Network: International Standards for Clinical Practice Guidelines. As a result, the third edition of the Clinical Practice Guideline Development Manual: A Quality Driven Approach for Translating Evidence into Action was updated to document the AAO-HNSF compliance to these new standards and published in January 2013. The AAO-HNSF published five new quality knowledge products: Clinical Consensus Statement: Appropriate Use of CT for Paranasal Sinus Disease  (November 2012) Clinical Consensus Statement: Tracheostomy Care  (January 2013) Clinical Practice Guideline:  Improving Voice Outcomes after Thyroid Surgery  (June 2013) Clinical Practice Guideline: Tympanostomy Tubes in Children (July 2013) Clinical Practice Guideline: Bell’s Palsy  (November 2013) Clinical Practice Guideline: Acute Otitis Externa  (February 2014)
U.S. Representative Paul Tonko (NY-20) visited Albany ENT & Allergy Services
2013 Annual Report: Academy Success with Changing Private Payer Policies
At AAO-HNS, we believe that one of the greatest member benefits is the support and advocacy at the national and regional levels to aid members in resolving issues with private payers. This includes concerns with coverage policies that may be overly restrictive or are not in line with the otolaryngology community’s agreed upon standard of care. In 2013, the AAO-HNS successfully obtained positive revisions to coverage policies with national payers, including Aetna (see highlight of success story below), Coventry, WellPoint, and United HealthCare. AAO-HNS Achieves Revisions to Aetna Policy on Rhinoplasty and Septoplasty As a result of hearing from members who were receiving denials from Aetna based on their medical coverage policy on septoplasty and rhinoplasty, the AAO-HNS coordinated with the AmericanAcademy of Facial Plastic and Reconstructive Surgery (AAFPRS) to submit comments in March regarding their criteria. Shortly after submitting comments, the Aetna National Medical Director, James Cross, MD, accepted our request to hold a conference call with him and other Aetna leaders to discuss concerns. After a collegial conference call with physician and staff representatives from the Academy and AAFPRS in May, Aetna revised its Clinical Policy Bulletin on Septoplasty and Rhinoplasty.   Among other changes, Aetna accepted Academy recommendations to change the minimum required time frame for medical therapy prior to performing a rhinoplasty and septoplasty from three months to four weeks. In addition to these specific revisions, many resources available to members to use in response to payer denials at the local and state level were updated in 2013. These include: CPT for ENT coding articles; Template payer appeal letters; Clinical Indicators; and Position Statements. The Academy continues to track these and other issues affecting members nationally and encourages members to email us at healthpolicy@entnet.org if experiencing issues. I-GO Summer Kickoff a Success To help strengthen the voice of the specialty, the Academy launched its In-district Grassroots Outreach (I-GO) program this summer. The goal is to engage members with their state and federal officials at home in their legislative districts. This helps Academy members to have their voices heard more frequently without the need to travel to Washington, DC, and, it provides legislators with a helpful resource at home. With the dedication, assistance, and leadership of AAO-HNS members during the Congressional August recess, the launch of the Academy’s I-GO program was a success. Several members hosted private practice visits for their Members of Congress, providing tours of their facilities, demonstrating the tools of the trade, and introducing them to the hard-working staff essential to running a successful practice. Members without private practices coordinated calendars with their elected officials and met locally in Congressional district offices or at fund-raising events. These local opportunities provided a more personal and relaxed setting for legislators and AAO-HNS members to interact and discuss the Academy’s legislative priorities and their influence on patient care. Interested in participating in an I-GO event? The AAO-HNS Government Affairs team stands ready to assist in scheduling and preparing you for your meeting. Simply email govtaffairs@entnet.org  today!
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2013 Annual Report: New Advocacy Campaign for Residents and Fellows-in-Training
At this year’s AAO-HNSF Annual Meeting & OTO EXPO℠ a new campaign was launched designed to increase Resident and Fellow-in-Training involvement in advocacy-related initiatives. As the future of the specialty, it is essential for Residents and Fellows-in-Training to learn about the Academy’s advocacy efforts and become involved early in their careers. The campaign, which is based on a simple point system, provides Residents and Fellows-in-Training the opportunity to earn points for themselves and their residency programs by participating in various advocacy-related activities that have been assigned specific point values. For example, one point can be earned for “one-click” activities, such as joining the ENT Advocacy Network, following @AAOHNSGovtAffrs on Twitter, friending us on Facebook, or connecting on LinkedIn. These simple actions would accumulate four points with limited effort! Additional points can be accrued by participating in an In-District Grassroots Outreach (I-GO) event or by donating to ENT PAC, the Academy’s political action committee. In addition to the benefit of learning more about the specialty’s advocacy activities and new leadership opportunities, participants can receive “rewards” for their involvement—including an exclusive ENT PAC “Resident/ Fellow-in-Training Investor” T-shirt or special recognition in the semi-annual ENT PAC Investors’ Report. The residency program with the most points in a calendar year will be invited to an exclusive networking event with top Academy Members at the AAO-HNSF 2014 Annual Meeting & OTO EXPOSM. For more information on how to get involved in the campaign and start earning points, email govtaffairs@entnet.org. ENT PAC, the political action committee of  the AAO-HNS, financially supports federal Congressional candidates and incumbents who advance the issues important to otolaryngology–head and neck surgery. ENT PAC is a NON-PARTISAN, ISSUE-DRIVEN entity that serves as your collective voice on Capitol Hill to increase the visibility of the specialty with key policymakers. To learn more about ENT PAC, visit www.entpac.org  (login with your AAO-HNS ID and password). 2013 Advocacy: By the Numbers270       Number of Capitol Hill meetings with key Members of Congress and/or their staff. 92       Number of political events attended to strengthen and/or establish key relationships with federal incumbents or candidates. 26.5        Percent cut to Medicare physician payments that was averted in January 2013. Efforts are under way to permanently repeal the flawed SGR formula and end the yearly “patches.” 248         Number of federal legislators cosponsoring legislation (H.R. 351/S. 351) to repeal the Independent Payment Advisory Board (IPAB). 351         Percent increase in number of followers for the Government Affairs social media tools, such as Twitter, Facebook, and LinkedIn. 1,787      Number of AAO-HNS members who receive timely legislative updates via the ENT Advocacy Network. To sign up, email staff at govtaffairs@entnet.org. 40      Number of regulatory and third-party payer advocacy letters the Academy Health Policy team and 3P prepared and submitted from January 1–December 1, 2013. 19       Number of third-party payer policies reviewed and commented on by Academy committees and 3P from January 1– October 15, 2013. 74      Number of position statements reviewed by Academy committees and 3P.
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2013 Annual Report: Medicare Physician Payment and Quality Initiatives: Academy Achieves Results for Otolaryngology
Examples of key Medicare policy changes achieved in 2013 include:  Acceptance of four Adult Sinusitis measures*  for 2014 Physicians Quality Reporting System (PQRS) reporting; Reduction of number of providers impacted by the value-based payment modifier in CY 2013; Revisions to practice expense inputs related to otolaryngology procedures; and An extension of the Administrative Claims Reporting Option for 2013 PQRS, and more. *For more information, see Segway to Performance Measures on p. 12 It is our hope that members have become accustomed to receiving notification from the Academy when the CMS releases its Medicare Physician Fee Schedule (MPFS) proposed and final rules in the summer and fall of each year. Academy advocacy efforts begin prior to the release of the rules. We seek to influence payment policies and quality initiatives impacting our members by having a seat at the table with high-level policy makers, including face-to-face meetings with CMS representatives. For example, twice this year in April and November, Academy leaders met with the CMS Chief Medical Officer, Patrick Conway, MD, to outline the comprehensive quality initiatives taking place within our specialty. We sought feedback on how we can attain credit in future CMS quality programs for some of these initiatives and outlined how current CMS quality programs could better meet the needs of the specialty. The timing of our face-to-face meetings was essential because they reinforced our written comments, and coincided with the time with which CMS develops policy for the next calendar year. Proposed policies are included in the proposed rule and the public has 60 days to comment (July–August), and make alternative proposals back to CMS on areas of disagreement or concern.  During this time, the Academy staff quickly review thousands of pages of text, analyze data, and draft summaries for Members. To view the Academy’s internal review process, see the timeline below.
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2013 Annual Report: AAO-HNS Engages Congress: SGR Repeal and Payment Reform
The SGR Roller Coaster Ride 2013 was supposed to be “the year” – the year that Congress would finally, and permanently, repeal the flawed Sustainable Growth Rate (SGR) formula used to calculate physician payments under the Medicare program. However, the momentum for repeal ultimately adhered to a rollercoaster-style ebb and flow, with the final outcome regarding passage of SGR-repeal legislation still unknown at the writing of this article. In February, the Congressional Budget Office (CBO) issued a report lowering its projected cost of repealing the SGR formula to $138 billion. As a result, repeal of the SGR, an annually perplexing issue for Congress, was essentially deemed “on sale.” Soon thereafter, the Health Subcommittee of the House Energy & Commerce (E&C) Committee held a hearing to discuss the viability of possible new payment models. While hearings on this subject are not out of the ordinary, its scheduling so early in the legislative year was promising. In the months that followed, physician leaders from 3P and the Ad Hoc Payment Model workgroup, along with staff from the AAO-HNS Health Policy and Government Affairs Business Units, participated in an ongoing dialogue with Committee staff in an effort to develop legislation that would incentivize the delivery of high-quality and efficient healthcare. As part of this effort, the AAO-HNS prepared and submitted five formal comment letters to Congressional Committees. These letters specifically discussed the positive and negative aspects of the proposed framework for SGR repeal, as it related to otolaryngology–head and neck surgery. The letters are available for review at www.entnet.org/advocacy. In July, legislation (H.R. 2810) was formally introduced in the U.S. House of Representatives and was soon unanimously (51-0) passed by the E&C Committee. During the August recess period, lawmakers were to begin the process of identifying “offsets” to finance SGR repeal. However, broader issues like passage of a “Continuing Resolution” to the fund the government and a required increase in the debt ceiling, soon began to overshadow targeted pieces of legislation like H.R 2810. Throughout the fall, those same issues plagued Capitol Hill, and resulted in the first government shutdown in almost twenty years. As a result, many in the physician community began to speculate that the ongoing ideological divide would hamper any additional efforts to advance permanent SGR legislation by year’s end. However, by late October the SGR issue reemerged at the forefront of Congressional talks, as the Senate Finance and House Ways & Means Committees released a new (and bipartisan) framework to repeal the SGR and replace it with a new payment system designed to emphasize and reward  “value” and transition away from a “volume”-based system.  Despite a general coalescence by lawmakers in regard to the “policy” to repeal/replace the SGR, the last, and perhaps greatest, barrier to passage of pending SGR legislation is the identification of the necessary “offsets” to finance the effort. If Congress fails to act in any regard, physicians face a 24.4 percent cut in Medicare physician payments on January 1, 2014.
AAO-HNS Members prepared to meet their respective Members of Congress on Capitol Hill.
2013 Annual Report: Advocacy
As the “Advocacy” arm of the Academy, the Health Policy and Government Affairs Business Units strive to serve as a powerful voice regarding legislative, political, regulatory, health policy, and third-party payer policies. We actively seek ways to increase member awareness of and involvement in these critical advocacy activities and employ a flexible, multi-factor approach to advocate for the interests of otolaryngologist-head and neck surgeons. Specifically, the Advocacy group works to: Enhance our legislative outreach efforts to policymakers to advance our legislative priorities. Increase the general awareness and recognition of the specialty  by the public and patients. Enhance our grassroots activities to recognize and incentivize member involvement in our legislative and political programs. Integrate health policy-specific priorities, using input from the Physician Payment Policy (3P) Workgroup and Coordinators James C. Denneny, MD, for Socioeconomic Affairs, and Michael Setzen, MD, for Practice Affairs, to maintain our visibility and credibility with national representatives regarding socioeconomic and federal regulatory issues. Advocate for appropriate reimbursement and fair policies with Medicare and private payers, providing members with information and guidance on reimbursement issues encountered at the state and local level. In the Advocacy section of this Annual Report, you will find a detailed assessment of how the Advocacy group has worked to achieve these goals throughout 2013.  Notably, the report focuses on our work to permanently repeal the flawed Sustainable Growth Rate (SGR) formula and replace it with a new payment model that incentivizes the delivery of high-quality and efficient healthcare. Other strategic accomplishments included the launch of an In-district Grassroots Outreach (I-GO) program; targeted efforts to increase resident and fellow-in-training involvement in advocacy activities; regulatory advocacy with government agencies such as the Centers for Medicare & Medicaid Services (CMS); and Academy endeavors to obtain positive changes to Medicare and private payer coverage policies for otolaryngology – head and neck surgery procedures.
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2013 Annual Report: Message From Leadership
Accomplishments, Achievements, Opportunities: AAO-HNS/F Each of us has a family, a unit of people we hold dear. But the real sustaining value of a family is to use our talents and abilities to create a better world for them to flourish. Leading by example creates the same spirit of service in them, which builds and enhances the family even more. Wise members of the family continue to find opportunities to bring the extended family back together. They provide a place of community where diverse family members come together, remembering their past, rekindling the spirit of what makes family so important to each of us, and celebrating accomplishments. We, otolaryngologist-head and neck surgeons, are a diverse group of people, representing many countries and many cultures. Yet we are family, with common goals and a common mission. We are a remarkable specialty, made up of remarkable physicians who deliver remarkable care to our patients—in our offices and hospitals and in our communities and the world around us. We don’t always reflect on the influence we have, and can have—individually and collectively—with the accomplishments, achievements, and opportunities that we make and that we leverage. When we do, we come away with a renewed sense of purpose and the knowledge that we have contributed to the tradition and community. As is true of all volunteerism, we gain far more than we give. My colleague and partner this past year, David R. Nielsen, MD, speaks passionately about our small specialty’s proportionately large influence in the world. “It is reassuring to know that we have a seemingly endless supply of talent and inspirational leadership,” he says. “We do it all—federal and state advocacy; education; research; quality improvement and patient safety; health policy; member services; practice management; communications online and through our academic journal; society relations; and superior IT, financial, and executive support for our mission. I applaud you, thank you, and commend you and all our members who work so hard after hours to give back to the specialty and the profession. Your dedication is the key to our success.” In this time of great uncertainty in healthcare, we remain blessed to be doctors, and privileged to serve our patients, in our hometowns or in far-away lands. We must continue to encourage the next generation of physicians, showing them that being an otolaryngologist-head and neck surgeon is both a privilege and an honor. Each year we unite as a community to learn and become even stronger, in order to better serve patients around the world. We are proud to have chosen this remarkable profession, this amazing specialty, and to belong to this incredible organization. The following report illustrates what our AAO-HNS/F has accomplished collectively this year. Most of this work has been done with the guidance of Members who constantly volunteer their time for us all. It has been an honor to represent you and the specialty this past year and I proudly present this Annual Report to record the AAO-HNS/F 2013 accomplishments, achievements, and opportunities. James L. Netterville, MD 2012/2013 AAO-HNS/F President with David R. Nielsen, MD Executive Vice President and CEO
2013 Annual Report: 2012-2013 Board of Directors
Officers President James L. Netterville, MD President-Elect Richard W. Waguespack, MD Secretary/Treasurer J. Gavin Setzen, MD Immediate Past President Rodney P. Lusk, MD Executive Vice President and CEO David R. Nielsen, MD Academy and Foundation At-Large Directors Director–Private Practice J. Pablo Stolovitzky, MD Director–Academic James A. Stankiewicz, MD Director–Private Practice Jerry M. Schreibstein, MD Director–Academic Bradley F. Marple, MD Director–Private Practice Paul T. Fass, MD Director–Academic Michael G. Stewart, MD MPH Director–Private Practice Duane J. Taylor, MD Director–Academic Kathleen L. Yaremchuk, MD Academy Coordinators Coordinator for Socioeconomic Affairs James C. Denneny III, MD Coordinator for Practice Affairs Michael Setzen, MD Chair, Ethics Committee Lauren Zaretsky, MD Coordinator-Elect for Practice Affairs Jane T. Dillon, MD Foundation Coordinators Coordinator for Development Nikhil J. Bhatt, MD Coordinator for Education Sonya Malekzadeh, MD Coordinator for Instruction Course Program Sukgi S. Choi, MD Coordinator for International Affairs Gregory W. Randolph, MD Coordinator for Research and Quality John S. Rhee, MD, MPH Coordinator for Scientific Program Eben L. Rosenthal, MD Journal Editor Richard M. Rosenfeld, MD, MPH Coordinator-Elect for International Affairs James E. Saunders, MD Chair, Ethics Committee Lauren Zaretsky, MD Board of Governors Representatives Chair, BOG Denis C. Lafreniere, MD Chair-Elect, BOG (EC/Non-Voting) Peter Abramson, MD Past Chair, BOG Sujana S. Chandrasekhar, MD Specialty Society Advisory Council (SSAC) Representatives Chair, SSAC Albert L. Merati, MD Academy and Foundation Non-Voting Invited Guests Chair, Women in Otolaryngology Susan R. Cordes, MD Chair, American Medical Association Delegation Liana Puscas, MD Representative, Young Physicians Committee Monica Tadros, MD Chair, Diversity Committee Lisa Perry-Gilkes, MD Chair, Section for Residents and Fellows-in-Training Nikhila Raol, MD AAO-HNS/F Counsel Powers Pyles Sutter and Verville, P.C. Robert M. Portman, Esq.
Year-Long Education Needs Assessment Initiative a Success
Sonya Malekzadeh, MD Coordinator, Education Following a year of education needs assessment, the American Academy of Otolaryngology—Head and Neck Surgery Foundation (AAO-HNSF) is now equipped with meaningful and valuable information to improve and advance the Foundation’s professional education program. We are deeply grateful to those who participated in the process. AAO-HNS education leaders, members, and current activity participants contributed to this broad evaluation. Members of the eight education committees examined current products and programs through a comprehensive needs assessment and SWOT analysis. The membership furthered this effort by completing a member-wide education survey addressing their current continuous professional development needs and requirements. Lastly, each educational resource was specifically evaluated by individuals who had directly participated in the activity. This robust data will provide the AAO-HNS Foundation the information needed to revamp and revitalize its education offerings. The themes of awareness, engagement, and value will be further explored and addressed through strategic planning prioritization, program-specific improvements, and balancing of resources to leverage strengths and improve opportunities. The Education Steering Committee along with the education committees will lead these efforts. In the ensuing months, a series of articles will inform the members of additional assessment findings and actions set forth to increase awareness, improve engagement, and deliver value. This January Bulletin, focused on education, will provide a summary of this year’s accomplishments and future directions. Please stay tuned as we build a professional education program that will meet your needs and exceed  your expectations. Through this assessment, three critical themes emerged: Awareness—enhance understanding of the breadth and depth of the Foundation’s education offerings. Engagement—encourage utilization and participation in education activities by both members and nonmembers. Value—focus on the quality of education activities.
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CPT Changes for 2014: What ENTs Need to Know
Michael Setzen, MD Immediate-Past Coordinator  for Practice Affairs Jenna Minton, Esq. Senior Manager, Health Policy As the medical community has come to expect, part of the annual rulemaking process conducted by the Centers for Medicare & Medicaid Services (CMS) includes the annual issuance of new and modified CPT codes, developed by the American Medical Association’s (AMA) Current Procedural Terminology (CPT) Editorial Panel, for the coming year. In addition, CMS includes new, or updated, values (also known as relative value units (RVUs)) for medical services that have undergone review by the AMA’s Relative Update Committee (RUC). CMS has the discretion to accept the RUC’s RVU recommendations for physician work, and recommendations for direct practice expense inputs, or it may exercise its administrative authority and elect to assign a different value, or practice expense inputs, for medical procedures paid for by Medicare. The final value, as determined by CMS, is then publicly released in the final Medicare Physician Fee Schedule (MPFS) rule for the following calendar year. The Academy is an active participant in both the AMA RUC valuation of otolaryngology-head and neck services, and the CMS annual rulemaking processes. As part of those efforts, we want to ensure members are informed and prepared for key changes to CPT codes and valuations related to otolaryngology-head and neck surgery serviced for CY 2014. The following outlines a list of coding changes, including new and revised CPT codes, as well as codes that were reviewed by the AMA RUC and could have modified Medicare reimbursement values for 2014: New Codes In CY 2014, several new CPT codes will be introduced, including: Two new codes to report flexible, transnasal esophagoscopy (otherwise known as TNE). These services will be reported with CPT codes 43197 and 43198. Six new codes to distinguish between rigid, transoral esophagoscopy procedures and flexible, transoral esophagoscopy. The existing codes will be used to report flexible, transoral procedures, and the new codes CPT 43191-43196 will be used to report rigid, transoral procedures. One new code to report chemodenervation of the larynx for spasmodic dysphonia. This code will replace the previously reported code CPT 64613. Otolaryngologists will now use CPT 64617 to report all injections to the larynx for the treatment of spasmodic dysphonia. Four new speech evaluation codes. These codes are intended to represent evaluation of speech fluency (92521); evaluation of speech sound production (92522); evaluation of speech sound production with evaluation of language comprehension and expression (92523); and behavioral and qualitative analysis of voice and resonance (92524). Codes Reviewed by the AMA RUC In addition to the creation of several new CPT codes for 2014, a number of existing CPT codes relating to otolaryngology were reviewed by the AMA RUC, and their RUC-approved values were submitted to CMS for final determination for the CY 2013 final rule. Members should be prepared for modified relative value units for some, or all, of these procedures in CY 2014. It is critical to note that once the final MPFS is issued by CMS, typically on or around November 1 of each year, Academy health policy staff will summarize the final rule and alert members to any critical changes in reimbursement for any of the following medical procedures. Existing codes that were reviewed in 2013 include: As noted above, health policy staff will provide members with a detailed summary of CMS approved values for the above services once they are issued in the 2014 final MPFS. Should members have any questions regarding the above information in the meantime, please email healthpolicy@entnet.org.
3P Update: Academy Efforts Regarding New Technology
James C. Denneny III, MD Coordinator for Socioeconomic Affairs Co-Chair of Physician Payment Policy Workgroup (3P) Background The AAO-HNS CPT team is responsible for ensuring that there is an accurate descriptor for physician work provided to our patients. This includes revising code descriptions for existing CPT codes as well as submitting applications for new CPT codes where the work is not described in the existing code’s structure. There are prescribed criteria for recommending editorial changes, as well as submitting new code applications. Editorial changes typically do not result in any change to the assigned value of a CPT code, however, a new code will require valuation through the AMA Relative Update Committee (RUC) process, and is subject to final approval by CMS through annual rulemaking. There are two types of CPT Codes, Category I and Category III. Category I codes are “Standard codes,” but do not guarantee insurance reimbursement, and typically have a higher threshold of utilization, literature support, and are a standard of care.  Category III codes are issued for new technologies that have less literature support, may be used for tracking, and are not valued by RUC, but may be paid by insurers. Access our website here for more information on the CPT Editorial Process: http://www.entnet.org/Practice/Applying-for-CPT-codes-and-Obtaining-RVU.cfm. The AAO-HNS has an experienced team on both the CPT and RUC side of the process. The 3P workgroup oversees and coordinates the operations of both the CPT and RUC teams with the assistance of the appropriate AAO-HNS committees.  The combined experience of the members of these teams is more than 50 years. There are two recent examples of how the New Technology Pathway process works which have created interest among our members. 1. New CPT Code for Endoscopic Zenker’s Diverticulotomy Recently, a new CPT code for endoscopic Zenker’s diverticulotomy was created and will be undergoing RUC survey for the January 2014 RUC meeting.  This occurred based on a change in treatment patterns over the last several years for Zenker’s diverticulum. Given that there was not a CPT code that accurately described the work done when an endoscopic approach was utilized; a proposal to create a new code was submitted to the CPT Editorial Panel to accurately describe that work and is likely to appear in the 2015 CPT book. 2. New Technology Pathway Application for Propel® Drug Eluting Stents Additionally, an application was received from IntersectENT through the Academy’s New Technology Pathway process (see: http://www.entnet.org/Practice/Valuing-CPT-Codes.cfm), which requested the creation of a Category I CPT code for the insertion of a drug eluting stent used in the treatment of sinus disease. We commend Intersect ENT for utilizing our prescribed process to present information relating to the use of their device. The 3P group, in conjunction with consultation from the Rhinology and Paranasal Sinus Committee (RPS) and CPT/RVU Committee, reviewed the information submitted by the company over a number of months. We reviewed the literature, had conversations with the company, visited the company’s exhibit at our recent meeting in Vancouver, received instruction in the insertion of the product, and had consultations with a number of rhinologists including those on RPS Committee 3P also met by email, phone and in person multiple times to discuss this issue. Members of the workgroup have been involved in the evaluation of sinus codes since the introduction of endoscopic sinus surgery. This includes the latest two valuations at the RUC. Based on this experience, 3P felt that the work described for the placement of the drug eluting stent in the operating room immediately following sinus surgery is already described and valued in the existing endoscopic CPT codes. In fact, there is a provision in each of these codes for placement of packing, spacers, and medications in the sinus cavities following endoscopic surgery. Surgeons across the country use a variety of materials following endoscopic surgery at the close of the procedure, and some do not use anything. The current work descriptor valued by the RUC includes the placement of these materials, when performed in the intraoperative setting; therefore, we do not feel there is sufficient justification for the creation of a new CPT code in the hospital outpatient setting. This does not prevent the stent, which is FDA approved, from being used. A similar scenario might exist if there were a new packing developed for ear surgery. The work to place the packing is already accounted for in the existing code valuation and positioning this newly developed packing would not be separately reported or reimbursed. 3P, however, felt that there would be a place for a new Category III CPT code relating to the in-office use of this drug eluting stent once evidence of efficacy in the office is demonstrated in the literature. The key will be to define the correct code structure in the context of existing ones and the development of literature to demonstrate adequate support for a Category I code. Thus, 3P recommended that Intersect ENT proceed with a request for a Category III CPT Code. This recommendation was also approved by the AAO-HNS Executive Committee. We also continue to collaborate with ARS leadership, as we have done on other rhinology issues in the past, and we are in communication with them about our decision. Our CPT and RUC teams have developed a very strong reputation for objectivity and accurate valuation of our codes over many years. Our reputation for integrity dealing with the CPT/RUC processes and health policy, in general, is paramount to us as the society representing Otolaryngology in this arena. We will continue to objectively participate in these activities on behalf of our members. For any comments or questions, please contact Dr. Denneny via the Health Policy team at HealthPolicy@entnet.org. ­ AMA Criteria for all CPT codes The proposed descriptor is unique, well-defined, and describes a procedure or service which is clearly identified and distinguished from existing procedures and services already in CPT. The descriptor structure, guidelines and instructions are consistent with current Editorial Panel standards for maintenance of the code set. The proposed descriptor for the procedure or service is neither a fragmentation of an existing procedure or service nor currently reportable as a complete service by one or more existing codes (with the exclusion of unlisted codes).  However, procedures and services frequently performed together may require new or revised codes. The structure and content of the proposed code descriptor accurately reflects the procedure or service as typically performed. If always or frequently performed with one or more other procedures or services, the descriptor structure and content will reflect the typical combination or complete procedure or service. The descriptor for the procedure or service is not proposed as a means to report extraordinary circumstances related to the performance of a procedure or service already described in the CPT code set. The procedure or service satisfies the category-specific criteria set forth below. AMA Criteria for Category I Code All devices and drugs necessary for performance of the procedure or service have received FDA clearance or approval when such is required for performance of the procedure or service. The procedure or service is performed by many physicians or other qualified health care professionals across the United States. The procedure or service is performed with frequency consistent with the intended clinical use (i.e., a service for a common condition should have high volume, whereas a service commonly performed for a rare condition may have low volume). The procedure or service is consistent with current medical practice. The clinical efficacy of the procedure or service is documented in literature that meets the requirements set forth in the CPT code change application. AMA Criteria for Category III Code The procedure or service is currently or recently performed in humans; AND At least one of the following additional criteria has been met: The application is supported by at least one CPT or HCPAC advisor representing practitioners who would use this procedure or service; OR The actual or potential clinical efficacy of the specific procedure or service is supported by peer reviewed literature which is available in English for examination by the Editorial Panel; OR There is; a) at least one Institutional Review Board approved a protocol of a study of the procedure or service being performed, b) a description of a current and ongoing United States trial outlining the efficacy of the procedure or service, or c) other evidence of evolving clinical utilization.
Figure 1, Micrograph Lassa Virus (LV) and Mycobacterium tuberculosis (MT).
Out of Committee: Lassa Fever and Tuberculosis in ENT Practice in Africa
Titus S. Ibekwe, MD, FWAC, University of Abuja Teaching Hospital, Abuja, Nigeria Segun Segun-Busari, MD, FWACS, University of Ilorin Teaching Hospital, Ilorin, Nigeria Tulio A. Valdez, MD, Connecticut Children’s Medical Center, Simsbury, CT Our awareness of a certain pathogen as a possible etiology for an otolaryngological (ENT) problem depends on how prevalent this pathogen is in the region where we practice. In ENT practice in Africa, it is important to be aware of the manifestations of infectious diseases, which may not be as common in other places in the world. Lassa fever (LF) and tuberculosis (TB) are common diseases in Africa with well-known otolaryngological manifestations. Lassa Fever LF is an acute arenaviral hemorrhagic infection transmitted by Mastomys natalensis (multimammate rat) prevalent in West African sub-region. It is highly contagious via the droppings and urine of the host carrier. LF can also be transmitted through airborne particles and contact with body fluids of infected humans. There have been reported cases of nosocomial, hospital-acquired infection, transmission from contaminated medical equipment, and other inanimate objects.1 Lassa virus can generate exaggerated immune responses, involving high titres of IgG and IgM.2 The resultant autoimmune responses culminate in loss of cochlear hair cells during the convalescent phase. Direct invasion of the spiral ganglion may result in the loss of integrity of the vestibulocochlear nerve.3 All these pathogenic processes occur during the acute phase of viral infection resulting in sudden sensorineural hearing loss (SNHL). About 57 percent to 60 percent of patients recover spontaneously during convalescence.4 The mode of presentation of LF is non-specific, hence the difficulty in clinical diagnosis (Table 1). The classical modes of presentation include high-grade fever >38°C, sore throat, retrosternal pain, cough, odynophagia, conjunctivitis, petechial hemorrhages, abdominal pains, vomiting, and diarrhea. Neurological symptoms (tremors, convulsions, meningitis symptoms, etc.) are not commonly present at this early stage, however SNHL is sometimes present. Recent research suggests that early SNHL and other CNS features predict a poor prognostication.5 Diagnosis is commonly made via ELISA (sensitivity 57 percent and specificity 77 percent6) and confirmed by Lassa Virus-PCR. Ribavirin remains the drug of choice for the management of LF and is efficient when commenced within the first week of active infection. Tuberculosis Africa is currently home to 11 percent of the world’s population, however it carries 29 percent of the global burden of tuberculosis cases and 34 percent of related deaths. The World Health Organization (WHO) estimates that the average incidence of tuberculosis in African countries more than doubled between 1990 and 2005, while throughout the world the incidence remained stable or declined.7 Tuberculosis, an aerosol-transmitted communicable disease caused by Mycobacterium tuberculosis (Figure 1), primarily affects the lungs. Extrapulmonary TB involves the ear, nose, and throat, lymph nodes, the brain, kidneys, bones, etc. A single cough can produce 3,000 infectious droplet nuclei.8 The size of the infecting tubercle bacilli and the immune status of the host determine the risk of progression from infection to disease. Hence, HIV infection remains the most common single predisposition to TB. Primary tuberculosis of the external ear is not uncommon. Tuberculosis of the middle ear, usually in coexistence with miliary pulmonary tuberculosis (PTB), is characterized by painless otorrhea, abundant granulation tissue, multiple tympanic perforations, bone necrosis, and severe hearing loss. However, most of our patients present with the first two clinical features. Our experience showed that otogenic complications such as facial palsy and SNHL appear more frequently in tuberculous otitis patients than in cholesteatoma. The laryngeal tuberculosis is a complication of PTB, which develops as infiltrates and curdled disintegration of tubercles presenting as ulcers with pharyngalgia and (cough) tussis. Tussis is not a characteristic attribute of laryngeal tuberculosis as it depends on changes in the lungs. Lesions of the vocal folds manifest as hoarseness, hyperemia, thickening, and infiltration. The changes are mainly present in the posterior third of the folds. There is characteristic ulceration on the superior surface due to pooling of mycobacterium-laden fluid around the arytenoids during sleep. Tubercular involvement of the nose is rare and is usually secondary to primary PTB.9 It is even more rare to see a case of nasal tuberculosis with simultaneous involvement of the lymph nodes without primary involvement of the lungs. Nasal and sinus tuberculosis remains silent and asymptomatic until well advanced. Patients with nasal tuberculosis usually present with nasal obstruction and discharge. Other symptoms include nasal discomfort, epistaxis, crusting, post-nasal drip, ulceration, recurrent polyps, and sometimes eye symptoms from nasolacrimal duct blockage. Nasal tuberculosis occurs in patients older than 20 years and women are affected more than men by a margin of 3:1.10 It is important to consider nasal tuberculosis in differential diagnosis. An outline on the mode of presentation is shown in Table 1. The quest to exclude malignancy may lead to unacceptable delays in treatment. The diagnosis of nasal tuberculosis is based on: histological identification of granulomatous inflammation (Figure1); positive testing for acid-alcohol resistant bacilli; and positive culture. Newer diagnostic tests have the advantage of speed and improved accuracy, but are not as yet completely evaluated for the diagnosis of extra-pulmonary tuberculosis.11 Several standard anti-Koch’s regime have been proposed with duration of therapy ranges between six and 12 months. Acknowledgement: We thank Farrel J. Buchinsky, MD, chairman, Infectious Disease Committee, AAO-HNS, for editing this article and all the members of the committee for their support. References Inegbenebor U, Okosun J, Inegbenebor J. Prevention of Lassa Fever in Nigeria. Trans R Soc Trop Med Hyg. 2010;104(1):51-54. Emmerich P, Günther S, Schmitz H. Strain-specific antibody response to Lassa virus in the local population of west Africa. J Clin Virol. 2008;42(1):40-44. Buchman CA, Levine JD, Balkany TJ. In: Essential Otolaryngology, Head & Neck Surgery. Lee KJ, editor. New York: McGraw-Hill Medical Publishing Division; 2003. Infections of the ear; pp. 462-511. Okokhere PO, Ibekwe TS, Akpede GO. Sensorineural hearing loss in Lassa fever: two case reports. J Med Case Report. 2009; 3: 36. Ibekwe TS, Okokhere PO, Asogun D, Blackie FF, Nwegbu MM, Wahab KW, Omilabu SA, Akpede GO. Early-onset sensorineural hearing loss in Lassa fever. Eur Arch Otorhinolaryngol. 2011;268(2):197-201. Ibekwe TS, Nwegbu MM, Asogun D, Adomeh DI, Okokhere PO. The sensitivity and specificity of Lassa virus IgM by ELISA as screening tool at early phase of Lassa fever infection. Niger Med J. 2012;53(4):196-199. WHO report 2007: global tuberculosis control: surveillance, planning, financing. Geneva: World Health Organization, 2007. (WHO/HTM/TB/2007.376.) Bates JH, Stead WW. The history of tuberculosis as a global epidemic. Med Clin North Am. 1993;77(6):1205-1217. Harries AD, Dye C: Tuberculosis. Ann Trop Med Parasitol. 2006;100(56):41531. Abebe M, Doherty M, Wassie L, Demissie A, Mihret A, Engers H, Aseffa A. TB case detection: can we remain passive while the process is active? Pan African Med J. 2012;11:50. Masterson L, Srouji I, Kent R, Bath AP. Nasal tuberculosis—an update of current clinical and laboratory investigation. J Laryngol Otol. 2011;125(2):210-213.
Academy Advantage Partner AllMeds: 2014 The Year (Just About) Everything Changes … and What to Do Now
By Bob Blakely 2014 will be a watershed year for many ENT practices, and those that prepare now could emerge in excellent shape—especially compared to those that don’t. EHR Incentives: Eligible professionals (EPs) have received $16 billion by meeting Meaningful Use (MU) criteria, but 2014 will present new challenges: In January 2014, Stage 2 of the program will roll out. 2014 is the last year for EPs to begin the Medicare program. To avoid penalties in 2015, EPs must begin meeting MU by July 1, 2014. WHAT TO DO NOW: Find an EHR provider that specializes in serving ENT practices similar to yours and has a proven track record of incentives success. ICD-10: The rollout of ICD-10 codes is around the corner. On October 1, 2014, ICD-10 will provide a fivefold increase of today’s current code-set. The AMA urged “physicians to start educating themselves now.” But, don’t throw out your ICD-9 code books! ICD-9 will continue to be used for worker’s compensation and states may also continue using ICD-9. Most likely, you’ll have to use both standards for some time. WHAT TO DO NOW: Check with your vendors for ICD-10 roll-out plans. Request training that focuses on your commonly used codes, especially those with one-to-many equivalents. HIPAA Updates: As Covered Entities, physicians must secure new agreements with each of their Business Associates (BAs), conduct security assessments, and provide their staffs with clear policies and procedures to ensure protected health information (PHI). WHAT TO DO IMMEDIATELY: Contact your vendors and update all BA agreements. Maintaining Staff Effectiveness: With the introduction of MU2, ICD-10, and HIPAA Updates, practices must spend considerable effort to maintain effective staffs. Billing specialists, in particular, will be heavily challenged to maintain productivity and revenue levels. WHAT TO DO NOW: Leverage professional associations, particularly those providing ENT-relevant assistance, such as AOA and AAO-HNS. Investigate Revenue Cycle Management (RCM) services to outsource critical billing functions to highly specialized consultants. Ask existing vendors if their products are integrated with those of a RCM provider. 2014 will be pivotal for healthcare professionals across the United States, as they work to meet expanding requirements that impact everything from patients to profits. Practices that put processes and people in the right place can find themselves better prepared to weather a challenging 2014. However, now—and not later—is the time to begin making plans for a prosperous new year. About the author: Bob Blakely is the Director of Government Affairs and Marketing at AllMeds Inc., a provider of the most widely used EHR solution to ENTs and other surgical specialties. He has been with AllMeds since 2006, during which he’s authored courses on electronic health record systems, federal EHR incentive programs, and co-created a guide to EHR implementation best-practices. He has worked in the healthcare IT field for 15 years, including stints at Lanier Healthcare™ and MedQuist™.
02_StarReviewers2013
Get Involved with the Journal
During the annual editorial board meeting of the Foundation’s journal, Otolaryngology–Head and Neck Surgery, in Vancouver, BC, Canada, 13 star reviewers were acknowledged for their exceptional performance. The journal has been recognizing these star performers since 2006, and 2013 marked the first two international recipients of the award. This recognition serves as a stepping stone to the journal’s editorial board and associate editor positions, bringing recipients greater responsibility and recognizing achievement. The journal welcomes reviewers from all areas of expertise and stages of career, including residents. It’s now easier than ever to claim CME credits by reviewing for the journal, and reviews completed before October will appear on your official AAO-HNS transcript, emailed in February. Reviewers can earn up to 15 CME credits per year simply by reviewing five journal articles provided the reviews meet accreditation requirements. In addition, reviewers who complete four or more reviews a year are listed in the journal’s January issue. The criteria for becoming a star reviewer are posted on the journal’s brand new reviewer page, http://www.otojournal.org. Many of our star performers, depending on their areas of expertise and interest, go on to be appointed to the journal’s editorial board and then serve as associate editors. Star Reviewer recipients receive: One honor point A ribbon to wear at the Annual Meeting identifying them as a top reviewer Numerous mentions in Academy print and digital media, including the Bulletin, the Meeting Daily, and the Official Program issue of the journal. We took time out of the meeting’s recognition of star reviewers to recognize our first two international recipients, Jacqui Allen, MD, and Eugenia Allegra, MD. 2013 Star Reviewers Lee M. Akst, MD Eugenia Allegra, MD, PhD Jacqui E. Allen, MBChB, FRACS Mark E. Boston, MD Michael Friedman, MD (fifth year) Babak Givi, MD (second year) Helene J. Krouse, PhD, ANP-BC, (third year) Daniel B. Kuriloff, MD Judith E. Lieu, MD (second year) Ho-Sheng F. Lin, MD Sonya Malekzadeh, MD Stephen C. Maturo, MD (third year) Gordon H. Sun, MD, MS And More… The journal’s online presence continues to expand, both in scientific content and tips for authors and reviewers. The new reviewer page now has two videocasts, recorded at prior AAO-HNSF Annual Meetings. The first video, recorded at the 2010 Annual Meeting, covers specifics on how to review a journal manuscript and features Editor-Elect John H. Krouse, MD, PhD; Matthew Ryan, MD, associate editor for general otolaryngology and case reports; and Cecelia Schmalbach, MD, associate editor for head and neck surgery. At the time of the recording, both Dr. Schmalbach and Dr. Ryan were star reviewers for the journal, and both went on to serve on the editorial board and were promoted to associate editors. The second video is another panel discussion, focusing on tips for reviewers. Participants are Mark K. Wax, MD, associate editor for facial plastic surgery, and Dr. Schmalbach. The site also features: Free access to the full text of the article “How to Review Journal Manuscripts,” written by the journal’s editor-in-chief and published in the April 2010 issue of the journal. Suggestions from 2011, 2012, and 2013 top reviewers. The exact criteria used to identify the 2013 recipients. The names of all the journal’s star reviewers since the award was instituted in 2006. An example of a highly rated review. A reviewer application form, which can be downloaded and emailed or faxed to the journal’s editorial office.
The WIO Section Assembly.
2013 Committee Highlights
Committees are the lifeblood of the AAO-HNS/F and a great way for members to contribute meaningfully to the organization and the specialty. At the AAO-HNSF 2013 Annual Meeting & OTO EXPO℠ in Vancouver, BC, Canada, Academy and Foundation committees met and discussed achievements during the past year and planned for 2014. On the following pages are brief summaries of actions taken by many of the committees. To view a list of current committee members, please refer to the November 2013 Bulletin, or visit http://www.entnet.org/community/committees.cfm. To join a committee, visit www.entnet.org/committees and fill out an  application before the February 3, 2014, deadline. STANDING COMMITTEES Audit Committee Kenneth W. Altman, MD, PhD, Chair The audit of the consolidated financial statements for the year ended June 30, 2013, (FY13) was substantially complete at the time of the Annual Meeting and was on track for completion in early October. The audit committee did not meet during the Annual Meeting, but met later in October 2013 to review the audit with staff and the independent auditors. Ethics Committee Lauren S. Zaretsky, MD, Chair Susan D. McCammon, MD, Committee Chair-Elect Susan D. McCammon, MD, was selected as chair-elect, effective October 2013, until she assumes the chair position October 2014. Two of three submitted miniseminars “Exercises in Futility and Off Label Uses of Drugs and Technology” were approved and presented at the 2013 Annual Meeting. The Ethics-based Patient Management Perspectives in Otolaryngology Module was completed and published. The Ethics Maintenance of Certification Instruction Course was completed and presented at the annual meeting. Eleven position statements were reviewed and recommended to the BODs to be reaffirmed, revised, or sunset. Several policies were developed, or revised, and presented to the BODs for approval in conjunction with the implementation of the Code for interactions with companies. Two of the most significant policies are the Financial and Intellectual Relationships Disclosure Policy and the related Resolution Policy. An official rollout of these policies and an online form is expected in the next few months. Additionally in 2014, a new member handbook is expected to be available and it will include member-related policies and guidance. Finance and Investment Subcommittee of the EC (FISC) Gavin Setzen, MD, Chair The FISC worked throughout the year transitioning the managed investment portfolio to the new independent investment advisor, selected by the FISC at the 2012 Annual Meeting, through an RFP process. During spring 2013, the FISC focused on working with staff to develop the FY14 budget, which was approved by the Board of Directors at its meeting in May 2013. On a quarterly basis, the FISC met to review financial statements, forecasts, and budget to actual variances and reviewed the annual audit and report of the Audit Committee. At the 2013 Annual Meeting, the independent investment advisor made a presentation to the subcommittee about the managed portfolios FY13 investment performance and market outlook. Investment performance reports are reviewed and discussed by the FISC quarterly and with the investment advisor at least bi-annually. The subcommittee continues to discuss a strategy for investing the proceeds from the sale of the former headquarters building, which were recently received from the buyer as repayment of a note entered into at the time of the sale. Preservation of principal is essential as the proceeds are intended to reduce debt on the current headquarters building. An updated reimbursement agreement outlining the terms pursuant to which the Academy and Foundation share costs and provide for reimbursement of expenses was endorsed by the FISC and approved by the ECs on behalf of the BODs. Science and Educational Committee Richard M. Rosenfeld, MD, MPH, Chair The Science and Educational Committee capitalized on opportunities for collaboration, advancement, and innovation in the Foundation’s research, quality, education, and knowledge offerings. In 2013, the committee put special emphasis on its role as an advisory body to the Foundation Board of Directors. Focus areas for 2013 included the identification and addressing of performance gaps in otolaryngology, relationship disclosure policies and procedures, and strategic assessment of the full slate of the Foundation’s scientific and educational products. ACADEMY COMMITTEES Airway and Swallowing Committee Joel H. Blumin, MD, Chair The Airway and Swallowing committee sponsored four basic and translational miniprograms as miniseminars at the 2013 Annual Meeting—”Reflux: Pathophysiology to Management;” “Airway: Advances in Management; Voice: From Cells to Song; and Dysphagia: From Science to Clinical Practice.” Two additional miniseminars under laryngology/broncho-esophagology were also presented—Practical Approach to Swallowing Problems and Endoscopic vs. Open Treatment of Laryngotracheal Stenosis. The committee has reviewed five position statements: Foreign Bodies of the Upper Aerodigestive Tract http://bit.ly/foreign_bodies; The Roles of Flexible Laryngoscopy Videostroboscopy http://bit.ly/flexiblelaryng; Fiberoptic Endoscopic Examinations of Swallowing http://bit.ly/fiberendo; Laryngoscopy and Bronchoscopy http://bit.ly/Laryngo_Broncho; Laryngopharyngeal Reflux http://bit.ly/Laryngo_Reflux. The committee continues to work on developing new miniseminar topics, and continues the ongoing discussion of new educational activities. Members of the committee have been active in the international tracheotomy collaborative and are gathering data regarding tracheotomy and developing best practice guidelines. Allergy, Asthma, and Immunology Committee James W. Mims, MD, Chair The committee presented four instruction courses and one miniseminar at the Annual Meeting: “Sublingual Immunotherapy (SLIT): Why and How?” “Skin Testing for Inhalant and Food Allergies” “Pediatric Allergy Update 2013” “Eosinophilic Gastrointestinal Disorders for the ENT” “Food Allergy 2013: State of the Science” Reviewed and updated Allergy and Remote Practice Allergy Policy Statements Reviewed and provided comments on an Aetna Immunotherapy  Policy Change Reviewed and updated “Allergies and Hay Fever” and “Antihistamines, Decongestants, and Cold Remedies” patient leaflets. In a joint effort with AAOA, the committee proposed to the Academy’s Executive Committee to sunset and remove the Allergy Clinical Indicator from the Academy’s website. The motion was approved. Two committee members are serving on the guideline development group for Allergic Rhinitis, which was originally submitted to the guideline task force by this committee. Participated in the development of an AAO-HNSF, AAAAI, and ACAAI joint letter to the FDA in response to their consideration of over-the-counter status for a nasal steroid (Sanofi/Nasacort). Credentials and Membership Committee Pierre Lavertu, MD, Chair The Credentials and Membership Committee is charged with determining eligibility for Academy membership, continuing review of Academy member categories, and developing campaigns to increase membership by making all otolaryngologist-head and neck surgeons aware of the need to support the Academy’s overall mission. At this year’s meeting, the committee discussed working closely with Academy staff on the creation and implementation of new alternatives for increasing the AAO-HNS membership and reinstating non-members and help in our overall efforts to ensure we do not lose members who transition out of residency. Complementary/Integrative Medicine Committee Edmund A. Pribitkin, MD, Chair The miniseminar “Integrative Approach to Atypical Facial Pain and Headache” was presented and supported by the Complementary/Integrative Medicine Committee and the Rhinology and Allergy Education Committee. The committee discussed possible topics for miniseminars for the 2014 Annual Meeting and proposed “Tinnitus and Dizziness in the Difficult Patient” as well as “A CIM approach to Difficult and Resistant Chronic Rhinosinusitis.” CPT and Relative Value Committee Jane T. Dillon, MD A Bulletin article was published on the importance of time and intensity when completing Specialty Society Relative Value Scale Update Committee (RUC) surveys. A RUC panel was developed and showcased at the annual meeting highlighting the importance of the surveys, and the AMA RUC process slides were posted onto the Academy website. The committee nominated and obtained Board approval for two new RUC trainees, Pete S. Batra, MD, and Peter Manes, MD, and one new CPT Alternate Advisor, Lawrence M. Simon, MD, and nominated and obtained Board approval for a new CPT/RVU Committee Chair, John T. Lanza, MD. The committee integrated and solicited participation of ARS members in the April RUC survey of four nasal endoscopy codes (31237-31240). A letter was submitted to CMS in support of a HCPCS J code for Propel drug-eluting sinus stent. CPT slides on AcademyU® were updated and reposted for member access and education on the general Academy website. Staff coordinated with Karen Zupko & Associates to draft a Bulletin article on correct coding for endoscopic skull-based procedures and to highlight the importance of RUC surveys in their coding course materials. Diversity Committee Lisa Perry-Gilkes, MD, Chair Awarded two Harry Barnes Endowment Travel Grants to assist with travel to the annual meeting. Awarded two Diversity Endowment Resident Leadership Grants to assist with travel to the annual meeting. Candice C. Colby-Scott, MD, wrote  an article for the June issue of  the Bulletin. Phyllis B. Bouvier, MD, wrote an article for the October issue of the Bulletin. Endocrine Surgery Committee Ralph P. Tufano, MD, Chair The committee provided 14 volunteers as faculty for another sold-out Ultrasound Workshop September 28 in Vancouver. The committee is working on “branding” thyroid/parathyroid on the Academy’s new website design, patient information materials, and in the 2014 annual meeting program. The committee will sponsor several miniseminars for the 2014 meeting. A committee goal is to work with AAO-HNSF leadership to establish a Head and Neck Endocrine Surgery category for listing instructional courses, miniseminars, and scientific program presentations and posters for the 2014 annual meeting. To highlight Thyroid Cancer Awareness month September 2014, the committee will write a Bulletin feature article and collaborate with the thyroid cancer patient support group ThyCa on community outreach in Orlando during the Academy’s annual meeting. Robert A. Sofferman, MD, is developing a Head and Neck Ultrasound Certification in conjunction with the American Institute for Ultrasound in Medicine (AIUM.) Ralph P. Tufano, MD, and others are working to establish Thyroid/parathyroid Surgery Courses for residents and fellows in their training programs. He proposed a miniseminar on thyroidectomy skills training to the Society of University Otolaryngologists (SUO). Several committee members took part in thyroid humanitarian missions to Africa and Asia led by Merry E. Sebelik, MD. Under the new survey guidelines, the committee will review the proposed survey on “Laryngeal Nerve Monitoring and Laryngeal Examination.” Because the committee is active year-round, there will be one or more conference calls to maintain the momentum through the year. Equilibrium Committee Joel A. Goebel, MD, Chair The committee presented two miniseminars at the Annual Meeting: “Emerging Concepts in Migraine Associated Dizziness,” moderated by Michael E. Hoffer, MD “Advances in the Objective Diagnosis of Ménière’s Disease,” moderated by Jeremy Hornibrook, FRACS Geriatric Otolaryngology Committee Robert T. Sataloff, MD, DMA, Chair Alan Rubin, MD, Chair-elect The committee was awarded the Model Committee designation this year and gratefully acknowledged the assistance of the Academy in achieving this honor. Work is beginning on a geriatric otolaryngology book with Thieme publishing to be available late in 2014. The book’s editors, Dr. Sataloff, Michael M. Johns III, MD, and Karen M. Kost, MD, distributed a robust outline that touches on more than 12 major topic areas addressing traditional clinical issues in treating the aged and other quality-of-life issues that influence treatment. As the book takes shape, a patient leaflet will be developed about otolaryngic care for the aging patient. Miniseminar topics were proposed for 2014 and 2015, including otolaryngic disease in the aging patient, balance and falls, and sleep surgery. Dr. Rubin was acknowledged as the incoming chair. Head and Neck Surgery and Oncology Committee Christine G. Gourin, MD, MPH, Chair The committee discussed electronic publication of the 4th edition update of the American Joint Committee on Cancer staging manual. Guideline topic discussion included management of the neck mass, which was identified by the committee as a suitable topic for guideline development. The committee presented two miniseminars: on “The ‘New’ Cancer Patient: Young, Non-Smoker, HPV+ Evaluation,” pertaining to the management and evaluation of HPV+ oropharyngeal cancer, which were well attended. The need for an annual update in the face of the HPV epidemic was discussed. Hearing Committee Douglas D. Backous, MD, Chair The committee responded to a letter to the editor in response to the publication of A New Standardized Format for Reporting Hearing Outcome in Clinical Trials. The committee participated in the external peer review of the American Society of Neurophysiological Monitoring (ASNM) Intraoperative neurophysiological monitoring (IONM) Practice Guidelines for Supervising Professionals. The committee participated in the external peer review of the AAO-HNSF Clinical Practice Guideline: Tinnitus. The committee reviewed/edited seven AAO-HNS position statements: Statement 1: Otology/Neurotology; Statement 2: Ototoxicity; Statement 3: Stapedectomy/stapedotomy; Statement 4: Red Flags—warning of ear disease; Statement 5: Hearing Impairment; Statement 6: Evaluation prior to hearing aid fitting; and Statement 7: Posturography. The committee presented three instruction courses at the annual meeting: “Medical-Legal Evaluation of Hearing Loss: Review and Update,” moderated by Robert A. Dobie, MD; “Sudden Sensorineural Hearing Loss: An Otologic Emergency?” by Sujana S. Chandrasekhar, MD, and James E. Saunders, MD; and “Implantable Hearing Devices: Indications, Surgery, Outcomes,” moderated by Jose N. Fayad, MD, and Jack J. Wazen, MD. Imaging Committee Gavin Setzen, MD, Chair The ultrasound (US) group, led by Robert A. Sofferman, MD, and including Russell B. Smith, MD, Lisa A. Orloff, MD, and Merry E. Sebelik, MD, worked diligently with the American Institute of Ultrasound in Medicine (AIUM) and ACS to develop U.S. Guidelines for Head and Neck. A future Bulletin article is planned to provide members more details. The committee and staff continue to advocate against decreased payment and prior authorization for in-office imaging services. Advocacy efforts included: Comments to the Milliman Care Guidelines requiring a CT scan prior to stapedectomy. National Imaging Associates (NIA, a Radiology Benefit Manager, RBM) restricting coverage of miniCT in Florida and New York; AAO-HNS sent Coventry letter; Dr. Setzen and staff joined call in August; Coventry agreed to pay for this in south Florida. United HealthCare (UHC) miniCT peer-to-peer review prior authorization issue: UHC changed systems error so it’s no longer required for a peer-to-peer review solely based on the use of a miniCT; published article in The News August 22 to let members know. Signed on to Coalition for Patient Centered Imaging (CPCI) comment letter on August 9 in opposition to HR 2914 to limit the in-office ancillary services exception to the STARK law. Two position statements were reviewed: Point-of-Care Imaging in Otolaryngology (reaffirmed) and Intraoperative Use of Computer Aided Surgery (added references). Joseph Scharpf, MD, and David R. Friedmann, MD, participated in the external peer review process for the clinical practice guideline (CPG) on Bell’s palsy, chaired by Reginald F. Baugh, MD. The committee volunteers, David Friedmann, MD, and Jeff Kim, MD, will participate in the external review for the CPG on tinnitus. The committee joined with the American Rhinologic Society (ARS) to develop a questionnaire to jointly survey Academy and ARS members, including residents and fellows-in-training, regarding practice patterns and other aspects of CT imaging in patients with paranasal sinus disease. A future issue of the Bulletin will include a summary of the survey results. The committee is reviewing more than 100 online courses to determine whether they are imaging-related or not to create a new library of courses that members could take to meet accreditation requirements. Implantable Hearing Devices Committee Craig A. Buchman, MD, Chair Presented an instruction course, “Implantable Hearing Devices: Indications, Surgery, Outcomes” at the annual meeting. Submitted comments and presentation at the Washington State HealthCare Authority (WHCA) Health Technology Assessment on Unilateral and Bilateral Cochlear Implants. Provided comments on the Wellpoint Clinical Guideline on Auditory Brainstem Responses (ABRs) and Evoked Otoacoustic Emissions (OAEs) for Screening and Diagnosis of Hearing Disorders. Submitted a letter to Intermountain related to their lack of coverage for bone-anchored hearing aids (BAHA). Reviewed and provided edits to two position statements: Implantable Devices and Cochlear Implants. Reviewed and provided edits to Cochlear Implants and Meningitis Fact Sheet. Reviewed and provided content edits to Health Information Page-Cochlear Implants. Updated and continues to maintain an Implantable Auditory Devices List. Infectious Disease Committee Farrel Buchinsky, MBChB, Chair The committee presented “Multi-resistant Bacterial Infections in 2013,” a miniseminar moderated by Tulio A. Valdez, MD. The committee conducted a survey on antibiotic usage in the perioperative period in common otolaryngological procedures. Committee members assisted with preliminary and external peer reviews for the Acute Otitis Externa guideline update. Committee members authored a Bulletin article focusing on infectious diseases encountered in West Africa. The Infectious Diseases Society of America (IDSA) sought the support of the committee with two of its congressional initiatives: Limited Population Antibacterial Drug (LPAD) proposal and the related Strategies to Address Antimicrobial Resistance (STAAR) Act. The committee reviewed and supported the retention of the Academy’s Communicable Diseases Policy. Media and Public Relations Committee Wendy B. Stern, MD, Chair The committee worked on public outreach activities and health observances such as World Voice Day and KIDS ENT month. The committee supported the Academy’s response to media requests from publications including the Wall Street Journal and Parade magazine. At the spring 2013 BOG meeting, the committee conducted a training session on social media. The committee also cosponsored a miniseminar, “Utilization of Social Media in Medicine,” at the Annual Meeting. The committee is working with the Ethics Committee to develop guidelines for Academy members for reference on the effective, ethical, and legal use of social media. The committee is striving to make public relations information more accessible to the membership, particularly with relation to guidelines. Medical Devices and Drugs Committee Anand K. Devaiah, MD, Chair The MDDC reviewed and reaffirmed the “Physician Drug Dispensing” Position Statement at the 2012 Annual Meeting. The Board of Directors approved this action item in December of 2012. The MDDC reviewed and revised the “Medical Use of Cocaine” Position Statement. The Board of Directors approved this action item in May 2013. The committee created an Excel database of committee member interests for media interviews, Bulletin articles, medical policy reviews with insurers, or any other requests for weighing in with clinical expertise. Several MDDC members provided expertise for WellPoint’s request for comments for Sinus Ostial Patency Policy and Usage of Propel Device. Medical Informatics Committee Subinoy Das, MD, Chair At the annual meeting, the committee worked on its plans for 2014 including: Development of a new miniseminar on telemedicine. A Bulletin article on electronic medical record (EMR) systems interoperability issues. Development of a medical informatics expert’s list. Development of an article about HIPAA challenges. Microvascular Committee Douglas B. Chepeha, MD The committee is engaged in a national retrospective review of reconstructive techniques after surgical salvage of patients who have failed chemoradiation treatment. Thirty-four institutions have sent data on 498 patients. The goal is to understand how different approaches to reconstruction affect fistula rate. The information is designed to guide future reconstructive approaches and help develop evidence for how surgeons should approach high-risk reconstructive cases. This work has been supported in part by a grant from the AAO-HNSF. The data was presented October 2 with about 200 members present. Univariate data was presented that suggests the use of vascularized tissue reduces fistula rate, however, multivariable regression will be needed to establish significant differences. This effort will be extended for subgroup analysis and a miniseminar is under development for the 2014 meeting. Patient Safety and Quality Improvement Committee David W. Roberson, MD, Co-Chair Rahul K. Shah, MD, Co-Chair Committee oversight of the Choosing Wisely campaign response by the Academy to identify test and/or procedures that should be questioned and to engage patients in discussions about appropriateness of care. PSQI engaged Academy committees and GTF, as many of the topics in our final list came from Academy published clinical practice guidelines. The AAO-HNSF top five list of things physicians and patients should question was presented at the Choosing Wisely® press conference in Washington, DC, in February. A committee-sponsored commentary article appeared in the April issue of Otolaryngology-Head and Neck Surgery. PSQI was instrumental in working with the FDA on the use of codeine post tonsillectomy and/or adenoidectomy. The FDA issued an alert last year. The committee communicated to the membership on the FDA’s action and representatives from PSQI were included in FDA conference calls to provide input on the issue. PSQI committee co-chair Dr. Roberson and EVP and CEO Dr. Nielsen co-authored a commentary article with an FDA official that was published in the June 6 New England Journal of Medicine (http://bit.ly/NEJMdrug). The PSQI sponsored two well-attended miniseminars at the annual meeting: “Big Patients Big Worries,” focused on reviewing the unique requirements of obese patients to ensure quality care. “In Office Safety: Are you putting your patients at risk?” focused on compounded pharmaceuticals, allergy vial preparation, and sterilization and safe use of equipment. It reviewed the position statement on performance measures. Data analysis and manuscript development is currently underway for the Post-Op Criteria for Obstructive Sleep Apnea (OSA) database study. The study assesses whether specific risk factors for adverse outcomes can be identified among patients with OSA undergoing ENT surgery. PSQI was notified that a paper by Cote, et al., “Death or Neurologic Injury after Tonsillectomy in Children,” recently published in Anesthesia & Analgesia, had conclusions similar to the committee’s “Major Morbidity and Mortality after Tonsillectomy” paper published in The Laryngoscope. The PSQI has reached out to Dr. Cote and colleagues in anesthesia about a possible joint effort to develop an evidence-based guideline for perioperative tonsillectomy care. A patient safety web link developed and tested last year to capture de-identified safety event information from members in a secure environment is now available to members. PSQI will be concentrating on best methods of communicating to members about the link and highlighting its location on the website to make it more prominent this year. In addition to the two publications mentioned above, Dr. Shah continues to address the most recent and relevant information on patient safety and quality improvement in his monthly Bulletin column. Pediatric Otolaryngology Committee Kenny H. Chan, MD, Chair The committee chair and membership developed Bulletin content for KIDS ENT month that included utility of clinical practice guidelines in pediatric otolaryngology as well as a fact sheet on safety issues. The committee developed Bulletin content on tonsillectomy and/or adenoidectomy analgesia and codeine black box warning. The committee chair and membership developed a GTDF proposal for laryngomalacia. The committee sponsored a miniseminar at the annual meeting on “Tonsillectomy Analgesia without Codeine.” Members of the committee reviewed and offered comment on AAO-HNS Policy Statements regarding “Infant Hearing Screening” and “Pediatric Otolaryngology.” Physician Resources Committee David W. Kennedy, MD, Chair The committee continues to work toward completing a consensus document to address what is believed to be an impending shortage of otolaryngologists. The document will assist in providing the specialty and our members with the education and tools needed to prepare for workforce changes. Fundamental to this document is understanding accurately the current workforce. This year we researched the different organizations publically reporting national otolaryngology numbers. A key finding was that the majority of these organizations use the same source, the AMA Master File, as the basis for their reporting. The final report is currently being analyzed. The committee was provided data by ABOto strongly suggesting that the other databases may underestimate the otolaryngology workforce. This database needs to be reconciled against these other data sources including the AAO-HNS membership data. A subgroup of the committee is working on otolaryngology workforce numbers reconciliation. Clearly providing accurate information to the specialty on this issue is critical for future workforce planning. Moving ahead, a committee subgroup will work with other academy groups, such as Women in Otolaryngology, the Diversity Committee, and the Section of Young Otolaryngologists to identify additional information that we need to collect from our workforce to improve data accuracy. The committee reviewed and provided feedback on two Academy position statements: “Reimbursement for Taking Hospital Call” and “Scope of Practice for Non-physician Providers.” Plastic and Reconstructive Surgery Committee Donna J. Millay, MD, Chair The PRS committee presented a miniseminar at the annual meeting titled “Coding and Precertification Strategies for Nasal Surgery.” Several committee members reviewed and provided comments on the Botulinum Toxin Treatment Policy Statement. Rhinology and Paranasal Sinus Committee Scott P. Stringer, MD, Chair Reviewed Aetna’s Rhinoplasty/Septoplasty policy. Reviewed and revised the Dilation of Sinuses, Debridement of Sinus Cavity after FESS and Sinus Endoscopy Position Statements; the Allergy Clinical Indicator; and the five patient information leaflets related to Rhinology. Submitted three miniseminars for the Annual Meeting. Included key rhinology codes within the Academy ICD-10 Superbill as a resource for the general membership. Facilitated successful participation in the Specialty Society Relative Value Scale Update Committee (RUC) surveys of nasal endoscopy codes 31237-31240 for the April RUC meeting. Skull Base Committee Gregory J. Artz, MD, Chair During the past year we have worked with Roberto Cueva, MD, in preparing guidelines for the reporting of results in vestibular schwannoma management. These guidelines were finalized and approved by the committee. The goal of these guidelines is to standardize reporting standards for all the major journals in otolaryngology. After discussions with the American Neurotologic Society and the American Otologic Society, we hope to gain approval from all the major journals in the next year. The committee will attempt to gain approval of one to two miniseminars for the 2014 Annual Meeting on topics that would interest the general otolaryngologist and improve their clinical care of patients. Topics under consideration include physiology and treatment of CSF leaks, outcome of endoscopic anterior skull-base surgery, and management of difficult otolaryngologist complaints such as otalgia and aural fullness. In addition, we will be assisting with skull-base content on the website as directed by the education and steering committees. We have been exploring the idea of compiling a list of skull base centers to be placed on the official AAO-HNS website to help direct referrals for rural and community otolaryngologists searching for centers of excellence to refer patients with complex skull base issues. Sleep Disorders Committee Pell Ann Wardrop, MD, Chair Presented two miniseminars, “Pediatric Obstructive Sleep Apnea Syndrome: Guidelines, Evidence, and Nuance” and “Creating a ComprehensiveSleepCenter in an Otolaryngology Practice,” at the annual meeting. Submitted two Academy letters to Medicare Administrative Contractors (MACs) expressing concern that otolaryngologists certified in sleep medicine are not permitted to fit oral appliances. Reviewed and revised eight position statements related to sleep medicine. Submitted one letter to Palmetto (a MAC) regarding their sleep testing policy in independent diagnostic testing facilities (IDTFs), which does not allow otolaryngologists to supervise or interpret sleep studies in that site of service. Reviewed and revised the UPPP Clinical Indicator. Collaborated with the Patient Safety and Quality Improvement Committee to develop and administer a sleep survey. Developed a new position statement on oral appliances. Trauma Committee Joseph A. Brennan, MD, Chair Two miniseminars were conducted by dedicated committee members at the annual meeting: “High-Anxiety Head and Neck Trauma Cases: Lessons Learned” and “Practical Otologic Considerations in Head and Neck Injury.” The Society of Military Otolaryngology successfully launched a Sunday Trauma Workshop with lectures and dinner, which was widely praised. Trauma Committee members are writing a textbook on Head and Neck Trauma, which should be published in 2014. The Trauma Committee plans to submit three miniseminars for the 2014 annual meeting on topics ranging from disaster preparedness for otolaryngologists to the challenges of sustaining a high-level trauma program. Additionally, the committee will be working with the Society of Military Otolaryngologists to conduct the 2014 Trauma Workshop focused on “Mass Casualty—Before, During, and After.” Voice Committee Clark A. Rosen, MD, Chair The Position Statement on Videostroboscopy was submitted with revisions due to changes in practice since original statement. Ryan C. Branski, PhD, worked to construct an “acceptable” compromise with other healthcare professionals involved. During the recent CPT Committee Meeting, the statement was accepted with the revisions. The Voice Therapy and Dysphonia position statement was also on the agenda at the annual meeting for the CPT Committee review. Dr. Rosen suggested that the committee direct attention to issues surrounding Botox single-dose versus multi-dose vial use, noting some pressure in the environment to restrict multi-dose use. VyVy N. Young, MD, and a pharmacy associate are conducting a literature search seeking optional suggestions that might include using an existing allergy hood set-up as an alternative to single vial restrictions. Another suggestion might be for the hospital or its own pharmacy to pre-mix at lower dosage quantity. Or, in some institutions an arrangement can be made, according to Albert L. Merati, MD, for the pharmacy technician to deliver an appropriate dose for use in the OR and take back once administered. It was also suggested that an evidence-based study be considered. Dr. Merati introduced the Global Trach Initiative and asked that members read the initiative documents. A draft position statement on In-office Photoangiolytic Laser Treatment of Laryngeal Pathology was presented for advice and comment to the CPT Committee. CPT requested additional background from the Voice Committee. Dr. Branski will work with committee members to submit miniseminar topics. Young Physicians Committee Monica Tadros, MD, Chair Formation of NEW Young Physicians Section! The committee received approval from the Academy Board of Directors to transition to an Academy Section effective October 2013. Ayesha N. Khalid, MD, will serve as the chair of the section during the initial transition year. A Governance Task Force will be formed to develop and document a new governance structure. Lawrence M. Simon, MD, developed a survey to collect information to inform AAO-HNS/F decisions about the young-physician demographic and needs gaps. The committee co-sponsored two miniseminars at the annual meeting: “Avenues to Leadership” and “Using Social Media in Medicine” and presented the instruction course “E&M Coding.” A Young Physicians’ “Reflections” article is planned for publication in Otolaryngology–Head and Neck Surgery every quarter. The first article was accepted from Dr. Simon for an upcoming publication. Creating a community connected through the new AAO-HNS/F community portal, ENTConnect, continues to be a priority of the young physicians. FOUNDATION COMMITTEES Development Committee Nikhil J. Bhatt, MD The Development Committee hosted a champagne reception during the annual meeting to thank members who made generous charitable contributions as Millennium Society Life, Patron, and Sustaining level donors. About 75 people attended including a majority of the Board of Directors, various Academy and Foundation leaders, as well as invited donors. Dr. Bhatt announced a fundraising campaign in honor of David R. Nielsen, MD, in recognition of his many years of service to AAO-HNS/F in anticipation of his stepping out of his role as EVP and CEO in 2015. Thanks to generous donations by Ken Yanagisawa, MD, and Julia Shi, MD, the AAO-HNSF Eiji Yanagisawa, MD, International Visiting Scholar Endowment has been established to honor Dr. Yanagisawa’s deep commitment to the AAO-HNSF’s international mission of encouraging outreach, worldwide collaboration, exchange of information, and education among those in the otolaryngology community. Art A. Ambrosio, MD, David O. Francis, MD, MS, and James Oberman, MD, were awarded the 2013-2014 Young Physicians Leadership Grant. Thanks to the generous donations of several of our active members, $3,000 in grant funding was secured to provide these three young physicians two travel stipends: $500 to attend the 2013 annual meeting and $500 to attend a leadership forum/Board of Governors meeting 2014, February 28-March 3, in Alexandria, VA. Humanitarian Efforts Committee Merry E. Sebelik, MD, Chair Susan R. Cordes, MD, Steven L. Goudy, MD, Liana Puscas, MD, and Selena E. Heman-Ackah, MD, coordinated and awarded 29 residents and fellows-in-training with Humanitarian Travel Grants in 2013 to offer services in 15 less-developed countries. This year, the AAO-HNSF recognized several humanitarians for their tireless work to several under-served populations, both domestically and overseas, including: James E. Saunders, MD, was awarded the 2013 Distinguished Award for Humanitarian Service. Phyllis B. Bouvier, MD, was awarded the Arnold P. Gold Foundation 2013 Award for Humanism in Medicine. The committee worked with AAO-HNSF Development Staff to: Renew and expand external funding for the Humanitarian Travel Grant Program. Increase visibility of AAO-HNS Members’ humanitarian efforts. Increased participation by AAO-HNS members in Global Surgery organizations beyond the AAO-HNS. Developed consensus among Humanitarian Efforts Committee members and activists identifying humanitarian educational needs of AAO-HNS membership, resulting in an array of proposals to submit to the 2014 Program Committee. History and Archives Committee Lawrence R. Lustig, MD, Chair Marc D. Eisen, MD, PhD, president of the Otolaryngology Historical Society (OHS), hosted the well-attended OHS annual meeting and reception at the Vancouver Club. The four OHS presenters, P. Ryan Camilon, Lanny G. Close, MD,  C. Eduardo Corrales, MD, and Amit A. Patel, MD, will write up their topics as Bulletin articles. In 2013, monthly Bulletin articles on historical topics resulted in increased OHS membership. OHS members are urged to sponsor residents as members and OHS attendees. Deadline for the 2014 OHS call for papers is May 15, 2014. Committee volunteers staffed the OHS booth in Vancouver and gave “Century of Excellence” books to renewing OHS members. The committee strongly urged the Academy to post the historical collection on the Academy website and encouraged posting links to historical articles from the “white” journal and Laryngoscope. Dr. Lustig announced the second edition of Otorhinolaryngology—an Illustrated History, by Neil F. Weir, FRCS, and Albert Mudry, MD, PhD. The Barelli/Kirchner papers now housed at the History Factory are being reviewed by Tracy L. Sullivan, former director of the AdamsCenter. William M. Wexler, MD, donated Rhode Island otolaryngologist Nathan Bolotow, MD’s historic nasopharyngeal endoscopes for the Academy HQ lobby display. Digitizing the oral histories was back-burnered, pending the recommendations of the Historical Archives Task Force. International Steering Committee Gregory W. Randolph, MD, Chair Looking back at the end of his four-year term, International Coordinator Dr. Randolph, noted that the International Corresponding Societies (ICS) network has grown to 54 societies affiliated with the Academy; 37 International Visiting Scholarships (IVS) and 68 international travel grants have been distributed to international otolaryngologists from 24 countries; and 60 percent of submissions to the “white journal” are international. The committee launched the first International Assembly at the Annual Meeting, which showcased the many international programs. Twelve International Visiting Scholars from Africa, Egypt, India, Latin America, and Southeast Asia attended the annual meeting followed by short-term observerships. The Global Health 2013 was well received and well attended with “good will ambassadors” from India, New Zealand, Panama, Thailand, and Uganda. Prof. Bernard G. Fraysse spoke on Francophone Africa. G. Richard Holt, MD, Regional Advisor for the Middle East, Eugene N. Myers, MD, FRCS Edin (Hon), former International Coordinator, and Ahmed M.S. Soliman, MD, of Philadelphia, hosted the first Egyptian-American Satellite Meeting at the Annual Meeting. Incoming International Coordinator, James E. Saunders, MD, is working closely with the Coalition for Global Hearing Health and the IFOS Hearing for All Initiative in support of the World Health Organization (WHO) Prevention of Deafness Program and its Technical Advisor Shelly Chadha, MD. The committee will work closely with Academy president Richard W. Waguespack, MD, to welcome the 2014 honored countries: Dominican Republic, Ecuador, Saudi Arabia, and the United Kingdom. International Otolaryngology Committee Nikhil J. Bhatt, MD, Chair Dr. Bhatt urged the committee to actively recruit new international members. Member “tool kits” with application forms and engagement brochures were distributed to the committee. Dr. Bhatt invited national societies to publicize the Orlando call for papers and to share the Orlando slides at their international congresses. Dr. Bhatt welcomed six international travel grantees (from China, Egypt, Japan, South Africa, and Venezuela) who are studying in U.S. and Canadian otolaryngology departments. This fall, the 2014 travel grant application forms will be distributed to U.S. and Canadian department chairs. The committee is actively soliciting mentor programs to host International Visiting Scholars in short-term observerships. The committee will be closely involved in the growth of the International Speakers Bureau that provides a resource of more than 130 Academy members available to speak at international congresses. Dr. Bhatt invited Academy leaders to the International Reception, an opportunity to celebrate and thank our international attendees on the final night of the Annual Meeting. Outcomes Research and EBM Subcommittee Scott E. Brietzke, MD, Chair Presented a miniseminar on “Pediatric OSAS: Guidelines, Evidence, and Nuance” at the Annual Meeting. Published two systematic reviews: “Macrolide therapy for chronic rhinosinusitis: a meta-analysis” and “Use of specific neuromodulators in the treatment of chronic, idiopathic cough: a systematic review.” Updated the eligibility specifications for the AAO-HNSF Maureen Hannley Grant to include special consideration for those looking to engage the CHEER Research Network and/or those looking to address the research gaps from one of the AAO-HNSF Clinical Practice Guidelines. Reviewed and updated two policy statements: Evidence-Based Medicine and Use of Animals in Research. Wrapped up the Parent Response to Ear Disease in Children with and without Tubes (PREDICT) QOL Study with two oral presentations at the annual meeting and will be submitting manuscript(s) for publication in late 2013. Work continues on two projects: Developing a resource of administrative and national survey databases for use by otolaryngologists, which will be posted on the Academy website (similar to the Outcomes Tools resource that was developed a few years ago). Database Compare is a large project that will look at the variability between large datasets, ultimately resulting in a journal publication. Panamerican Committee Juan Manuel Garcia, MD, Chair Dr. Garcia listed the committee’s goals to increase: Active participation of U.S. otolaryngologists at the Panamerican Congress, Cartagena, Colombia, October 26-29, 2014 Five Latin Americans’ awareness of and membership in the AAO-HNS Collaboration with the Latin American Leadership Summit (Cumbre de Lideres) and J. Pablo Stolovitzky, MD, in the resident and faculty exchange programs with Latin American ORL departments and six U.S. departments. The committee will send Annual Meeting and Academy membership information to all Latin American ICS leaders and members of the Cumbre de Lideres, including slide sets in Spanish and English. The 2013 Antonio de la Cruz scholar was Angelo M. Campos, MD, of Colombia. Another International Visiting Scholar was Christian Gomez Quiroz, MD, of Peru. Ramon A. Franco, Jr., MD, Regional Advisor for Central America, invited Amarilis M. Melendez-Medina, MD, of Panama as the “goodwill ambassador” at the Global Health 2013 Symposium. EDUCATION COMMITTEES Education Steering Committee Sonya Malekzadeh, MD, Chair, Coordinator of Education The Education Steering Committee provided leadership on several initiatives in 2013, including completion of the Otolaryngology Review: A Lifelong Learning Manual. The Manual will be released in spring of 2014. In addition, the education committees reviewed 27 expiring courses, published 21 Online Lectures, and submitted 135 questions to use for the Academic Bowl and the Question Bank. Core Otolaryngology and Practice Management Education Committee Brendan C. Stack, Jr., MD, Chair The committee continues to provide policy and content oversight to the Coding and Reimbursement workshops held regionally each year. Its members serve as experts in ever changing coding and practice management issues. In addition, the committee produced a Home Study Course on “Clinical Competency Issues.” Facial Plastic and Reconstructive Surgery Education Committee J. Randall Jordan, MD, Chair The committee is developing a Home Study Course titled “Plastic and Reconstructive Problems,” as well as a PMP course on “Nasal Reconstruction.” The Academy welcomed Dr. Jordan as the new chair of the committee  in October. General Otolaryngology Education Committee Karen T. Pitman, MD, Chair The committee provided leadership to the third successful ENT for the PA-C conference held in conjunction with AAPA and SPAO in New York. The Home Study Course on “Trauma and Critical Care Medicine” will be released in early 2014. The committee also developed a very popular MOC Review Course for the annual meeting. Head and Neck Surgery Education Committee Richard V. Smith, MD, Chair The committee produced a Home Study Course on “Neoplastic and Inflammatory Diseases of the Head and Neck.” The committee is currently developing a PMP course on “Adult with a Neck Mass.” Laryngology and Bronchoesophagology Education Committee Catherine R. Lintzenich, MD, Chair The committee produced a PMP course on “Adult with Shortness of Breath” and a Home Study Course on “Laryngology, Voice Disorders, and Bronchoesophagology.” Otology and Neurotology Education Committee Bradley W. Kesser, MD, Chair The committee produced a Home Study Course on “Otology and Neurotology” and a PMP on “Adult with Recurrent Vertigo.” Pediatric Otolaryngology Education Committee Kenny H. Chan, MD, Chair The committee worked in conjunction with ASPO to produce the Pediatric Otolaryngology Continuing Education Webinar Series. It included 10 episodes, each one focused on a pertinent pediatric otolaryngologic topic. The committee also produced a Home Study Course on “Congenital and Pediatric Problems” and a PMP on “Child with Recurrent Throat Pain and Fever.” Rhinology and Allergy Education Committee Brent A. Senior, MD, Chair The committee published a Home Study Course on “Rhinology and Allergic Disorders” and a PMP course on “Adult with Epistaxis.” The PMP “Adult with Recurrent Rhinorrhea” will be published  this month. Board of Governors (BOG) Committees Representatives from Board of Governors societies from across the country were well represented during the AAO-HNSF 2013 Annual Meeting & OTO EXPOSM. Highlights from the meeting include: BOG Legislative Representatives Committee Paul M. Imber, DO, Chair After a detailed review of legislative efforts to repeal the Sustainable Growth Rate formula, the committee was introduced to exciting new programs including the launch of the In-District Grassroots Outreach (I-GO) program and a new initiative encouraging residents and fellows-in-training to engage in the Academy’s advocacy activities. Members also received updates on recent strategic changes to the Academy’s Government Affairs programs, such as new member opportunities regarding state legislative tracking and the conversion of the BOG Spring Meeting & OTO Advocacy Summit to a spring  leadership event. BOG Rules and Regulations Committee Joseph E. Hart, MD, Chair The committee discussed plans to streamline the operations of the BOG and suggestions on how to increase interest in BOG awards. BOG Socioeconomic and Grassroots Committee David R. Edelstein, MD, Chair The committee continued the rollout of their Regional Representation Plan to improve communications across BOG regions and to offer members a voice where viable BOG societies aren’t in existence. Individual regional representatives from each of the 10 regions were appointed to the committee. Plans are underway for the regional representatives to conduct periodic conference calls with members within their regions. The committee sponsored several panel presentation sessions on a variety of topical issues including: quality controls, implementation of ICD-10, the impact of patient satisfaction scores, and insurance challenges. The committee continues to monitor suggestions for important grassroots issues to develop future polls to BOG member societies. BOG Executive Committee-sponsored Miniseminar Wendy B. Stern, MD, BOG Secretary “Hot Topics in Otolaryngology 2013: ACOs” Dr. Stern moderated a compelling panel presentation on current hot topics in otolaryngology with a focus on Accountable Care Organizations (ACOs). The BOG Executive Committee along with the 3P Workgroup also jointly sponsored a miniseminar, “Alternative Payment Models and Academy Advocacy.” BOG General Assembly BOG committee chairs provided updated reports on their committee’s activities during the past year. The New York State Society of Otolaryngology received the 2013 BOG Model Society Award. Michael Setzen, MD, received the 2013 BOG Practitioner Excellence Award. Denis C. Lafreniere, MD, BOG Chair, presented Recognition Awards to Sujana S. Chandrasekhar, MD, and Wendy B. Stern, MD, for their service on the BOG Executive Committee. Dr. Lafreniere presented BOG Chair Awards to: Gerald Leonard, MD, Robert T. Sataloff, MD, and J. Pablo Stolovitzky, MD. Governors (or their alternates) in attendance elected Dr. Stern to the position of BOG Chair-Elect and Sanjay R. Parikh, MD, to the position of BOG Secretary Section for Residents and Fellows-in-Training (SRF) Nikhila M. Raol, MD, Chair The Section for Residents and Fellows-in-Training (SRF) functions as an advisory board to the Board of Directors (BOD). During the Annual Meeting, Monday was officially recognized as Residents Day with several special events geared toward residents. SRF General Assembly The Section held a well-attended General Assembly meeting. During the session, attendees elected the following new officers: Kanwar S. Kelley, MD, JD, Chair John M. Carter, MD, Vice Chair Hamad Chaudhary, MD, Member-at-Large Meghan N. Wilson, MD, Information Officer Sanjeet Rangarajan, MD, BOG Governor David S. Cohen, MD, BOG Legislative Representative Margaret S. Carter, MD, BOG Public Relations Representative In addition, Dr. Raol transitioned to Immediate Past Chair. SRF-sponsored/co-sponsored Miniseminars “Understanding and Managing Career Burnout” “Grant Writing Pearls and Pitfalls: Maximizing Your Funding” “Getting Published: Letters, Commentaries, and Social Media” “Using Social Media in Medicine” Women in Otolaryngology  (WIO) Section Susan R. Cordes, MD, Chair The Women in Otolaryngology (WIO) Section seeks to support women otolaryngologists by identifying their needs, fostering their development, and promoting women as leaders in the specialty. The Section’s Communications Committee connects Women in Otolaryngology via several media outlets including Bulletin articles, quarterly eNewsletters, and an ongoing social media presence. The Section’s Research and Survey Committee completed an analysis of women on journal editorial boards, which was presented as a poster at the Annual Meeting. The Endowment Committee funded four projects benefitting women in otolaryngology. The Program Committee secured an excellent speaker for the WIO Luncheon and presented a miniseminar, and the Awards Committee identified candidates for various awards, including the Helen F. Krause, MD Trailblazer Award. The Leadership and Mentoring Committee continued to work on improving a resident mentoring program and moved forward on plans for a longitudinal leadership program to begin next fall. WIO Section Committees Each of the six WIO committees conducted committee meetings to plan and coordinate their activities for the coming year. The 2012-13 committees’ leaders were: Awards, Valerie A. Flanary, MD, Chair Communications, Erika A. Woodson, MD, Chair Development/Endowment, Pell Ann Wardrop, MD, Chair Leadership Development and Mentorship, Mona M. Abaza, MD, Chair; Carol R. Bradford, MD, Chair-Elect Program, Lauren S. Zaretsky, MD, Chair; Suman Golla, MD, Chair-Elect Research and Survey, Linda S. Brodsky, MD, Chair; Sujana S. Chandrasekhar, MD, Chair-Elect WIO Luncheon/General Assembly Christina M. Surawicz, MD, gastroenterologist, Seattle, WA, kicked off the WIO luncheon with her well-attended interactive presentation, “Women and Leadership.” During the session, the Section honored Dana M. Thompson, MD, as the recipient of the 2013 Helen F. Krause, MD Trailblazer Award. WIO members elected to leadership positions: Christine B. Franzese, MD, Chair-Elect, and Dale Amanda Tylor, MD, Member-at-Large. The WIO Governing Council welcomed incoming chair, Mona M. Abaza, MD, and thanked outgoing chair Dr. Cordes for her great leadership throughout the past year. General Assembly attendees had the opportunity to network with their colleagues and learn more about WIO Section committees and the Academy by participating in breakout roundtable discussions. The WIO Endowment Fund has continued to be very successful in its fundraising efforts and plans to once again offer Requests for Proposals that fulfill the Section’s charge to support the career development of women otolaryngologists-head and neck surgeons. The Section encourages women in all aspects and phases of their careers to consider participation and/or leadership in the WIO Section through the committee application process or by running for elected office. WIO Co-Sponsored Miniseminar “Avenues to Leadership: Opportunities at Every Level” ADVISORY/OTHER COMMITTEES Ad Hoc Payment Model Workgroup James C. Denneny III, MD, Chair Clarified differences and utility of clinical indicators, consensus statements, policy statements and guidelines for members and payers. Completed July 2013; printed in August Bulletin and available on website: http://www.entnet.org/Practice/loader.cfm?csModule=security/getfile&pageID=175934 Reviewed AMA draft tool on Value-Based Contracting Readiness Assessment and submitted comments  on February 15. Developed catalogue of current portfolio of quality measures, outcomes data, and care paths. Provided comments on AAO-HNS letters to House and Senate on SGR repeal/payment reform. Began efforts to seek out a partner in the payer industry to assist with the development of payment models. This will be an ongoing effort during the end of 2013 and beginning 2014. For early 2014, workgroup will analyze trends in payment reform. Additionally, it will provide information to Members on episode bundling, and outreach to private payers, and oversee efforts with other groups. The group continues to look for collaborative partners to evaluate and analyze data to assist with recommendations for a new payment model for otolaryngology. Centralized Otolaryngology Research Efforts (CORE) Study Section Jay O. Boyle, MD (Head and Neck Surgery Sub-Committee Chair) Christine G. Gourin, MD (Head and Neck Surgery Sub-Committee Chair-elect) David R. Friedland, MD, PhD (Otology Sub-Committee Chair) Rodney J. Schlosser, MD (General Sub-Committee Chair) In 2013, the CORE leadership (including the boards and councils of all participating societies) approved a portfolio of 41 grants totaling $848,730 (up 13 percent from 2012). A record 28 percent (11) of those selected to receive funding were resubmitted applications. Presented one miniseminar, “Grant Writing Pearls and Pitfalls: Maximizing Your Funding,” at the Annual Meeting. Jean Andersol Eloy, MD, et Al., published three manuscripts about the program: AAO–HNSF CORE Grant Acquisition is Associated with Greater Scholarly Impact Does Receiving an AAO–HNSF CORE Grant Influence Career Path and Scholarly Impact among Fellowship-Trained Rhinologists? The Impact of AAO–HNSF CORE Grant and NIH Funding in Laryngology Instruction Course Advisory Committee Sukgi S. Choi, MD, Instruction Course Coordinator Capitalizing on the huge success of the two Clinical Fundamentals instruction courses presented at the 2012 Annual Meeting & OTO EXPOSM in Washington, DC, eight additional Clinical Fundamental instruction courses were included on the 2013 program. These courses were designed to meet the American Board of Otolaryngology’s Maintenance of Certification requirements for Clinical Fundamentals (Part II) and were also eligible for AMA PRA Category 1 Credit. A three-hour General Otolaryngology Review Course was included within the program. The course was designed to meet the American Board of Otolaryngology’s Maintenance of Certification requirements for Clinical Fundamentals (Part II) and was also eligible for AMA PRA Category 1 Credit. The opportunity for AAO-HNS/F resident members to attend the afternoon instruction course program for free has been expanded this year. A minimum of 10 seats were reserved for resident members in all instruction course rooms (not including minicourses, hands-on, or the clinical fundamentals courses). Physician Payment Policy (3P) Workgroup James C. Denneny III, MD Michael Setzen, MD, Co-chairs Reviewed all position statements (75 total reviewed by committees) Five comment letters to Congress on repeal of the SGR and payment reform. Eleven comment letters to CMS and other regulatory bodies, including comments on proposed rules on the 2014 Medicare Physician Fee Schedule, Hospital Outpatient and AmbulatorySurgicalCenters and Inpatient payment systems, Physician Compare website redesign, and ACO exclusivity. Met with CMS face-to-face in April regarding payment and quality programs related to otolaryngology. Developed three quality fact sheets, which outline the key components of CMS’ quality incentive programs, including: ERx, PQRS, and EHR Meaningful Use. Created a customizable ENT ICD-10 Superbill to assist members in the transition to ICD-10 coding by October 2014. Successfully advocated for positive revisions to WellPoint’s policy on Tonsillectomy in Children. Successfully advocated for revision and clarification of Aetna’s Allergy Immunotherapy policy. Continued ongoing third party payer advocacy efforts with United Healthcare’s (UHC’s) and Aetna’s rhinoplasty, septoplasty coverage policies. Nineteen responses were provided to third party payers regarding their medical policies with input received from Academy committees. Surveyed and presented five CPT codes to the AMA RUC. Reviewed and/or presented on 21 code change proposals from January 2012-October 2013. The CPT team also drafted and reviewed three AMA CPT® Assistant Articles, as well as four new CPT for ENT articles to assist members with achieving correct coding. Reviewed Bell’s Palsy Clinical Practice Guideline. Two health policy miniseminars for the annual meeting were hosted by 3P, including a 3P miniseminar on new strategies in Academy advocacy for physician payment and an ICD-10 transition miniseminar. In the next year 3P will work with Academy committees to review outstanding Position Statements and four Clinical Indicators. 3P’s new co-chair, Jane T. Dillon, MD, will join the current co-chair, Dr. Denneny, to focus 3P more on the future of physician payment, coordinating with the Academy’s quality efforts. For additional information on any of these issues, contact healthpolicy@entnet.org. Program Advisory Committee Eben L. Rosenthal, MD, Scientific Program Coordinator Several new miniseminars on management of obstructive sleep apnea, new detection and imaging methods in otology and cancer, as well as important updates on healthcare legislation from the Board of Governors were included in the Annual Meeting programming. This year Annual Meeting attendees had the opportunity to view all scientific posters online at kiosks located in the poster hall or through the annual meeting mobile app. Poster presenters and attendees also enjoyed breakfast Tuesday morning in the poster hall. The oral presentations given during the Annual Meeting received a face-lift this year. In response to comments we received from oral presenters and previous year attendees, select oral presentations were given in a new accelerated format that consisted of a three-minute oral presentation and two minutes of discussion. Specialty Society Advisory Council Albert L. Merati, MD, Chair The SSAC continued its discussion of submitting a proposal for an extended miniseminar or “spotlight series” for the 2014 annual meeting. A motion was presented and seconded that SSAC participating societies continue to support the CORE Grants Program. The SSAC continues to examine cost sharing options for the program. Surgical Simulation Task Force Ellen S. Deutsch, MD, Chair Presented an overview of simulation in otolaryngology at the Council of Medical Specialties Simulation Summit in Washington, DC. Presented at the AmericanCollege of SurgeonsSimulationCenter Accreditation Meeting, March 15 in Chicago. Conducted comprehensive survey of use of simulation in otolaryngology residency programs. Conducted open simulation meetings at the Combined Otolaryngology Spring Meetings (COSM) and AAO-HNSF 2013 Annual Meeting &  OTO EXPOSM. Robotic Surgery Task Force Eric M. Genden, MD, Chair The Robotic Surgery Task Force continued work on a best practices for training and credentialing in robotic surgery within otolaryngology-head and neck surgery. The Task Force represents the AAO-HNS/F in national robotic surgery organizations and initiatives, such as the development of Foundations for Robotic Surgery.
Wendy B. Stern, MD, BOG Chair-Elect
We Have Our Finger on the Pulse of Our Membership
The Board of Governors (BOG) is hard at work. Healthcare reform and the passage of the Affordable Care Act into law in 2010 have greatly influenced the practice of medicine. The impact of changes such as implementation of ICD-10, the opening of enrollment for health exchanges, the development of various payment paradigms, and the consequences of practice guidelines felt by all of our members. There are so many moving targets that we need to be aware of and respond to. The BOG’s commitment is to represent and address these concerns and needs of our Academy members through the member societies as represented by their governors, committees, and Academy health policy and government affairs teams. We need to have our finger on the pulse of the membership. The past year has been remarkable for accomplishing this. The biggest news in this regard has been the concerted effort to make your voices more accessible by restructuring the BOG itself. However, there are still societies and pockets of the country that we don’t hear from. Under the present BOG leadership, and the efforts of the BOG Socioeconomic and Grassroots Committee, we have identified 10 regions across the states and the territories, and appointed 10 regional representatives so that societies, big and small, can report more easily to the BOG. The success of this was evident during this fall’s BOG meeting in Vancouver, BC, Canada, on September 28. Eight of the 10 regional representatives were present and all regions were represented at the meeting. Each region delivered compelling reports that are now being considered by the appropriate resources. It is our goal that this new structure will provide better communication not only through the Governors and the society’s representatives to the BOG Socioeconomic and Grassroots and the BOG Legislative Affairs Committees, but also the regional reps who will call on their assigned societies. If you feel your society or region wasn’t part of this year’s regional effort, it may be that we don’t have your contact information or know who your leadership is. We want to hear from you. This is your opportunity to be heard. Let us know these important details by emailing BOG@entnet.org. The fall meeting had many other highlights. The AAO-HNS Government Affairs team introduced the “state trackers” and In-district Grassroots Outreach (I-GO) programs. These programs will radically change the way we are able to respond to state legislative bills and interact locally with our elected officials. It will make us more effective in our efforts to support or defeat bills that affect our ability to successfully care for our patients. A key element is the identification of individual Academy members who will serve as “trackers” for their states. The concept is to work collaboratively with the local ENT specialty society in coordination with the state medical society. The tracker will receive support from the BOG and the Academy in the form of regular emails, which will summarize pertinent bills, monthly conference calls, and assistance in writing action reports and letters to legislators, if appropriate. The BOG is developing this list of trackers right now and welcomes hearing from interested individuals. During the past year, the BOG hosted many interesting lectures, including a session on the use of social media in medicine; a lecture by Rahul K. Shah, MD, “Patient Satisfaction Scores and How They Impact Your Practice;” and a session on insurance exchanges. The BOG also presented a well-attended, successful, and thought-provoking miniseminar at this year’s annual meeting entitled, “Hot Topics in Otolaryngology 2013: ACOs.” Our speakers were excellent. Raymund C. King, MD, JD, laid the legal and health reform backdrop for ACOs, while C. Brett Johnson, JD, MPH, MS, described the manifestations and impact of ACOs. James C. Denneny III, MD, described the Academy’s approach and attitude to the changing payment policies and paradigms, and Denis C. Lafreniere, MD, now the BOG immediate past chair, concluded the miniseminar by describing how the BOG is responding to the needs of our membership and the Academy. We are already planning BOG-related activities taking place in Alexandria, VA, March 2-3, 2014. These BOG meetings will be part of an AAO-HNS Leadership Forum, February 28 through March 3, and will  feature strategic planning, BOG committee meetings, leadership sessions, advocacy briefings, and CME. It is an opportunity to get involved, network, and learn. We hope to see someone from every society. Even if you are not a society representative, come. Guests are invited to sit in on committee meetings/sessions and participate in training and possible CME. Check us out!
David R. Nielsen, MD AAO-HNS/F EVP/CEO
You and Your Academy Media Choices
Earlier in the year, some of you participated in a survey on how you read and use the Bulletin, and how you would prefer to use it in the future. While the Bulletin is not an “academic” clinical publication, for purposes of evaluating its success and effectiveness as a periodical it is included in the universe of otolaryngology publications along with ENT Today when comparing such measures as circulation, readership, ads, citations, and other forms of use. Data of this type from the publishing world helps us compare our periodicals to one another and benchmark, improve, and market the Bulletin. It influences advertising sales, submissions of columns from members and other societies, encourages use for meeting notices, and demonstrates the importance of this vehicle for all of our members to communicate broadly about specialty society interests, socioeconomic, political, business, and practice issues. PERQ/HCI by Kantar, a proprietary publication evaluating service, looks at medical journal readership among healthcare professionals and is of particular importance to the Bulletin as a non-academic periodical. Within this universe of otolaryngology publications, the Bulletin has a long-standing history of being highly ranked for readership (in the industry this means “eyeballs on the page”), making it particularly attractive for classifieds, ads, meeting notices, and member use to share information to the broader Academy membership. During my tenure here, it has always ranked among the top third of the more than nine measured otolaryngology publications. On our survey, more than 300 of our members gave direct feedback to specific questions. The questions were strongly worded to elicit honest opinions, both negative and positive, for the purpose of improving the Bulletin. Here is a short capitulation of what we found. The majority of respondents peruse every Bulletin issue and read articles of interest or read every issue cover to cover (74.2 percent). The vast majority of respondents read the Bulletin in print (90.5 percent) rather than online (19.0 percent). A majority collectively said they would use a mobile device to access some element of the Bulletin such as a Table of Contents (37 percent), listen to a podcast or browse and article (31 percent); access available alerts (20 percent); or comment on topics (13 percent). However, a large number (47 percent) said they would not use their mobile device to read the Bulletin. As you can see, we seem to be evolving in our preferences for access to content. As a “curator” for content, the Academy will continue to respond to this evolution in ways that we hope will increase the relevance of our content and programming, as well as facilitate the real-time and point-of-service access that is increasingly demanded. While statistics can sometimes be re-enforcing, they can also be misunderstood or misused and can lead to erroneous conclusions. There are some examples in our survey. We asked which topics were of least interest to our readers. At first glance, the topics rated of least interest to readers revealed subjects that we know from other survey resources are important to our members (advocacy efforts, articles about work and peers, and advertising and classifieds). Since we know that our members care a lot about these topics, it would be a mistake to assume that these topics should be eliminated. In fact, 35 percent, 25 percent, and 24 percent respectively list these topics in the top three reasons why they read the Bulletin. So instead of assuming the three least important topics are not appreciated, we should be amazed to find that the least popular topics are still critical to between a quarter and a third of our members. In other words, the least valued topic on the list is still among the most important topics for a fourth of our readers! The same careful interpretation is required when looking at the least useful content. While humanitarian, international, and editorial content received the lowest ranking out of our list of 10 subjects, 60 percent to 66 percent of respondents stated that this content was “very” or “somewhat” useful to their practices. Again, since we know the huge interest and devotion our members give to international and humanitarian efforts, isn’t it remarkable that our lowest scores have such overwhelming support? If this were an election, 66 percent would be considered a landslide victory! While we have learned much about how the Bulletin can evolve and better meet your needs, a strong underlying message is this: we are a diverse specialty with many varying ideas of what should be prioritized. And the Bulletin is doing a remarkable job of meeting our needs.