Published: January 3, 2014

Grant’s Final Battle

David H. Darrow, MD, DDS In 1879, having failed to win a third Republican nomination for president, Ulysses S. Grant relocated to New York City with his wife, Julia. A career soldier and statesman, Grant had no special skills to rely on for regular income, and had declined offers to publish his memoirs. Encouraged by his son, Buck, he chose instead to lend his money and his name to investors Ferdinand Ward and James Fish; along with Buck, the four established the banking and brokerage firm of Grant & Ward. Although the firm initially thrived, the Grants discovered in 1884 that Ward and Fish had engaged in a Ponzi scheme. Grant & Ward collapsed, and Ward and Fish were eventually convicted and imprisoned. The Grants were bankrupt and moved out of the city with the assistance of donations. Concerned about his legacy and his family’s financial situation, Grant finally agreed to author four articles, and entered initial discussions for a book. At about the same time, while eating a peach, Grant noted a sore area in his throat. By the time he was referred to otolaryngologist John H. Douglas more than three months later, his exam revealed “…a scaly squamous inflammation, strongly suggestive of epithelial trouble.” Also noted were rigidity of the right tongue base and a nodule in the right neck. That Grant was an avid smoker of cigars is no secret. Many accounts suggest he smoked 10 to 20 cigars a day. The degree to which he consumed alcohol is debated, but it is clear that Grant was no stranger to the bottle. Grant stopped smoking and started topical therapies including various gargles and 4 percent cocaine for pain. His physicians, however, ruled out surgery. Increasingly aware of his ultimate fate, Grant decided to author his memoirs so the royalties could provide Julia with an income. He accepted an offer from Samuel Clemens (Mark Twain) to use Twain’s publishing company and agreed to a 75 percent royalty. The subsequent months became a public race to complete his memoirs before his death. As his disease advanced, Grant fought through bouts of hemoptysis and airway obstruction, often choosing to sleep seated to avoid suffocation. Despite the circumstances, Grant continued to write an average of about 750 words a day. Grant’s writing was completed by early July, but revisions had to be completed by Twain and Grant’s son Frederick. The book was completed on July 20, 1885, three days before his death. It is estimated that, in his final victory, Grant left to Julia about $450,000 in royalties.

Illustration of General Grant’s death from Harper’s Weekly, August 1, 1885. Dr. Douglas is second from the left. http://www.encore-editions.com/the-death-of-general-grant-at-mount-mc-gregor-saratoga-co-new-york-july-23rd-1885.Illustration of General Grant’s death from Harper’s Weekly, August 1, 1885. Dr. Douglas is second from the left.
http://www.encore-editions.com/the-death-of-general-grant-at-mount-mc-gregor-saratoga-co-new-york-july-23rd-1885.

David H. Darrow, MD, DDS

In 1879, having failed to win a third Republican nomination for president, Ulysses S. Grant relocated to New York City with his wife, Julia. A career soldier and statesman, Grant had no special skills to rely on for regular income, and had declined offers to publish his memoirs. Encouraged by his son, Buck, he chose instead to lend his money and his name to investors Ferdinand Ward and James Fish; along with Buck, the four established the banking and brokerage firm of Grant & Ward.

Although the firm initially thrived, the Grants discovered in 1884 that Ward and Fish had engaged in a Ponzi scheme. Grant & Ward collapsed, and Ward and Fish were eventually convicted and imprisoned. The Grants were bankrupt and moved out of the city with the assistance of donations.

Concerned about his legacy and his family’s financial situation, Grant finally agreed to author four articles, and entered initial discussions for a book. At about the same time, while eating a peach, Grant noted a sore area in his throat. By the time he was referred to otolaryngologist John H. Douglas more than three months later, his exam revealed “…a scaly squamous inflammation, strongly suggestive of epithelial trouble.” Also noted were rigidity of the right tongue base and a nodule in the right neck.

Grant writing his memoirs at Mt. McGregor, NY. The photo appeared in The Century Magazine, July 1908.Grant writing his memoirs at Mt. McGregor, NY. The photo appeared in The Century Magazine, July 1908.

That Grant was an avid smoker of cigars is no secret. Many accounts suggest he smoked 10 to 20 cigars a day. The degree to which he consumed alcohol is debated, but it is clear that Grant was no stranger to the bottle. Grant stopped smoking and started topical therapies including various gargles and 4 percent cocaine for pain.

His physicians, however, ruled out surgery. Increasingly aware of his ultimate fate, Grant decided to author his memoirs so the royalties could provide Julia with an income. He accepted an offer from Samuel Clemens (Mark Twain) to use Twain’s publishing company and agreed to a 75 percent royalty.

The subsequent months became a public race to complete his memoirs before his death. As his disease advanced, Grant fought through bouts of hemoptysis and airway obstruction, often choosing to sleep seated to avoid suffocation. Despite the circumstances, Grant continued to write an average of about 750 words a day.

Grant’s writing was completed by early July, but revisions had to be completed by Twain and Grant’s son Frederick. The book was completed on July 20, 1885, three days before his death. It is estimated that, in his final victory, Grant left to Julia about $450,000 in royalties.

More from January 2014 - Vol. 33 No.01
AMA CPT® Assistant— Coding Update: Auditory System (69210)
Auditory System code 69210, Removal impacted cerumen requiring instrumentation, unilateral, is revised in the Current Procedural Terminology (CPT®) 2014 code set to include the use of instrumentation in the removal of impacted cerumen (ear wax) and to clarify that the procedure is unilateral. Developed in collaboration with the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS), this article discusses the following three coding scenarios related to ear wax removal and the appropriate CPT codes to report once the 2014 revisions become effective: The patient presents to the office for the removal of ear wax by the nurse via irrigation or lavage. The patient presents to the office for the removal of ear wax by a physician (any specialty) via irrigation or lavage. The patient presents to the office for ear wax removal which requires magnification provided by an otoscope or operating microscope, and instruments such as wax curettes, forceps, or suction by the primary care physician or otolaryngologist. This latter situation occurs most commonly when impacted cerumen completely covers the eardrum and the patient has hearing loss. Question: Are all of these procedures appropriately reported with CPT code 69210, Removal impacted cerumen requiring instrumentation, unilateral? Answer: No. Only the third scenario listed above would be reported with CPT code 69210. A major element in determining whether code 69210 should be reported is based upon an understanding of the definition of impacted cerumen. The AAO-HNS defines cerumen as impacted if any one or more of the following conditions are present: cerumen impairs the examination of clinically significant portions of the external auditory canal, tympanic membrane, or middle ear condition; extremely hard, dry, irritative cerumen causes symptoms such as pain, itching, hearing loss, etc; cerumen is associated with foul odor, infection, or dermatitis; or obstructive, copious cerumen cannot be removed without magnification and multiple instrumentations requiring physician skills. Another key factor in determining whether code 69210 should be reported is what instruments are utilized to remove the impacted ear wax. In this context, instrumentation is defined as the use of an otoscope and other instruments such as wax curettes and wire loops, or an operating microscope and suction plus specific ear instruments (eg, cup forceps, right angle forceps). Accompanying documentation should indicate the time, effort, and equipment required to provide the service. Additionally, the descriptor of code 69210 has been clarified to reflect that code 69210 is a unilateral code. For bilateral impacted cerumen removal, report code 69210 with modifier 50, Bilateral Procedure, appended. Other issues may also require consideration. Removing wax that is not impacted does not warrant the reporting of code 69210. Rather, that work would appropriately be reported with an evaluation and management (E/M) code regardless of how it is removed (eg, lavage, irrigation, etc). Therefore, based on this information, scenarios 1 and 2 would not be reported with code 69210. These scenarios would be reported with the appropriate E/M code. Scenario 3, however, would be reported with code 69210 because both criteria were met: the patient had cerumen impaction and the removal required physician work using an otoscope or other magnification and instrumentation, rather than simple lavage. Add-on code +69990, Microsurgical techniques, requiring use of operating microscope (List separately in addition to code for primary procedure), should not be reported if the operating microscope is used for cerumen removal. In this later instance, however, code 92504, Binocular microscopy (separate diagnostic procedure), may be reported additionally. Finally, an E/M code may be reported if there is a separate and distinct service performed at the same session. In that instance, modifier 25, Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service, should be appended to the E/M code. CPT® Assistant October 2013
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Confused about the Quality Reporting Deadlines? We’re Here to Help!
As the new year begins, it is important for members to stay abreast of the various upcoming quality initiative deadlines. In an effort to provide clarity and highlight valuable resources, the Academy encourages members to utilize the Centers for Medicare & Medicaid (CMS) eHealth Programs Timeline, which can be found at http://www.cms.gov/eHealth/downloads/Timeline_091213_FINAL.pdf. The interactive timeline not only emphasizes looming deadlines, but also provides explanatory steps to ensure compliance with new and ongoing initiatives.   Key 2013 Dates 2013 proved a critical year for physicians participating in various quality initiatives. Important dates and deadlines included: October 1—Start of the EHR Meaningful Use (MS), Stage 2 reporting period for eligible hospitals and Critical Access Hospitals (CAHs) for the 2014 fiscal year. October 15—Last day for groups to register for participation in Group Practice Reporting Option (GPRO) for the 2013 Physician Quality Reporting System (PQRS) program year via Web Interface or registry reporting. October 15—Last day for individuals and groups participating in GPRO to submit administrative claims-based reporting to avoid penalties in 2015. October 15—Last day for groups of 100 or more Eligible Professionals (EPs) to self-nominate/elect quality-tiering for Value Based Payment Modifier. November 30—Last day for Medicare eligible hospitals and CAHs to register for the Medicare EHR Incentive Program for 2013. November 30—Last day for Medicare eligible hospitals and CAHs to register and attest to receive an incentive payment and for eligible hospitals to submit their 2013 fiscal year data through QualityNet to receive an incentive payment. December 31—Reporting PQRS for 2013 for both group practices (participating in GPRO) and individual EPs ended. December 31—Reporting for 2013 Electronic Prescribing (eRx) incentive for group practices (participating in GPRO) and individual EPs ended. What to Expect in 2014 So what’s in store for 2014? 2014 will be as pivotal as 2013 regarding quality initiative rollout dates. Members should be aware that February 28, 2014, is the last day for EPs to register and attest to receive an incentive payment for 2013. Additionally, February 28 is also the last day to submit PQRS data through some reporting methods (Registry and EHR direct submission). February 28 is also the last day to submit Clinical Quality Measures (CQMs) for the EHR Incentive Program Electronic Reporting Pilot. Lastly, the deadline to complete your practice’s transition to ICD-10 is October 1, 2014. Academy Resources In addition to CMS’s interactive timeline, the Academy has numerous resources available to members, including: PQRSwizard:  PQRSwizard is a CMS-certified registry product tailored for otolaryngologists. This online tool helps collect and report quality measure data for the PQRS incentive payment program. Access the tool at https://aaohns.pqrswizard.com/ and http://entnet.org/PQRS. ICD-10 ENT Superbill: The ICD-10 ENT Superbill is designed to assist members in quickly completing and submitting procedure(s) and diagnosis(s) codes from a patient visit for reimbursement. A sample for members can be found at http://bit.ly/entICD10. Quality Program Initiative Fact Sheets: The Academy has developed three quality program initiative fact sheets that provide an overview of each quality initiative (PQRS, EHR, and eRx). Access the fact sheets at www.entnet.org/cmspenalties. These materials and resources are designed to aid in member participation in the initiatives. The Academy understands that the breadth of reporting requirements imposed on physicians can be daunting. Please feel free to email us for support or to suggest additional resources that would be helpful at healthpolicy@entnet.org or quality@entnet.org.
The Intersection of Quality, Safety, and Satisfaction
Rahul K. Shah, MD George Washington University School of Medicine; Children’s National Medical Center, Washington, DC We are all familiar with the Institute of Medicine’s landmark clarion call to improve the safety and quality of care delivery in the United States healthcare system. This report, released almost 15 years ago, served as a catalyst for the modern patient safety and quality improvement efforts and successes. As the last decade and a half has progressed, the role of the consumer (i.e., patient) of healthcare has emerged. The power of the consumer in the healthcare transaction has grown tremendously. Hospitals actively compete for patients to provide care for some services that have high margins and are lucrative for the hospital. How do the hospitals compete for these patients? Of course they must all have excellent outcomes. For example, perhaps a couple of decades prior, we would have been able to compare three hospitals and see disparate results in terms of outcomes—i.e., one would be at 30 percent, another at 50 percent, and the best at 80 percent. Metrics at present are so narrowly defined and the quality of care has improved so significantly that when comparing institutions and providers, quality scores are within a range of a few single digits; for example, these three institutions may now score 98.7 percent, 98.9 percent, and 90.9 percent. What do these numbers mean for the consumer? How is the consumer going to be able to choose where to take their care? They are probably not going to base their decision on these outcome or quality metrics. Satisfaction Surveys Enter the patient satisfaction movement/craze to which physicians are beginning to have to pay attention. There are myriad healthcare satisfaction and experience surveys. These are nothing new; however, they were not widely popular until the past couple of years. Indeed, some otolaryngology practices are piloting the HCAHPS (hospital consumer assessment of healthcare providers and systems) survey for their outpatient practices. These surveys are a “measure” of the “experience” of the consumer. There is variability in such patient satisfaction and experience metrics that perhaps the consumer will be able to discern and select the best institution from these measures. Providers continue to be squeezed in a schizophrenic environment where there are competing demands, unfunded mandates, and outright financial deductions for not adhering to or meeting certain metrics. As I often say, I could easily have the highest patient satisfaction scores in the hospital: I would only see one patient every week. Of course, this extreme is not sustainable on many levels. I have been fortunate to have spent time with and heard a few talks from James Merlino, MD, the chief experience officer of the Office of Patient Experience at the Cleveland Clinic, when he discussed the intersection of patient safety, quality improvement, and patient satisfaction. He has come up with an excellent example of how they intertwine. He uses the airline industry as an example and paints the following story: our first priority when choosing an airline is to ensure we get to where we need to be safely, without crashing (patient safety); once we understand that we are safe, we then want to ensure that we arrive on time and leave on time within reason (quality); once this is established, only then do we consider the inflight amenities and overall comfort (patient satisfaction). Dr. Merlino’s analogy captures eloquently how we should think about patient safety, quality, and patient satisfaction in healthcare delivery. As there will inevitably be many competing priorities and many ideas du jour, it is imperative that Academy members have the ability to rise above the fray and see the proverbial forest for the trees. The analogy further helps us understand the intersection between patient safety/quality improvement and patient satisfaction by prioritizing each one and putting them in a linear perspective. The connectedness is much tighter than we appreciate at first glance, and the relationship is perhaps also much more symbiotic than we appreciate. The study of patient satisfaction is an emerging frontier in the care delivery cycle and one that Academy members need to be versed in. Our own Academy member, Emily F. Boss, MD, MPH, has published several peer-reviewed articles on this topic and explains in her excellent articles the relationship between patient satisfaction, disparities in care, and improvement opportunities. Suffice it to say, the next couple of years will be interesting as providers learn how to navigate these intersecting priorities. We encourage members to write us with any topic of interest and we will try to research and discuss the issue. Members’ names are published only after they have been contacted directly by Academy staff and have given consent to the use of their names. Please email the Academy at qualityimprovement@entnet.org to engage us in a patient safety and quality discussion that is pertinent to your practice.
State Legislatures Back in Session
As we celebrate the new year, many state legislatures across the nation are convening their legislative sessions. AAO-HNS “state trackers” should watch for legislative reports in their email. Reports are sent daily, but will include updates only on bills that are newly introduced, amended, scheduled for a hearing, or receiving a floor vote. If you are concerned you may not be receiving reports, please email govtaffairs@entnet.org. State trackers should also prepare for our next legislative conference call on January 22. The goals of the conference call series are to help educate state trackers, provide a forum to identify national trends, and receive input on the specific needs of each state. The calls last about one hour and will be limited to participants in the state tracking program and state society staff. Trackers will receive an email with the time and login information for the conference call. Thank you to all AAO-HNS members who have already volunteered to fill this important role! If you are interested in becoming a state tracker in your state, please email govtaffairs@entnet.org.
UC-Irvine Residents achieve full participation in the 2013 campaign.
New Year, New Advocacy Campaign: Attention Residents and Fellows-in-Training
At last year’s AAO-HNSF Annual Meeting & OTO EXPO℠, the new Resident and Fellow-in-Training Involvement Campaign was introduced as a means to increase participation from these groups in advocacy-related initiatives. It is essential for residents and fellows-in-training as the future of the specialty to learn about the Academy’s advocacy efforts and become involved early in their careers. The campaign, which is a competition among otolaryngology residency programs, provides AAO-HNS residents and fellows-in-training the opportunity to earn points for themselves and their residency programs. With the start of a new year, now is the perfect time to have your residency program become fully involved with this new campaign! Participation is easy, and in some instances, it only takes a minute to join this ongoing effort. Take part in these small activities and earn points for yourself and your program. Join the ENT Advocacy Network and earn one point. Follow @AAOHNSGovtAffrs on Twitter, friend us on Facebook, and connect on LinkedIn to earn a total of three points. Donate to ENT PAC and gain five points.* These points also come with great rewards. For example, participants in the program receive an exclusive Advocacy Investor T-shirt by earning seven points. The training programs that receive 100 percent participation receive a special breakroom treat. The program with the most points overall will be rewarded with an exclusive networking event with top Academy members at the next annual meeting. Who will be the top advocacy training program in 2014? Only time—and advocacy involvement—will tell! For more information on how to earn more points and increase your training program’s ranking in this fun challenge, email govtaffairs@entnet.org. *Contributions to ENT PAC are not deductible as charitable contributions for federal income tax purposes. Contributions are voluntary, and all members of the American Academy of Otolaryngology-Head and Neck Surgery have the right to refuse to contribute without reprisal. Federal law prohibits ENT PAC from accepting contributions from foreign nationals. By law, if your contributions are made using a personal check or credit card, ENT PAC may use your contribution only to support candidates in federal elections. All corporate contributions to ENT PAC will be used for educational and administrative fees of ENT PAC, and other activities permissible under federal law. Federal law requires ENT PAC to use its best efforts to collect and report the name, mailing address, occupation, and the name of the employer of individuals whose contributions exceed $200 in a calendar year. State Legislatures Back in SessionAs we celebrate the new year, many state legislatures across the nation are convening their legislative sessions. AAO-HNS “state trackers” should watch for legislative reports in their email. Reports are sent daily, but will include updates only on bills that are newly introduced, amended, scheduled for a hearing, or receiving a floor vote. If you are concerned you may not be receiving reports, please email govtaffairs@entnet.org. State trackers should also prepare for our next legislative conference call on January 22. The goals of the conference call series are to help educate state trackers, provide a forum to identify national trends, and receive input on the specific needs of each state. The calls last about one hour and will be limited to participants in the state tracking program and state society staff. Trackers will receive an email with the time and login information for the conference call. Thank you to all AAO-HNS members who have already volunteered to fill this important role! If you are interested in becoming a state tracker in your state, please email govtaffairs@entnet.org.
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ENT PAC
2014 is an election year for Congress. ENT PAC, the political action committee of the AAO-HNS, financially supports federal Congressional candidates and incumbents who help and/or 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 our PAC website at www.entpac.org (log-in with your AAO-HNS ID and password).
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Follow Government Affairs on Twitter
Do you want to be one of the first to know the status of healthcare bills moving through Congress? Follow the Government Affairs Twitter account @AAOHNSGovtAffrs. By following us, you can learn more about the issues affecting the specialty, including repeal of the flawed Sustainable Growth Rate (SGR) formula, medical liability reform, scope-of-practice battles, Graduate Medical Education (GME) funding, truth-in-advertising (TIA) initiatives, and efforts to repeal the Independent Payment Advisory Board (IPAB). Not a fan of Twitter? You can also check the Government Affairs webpage for updates at http://www.entnet.org/Advocacy.
No Travel Necessary!
Interested in where your Members of Congress stand on the issues important to the specialty? Join the growing number of otolaryngologist-head and neck surgeons participating in the AAO-HNS In-district Grassroots Outreach (I-GO) program! I-GO volunteers work with Academy staff to meet with their elected officials at town hall meetings, fundraising events, their practice location, or in a legislator’s district office to discuss important issues affecting the specialty and patients. Key topics being discussed include the repeal of the Sustainable Growth Rate (SGR) formula, Graduate Medical Education (GME) funding, and truth-in-advertising legislation. The Academy is currently recruiting members for the upcoming President’s Day recess. If you are interested in becoming a local voice for the specialty, email govtaffairs@entnet.org.
Ideological Divide Sets Stage for Bumpy Start to 2014
It’s that time of year again—a time for fresh starts and new perspectives, right? If only that thought rang true for Congress. As the second session of the 113th Congress convenes this month, we find that not much has changed and the ideological divide that paralyzed the nation’s capital for several weeks last October is still alive. This month, Congress would have faced the first of two critical deadlines put in place by the “compromise” that ended last fall’s government shutdown. Congressional leaders had set a January 15 deadline to develop a framework for funding the government. However, in mid-December, U.S. Representative Paul Ryan (R-WI) and U.S. Senator Patty Murry (D-WA) announced that a two-year budget deal had been reached. Included as an amendment to this bill was language to halt (for three months) the 20+ percent cut in Medicare physician payments scheduled for January 1, 2014. Instead, physicians will receive a .5 percent positive increase during that time. This payment “bridge” is intended to avoid payment disruptions as Congress completes its work on permanent SGR repeal legislation early next year. The budget compromise, including the SGR “bridge,” was passed (332-94) by the U.S. House of Representatives on December 12, and, at the writing of this article, the U.S. Senate was scheduled to consider the legislation sometime during the week of December 16. Looking to next month, Congress will again contend with increasing the nation’s borrowing capacity, with the February 7 deadline capping what could well become an extremely contentious start to the year. Several key issues—including changes to entitlement programs, and tax reform—remain focal points for the negotiations. In addition, implementation of the Affordable Care Act and general healthcare reform efforts will likely also remain recurring themes as Congressional leaders again attempt to find common ground regarding the aforementioned issues. The ease—or pain—by which these two early deadlines are addressed will undoubtedly be woven into the election-year rhetoric that will begin taking center stage as the primary season for the 2014 mid-term elections gets underway. So, unfortunately, 2014 is poised to be yet another year that lacks substantial legislative activity, with the outcome of this year’s elections largely determining the outlook for Congressional comity versus continued contentiousness through 2016.
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How Do We Improve Education? We Asked and You Responded!
Sonya Malekzadeh, MD Coordinator for Education Last year, we asked you, our members, to voice your opinions and to provide feedback on ways to improve the Foundation’s education programming. Your response has been tremendous. The compilation of ratings and comments will be an invaluable resource in planning an exciting future for the Foundation, one that meets the needs and interests of the diverse AAO-HNS membership. Based on a thorough analysis of this needs assessment initiative data, it has become increasingly clear that we will need to focus on three central themes: awareness, engagement, and value. Accordingly, the Foundation will use this information to direct the development of a new and innovative professional development program. As President Richard W. Waguespack, MD, described in his column (see page 7), our overarching goal is to increase awareness and user engagement, with the measure of our success being member access to premium otolaryngology content on the web and in print. The otolaryngology community’s understanding of, and involvement in, our education mission is essential to successful programming. Your feedback indicates that in addition to traditional education methods, a growing number of members desire a larger eLearning environment and expanded electronic platform. With a better appreciation of our members’ preferred learning styles in education and training, combined with today’s expanding technology, we will be better equipped to offer many new and varied formats to enhance learning experiences. Additionally, a thorough review of existing education products will help us enrich and improve these resources to best meet your education needs and learning preferences. Look for electronic upgrades and web-based formats of your favorite education products in the ensuing months. One message came across loud and clear from your survey responses: when it comes to providing quality education and knowledge resources the Foundation “can’t do it alone.” Collaboration will provide greater opportunities to enhance the education offerings and to create superior programs that will effectively meet the education needs of both general otolaryngologists and specialists. Building on our relationships with the American Board of Otolaryngology, our sister societies, and other healthcare groups, we will assemble a comprehensive set of resources for all our learners. As we prepare to introduce you to the Foundation’s improved learning platform, we’d like to thank the hundreds of members who’ve taken the time to respond in depth to our surveys. Your comments will help make otolaryngic education better, and we promise to keep listening. You will continue to play an integral role in redefining and planning future programming. As I reflect on the last two years, I share with you my sense of pride in our education faculties. While we have made strong progress, we must also embrace the new challenges and opportunities that lie ahead. I am enthusiastic and optimistic that with the assistance of our education leadership and numerous dedicated volunteers, we will deliver state-of-the-art knowledge and education resources of value to all our learners. Academic Bowl Winner Congratulations to Geisinger Medical Center, Danville, PA, for winning the seventh Annual AAO-HNSF Academic Bowl at the AAO-HNSF 2013 Annual Meeting & OTO EXPOSM.The Academy is grateful to the additional teams that competed: University of Michigan University of Missouri Northwestern University Special thanks to Mark K. Wax, MD, who moderated the event.
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AcademyU® is All about YOU
Your copy of the 2014 Education Opportunities has arrived with this Bulletin. Hopefully you have already paged through it to see how the Foundation is making you aware of the many education and knowledge resources we offer to members and non-members alike. The Education emphasis this year will be on YOU, encouraging our members to engage in the education and knowledge resources the Foundation offers. In an effort to continually create greater awareness of all the education and knowledge resources available across the Academy and Foundation, we are introducing new “elements” to the AcademyU® education and knowledge “table.” While you may be familiar with many of these resources, our intent is to showcase how they contribute to your overall professional development. Find access to all at www.entnet.org/academyU. Clinical Practice Guidelines (Cpg) This new element is an outcome of efforts to provide members with the tools needed to implement the guidelines into your practice. Cpg will take you directly to all the Clinical Practice Guidelines and other resources for you to use to familiarize yourself with them. Cpg will be updated as new materials are developed and new guidelines are released. Otolaryngology-Head and Neck Surgery Journal The journal is the premiere source for contemporary, ethical, and clinically relevant information in otolaryngology and head and neck surgery that can be used by otolaryngologists, scientists, clinicians, and related specialists to improve patient care and public health. OTO Jnl will link you to the journal website where you have access to the journal online, selected podcasts, and meeting abstracts. Annual Meeting Webcasts and Posters (AmW and AmP) Annual Meeting learning never ends with online access to the presentations and posters. At each Annual Meeting & OTO EXPOSM nearly every miniseminar, instruction course, and oral presentation is recorded for future viewing. These webcasts (AmW) are available for purchase and viewing shortly after the meeting has ended. And, as a special benefit, Members are given their choice of six free webcasts each year. Prior annual meeting webcasts are available for purchase as far back as 2004. In addition, poster presentations (AmP) for several past meetings are available for no charge. ENT for the PA-c Annual Conference (PA-c) Each year, the Foundation partners with the Society for Physician Assistants in Otolaryngology to hold a special conference for physician extenders, especially physician assistants and nurse practitioners. In its fourth year, the 2014 event will take place April 24-27 in Pittsburgh, PA, hosted by the University of Pennsylvania Medical Center and Jonas T. Johnson, MD. This conference provides both extensive hands-on workshops and didactic lectures from top otolaryngology experts. Click on PA-c to register. Pediatric Otolaryngology Webinar Series (Pws) In collaboration with the American Society of Pediatric Otolaryngology, the Foundation is cosponsoring a series of webinars targeting the pediatric otolaryngologist. There are 10 webinars in the year-long series presented by experts in the field covering such topics as pediatric sleep disordered breathing; cochlear implant update; management of acute airway; and evaluation and management of laryngeal cleft. Practice Management Resources In this ever-changing world of healthcare, it is vital otolaryngologists remain up to date and aware of the new policies and actions that affect their practices. The Academy’s health policy resources are excellent tools to help you navigate through these changes. Pmr will link you to resources available in the areas of coding and practice management, quality and safety, and payment reform. Remember, AcademyU® is YOUR otolaryngology education source. Its mission is to meet your professional development needs by providing education and knowledge elements that span several learning formats and designs. Please be aware, stay engaged, and realize the value of education from the Academy.
Technological advances attract a crowd of Academy members to an exhibit hall demonstration.
Technology Enhances the Education Experience for Members
The Foundation is continually exploring ways to improve education opportunities for Members. New technologies within professional education provide many options to enhance one’s learning experience. There are several projects in development at the Academy that, through technology, will provide more meaningful and rewarding education and knowledge products, and services for you in 2014. Below is a glimpse of what this means for you. Web-based Learning One result of the 2013 Education Needs Assessment survey was a clear preference among members for more web-based education formats. Members indicated they are using smartphones, tablets, and eReaders for continuing education information. In addition, preferred learning formats included online self-paced courses, smartphone and tablet apps, and webinars. Survey respondents also offered useful suggestions about integrating more technology into the Foundation’s education program. Because of these preferences and expectations, the focus will be toward more eLearning in the design of future education and knowledge resources. Members will see this transition in 2014 as each education and knowledge resource goes through a thorough review to see how it can be enhanced by new technology. AcademyU®.org AcademyU.org is coming soon. This new education site will make for a richer member education experience by providing the ability to offer new products and services. Quick and easy access to all the Foundation’s education and knowledge resources will be available through an improved search capability. Real-time access to continuing education credit information will help you track your progress and credit awarded. This new site will also provide robust analytics that the Foundation will use to evaluate its products and inform the development of new content. New Academy Website Plans are well under way to create a brand new entnet.org. This includes a complete revamp of the site designed to improve navigation, keyword searching, and easy access to content. It will employ responsive design, which allows one to engage with the site through multiple devices including smartphones and tablets. What this means for professional education is a more easily searchable site that allows members to access education and knowledge resources of most interest to them. Plans are to organize the education content not only by specialty area, but also by audience type. Member Engagement Portal Efforts are currently under way to launch ENTConnect, the new and engaging Member Portal. This will be a highly interactive site where members can gather, share, and talk with each other. The site will host many features that allow for meaningful connections with colleagues across the country and the world. Education and knowledge resources will be created and developed through this interactive platform by allowing the Education Committees to share and review documents. Education course participants can engage in discussions about the activity and more interactive learning can occur by using this platform. “These initiatives are very exciting and a positive step for the Academy. Participants in the education and knowledge resources will benefit greatly from these new and innovative tools that will make learning both enjoyable and productive,” said Sonya Malekzadeh, MD, Foundation Coordinator for Education. As always education leadership wants to hear from you if you have an innovative education idea that uses these new technology resources.
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Foundation Education for Board Certification
It is estimated that nearly half of our members will participate in the Maintenance of Certification® (MOC) or Maintenance of Licensure (MOL) process during the next few years. In addition, our resident members will be working toward passing their Board Certification as they complete their residencies. These members have made it clear that they are looking to the Foundation to provide them the resources they need to prepare for these professional milestones. The Foundation continues to address this concern and provide useful education and knowledge resources.   AcademyQ Knowledge Assessment Tool In the summer of 2012, the Foundation launched the AcademyQ Knowledge Assessment Tool in the form of an iPhone/iPad app. This app assists members in enhancing their knowledge of otolaryngology-head and neck surgery with hundreds of study questions to test recall, interpretation, and problem-solving skills. This mobile app includes questions across the eight specialties. Users are provided with instantaneous, detailed feedback, and they can highlight, take notes, and mark questions for future review. The app is available through the Apple App Store by keyword searching “AAOHNS.” There are 10 free questions available with the download and an additional 390 questions available for $49.99. Work is under way in 2014 to publish new questions and to provide further enhancements to the product.   Clinical Fundamentals In response to a request from the American Board of Otolaryngology (ABOto), the Foundation is offering a series of both Annual Meeting Instruction Courses and online courses that address 10 clinical fundamentals topics all physicians should be aware of and trained in. As a component of Part III of MOC®, physicians are required to view and pass the following courses: Clinical Outcome Measures/Evidence-Based Medicine Treatment of Anaphylaxis HIPAA: Updates and What it Means for You DVP: How, When, Why in Otolaryngology Integration of Quality and Safety into Otolaryngology Anesthesia-Related Topics for Otolaryngologists Management of the Addicted Surgeon Ethics and Professionalism Pain Management in Head and Neck Surgery Universal Precautions for the Otolaryngologist These courses were presented at the 2012 and 2013 annual meetings and have been recorded and published as online courses through AcademyU®. They will continue to be offered as instruction courses at future annual meetings. Whether someone takes the live or online course, he or she is required to pass a post-test to receive the appropriate MOC® credit. Passing the post-test qualifies one for one hour of CME credit per course. The online per course fee is $75 for members and $100 for nonmembers and can be accessed through the AcademyU section of www.entnet.org./academyU. Otolaryngology Review: A Lifelong Learning Manual In an effort to meet the education needs of our members who may be preparing for board certification or recertification, or just looking to keep up with the continually growing field of otolaryngology, the Foundation is updating the 2002 Maintenance Manual for Lifelong Learning. Renamed Otolaryngology Review: A Lifelong Learning Manual, it is the result of great effort on the part of the eight Education committees. This important education resource reflects the Foundation’s commitment to lifelong learning and providing resources for members undergoing certification or recertification. The primary goal of the updated manual is to address issues of practical importance to otolaryngologist-head and neck surgeons in order to improve patient care. The 2014 edition will have more than 100 chapters across 10 sections representing the most critical topics otolaryngologists need to be aware of in their practices. Otolaryngology Review will be available by summer 2014. These are just three ways the Foundation is responding to its members’ requests for assistance with Board certification. As current education and knowledge resources undergo review and update as a result of the 2013 Education Needs Assessment Initiative, emphasis will be placed on more ways to provide members with the tools they need to maintain their high level of patient care.
Dr. Rosenfeld during the Annual Meeting Guideline on Tubes miniseminar.
Education and Research: A Critical Partnership
One milestone of the Education strategic plan is to extend education and knowledge resources focused on topics critical to patient care. This includes clinical practice guideline (CPG) education. During the past year, staff and leadership from both Education and Research and Quality Improvement have been meeting to discuss how best to partner and educate healthcare professionals on Academy-developed CPGs. This collaboration has resulted in a five-point action plan. Determining Education Gaps and Needs in Relation to Guidelines The Education Gaps and Needs Initiative incorporates the selection of topics for new education activities that are based on formal gaps and needs analyses. Given the extensive amount of time and resources that go into the identification of new guideline topics and voting by the specialty societies, it is a natural progression to then take the quality improvement foci included in the CPGs and develop education products. The key action statements of each CPG will be used in designing new education activities. The goal is to incorporate CPG recommendations into Education Committee activity, topic, and format selection. Marketing and Distributing Guideline Education Activities It is imperative to cross-promote CPGs to both the Education and Research and Quality Improvement audiences. CPG education will be incorporated into the overall AcademyU® Education Source and the dedicated guideline webpages will also include links to the new education offerings. Some of the most immediate tools available include the CPG journal podcasts and online lectures. We are working together to identify additional tools that would be of value to the membership. One of these ideas includes the development of slide sets for each guideline. These will be made publicly available to help both members and non-members educate others about the AAO-HNSF CPGs at their state and local levels. Education Representation and Participation in Guideline Development Efforts have also been made to bridge the gap between CPGs and education. An Education representative currently serves on the Guidelines Task Force and on each of the current guideline development groups. Job descriptions and role expectations are being developed for these positions. Ensuring Compliance with New Education Activities It is critical that newly developed education and knowledge resources be compliant with CPGs. This will be done by ensuring all current education content is reviewed for compliance and all new content being developed incorporates the recommendations of the published guidelines. Faculty Development Work is under way on author guidelines that include instructions on how to develop content that is compliant with the CPGs. Concurrently, there will be faculty training to ensure awareness of all Academy CPGs and how to incorporate content into the education activities they develop. The AAO-HNSF is excited to be moving into this new phase. Since the Academy started developing CPGs in 2006, efforts have focused solely on dissemination. With more than 350,000 downloads of our guidelines from the National Guideline Clearinghouse and more than 1,200 citations for them, we have been successful with dissemination. This new collaboration between Education and Research and Quality Improvement will enhance efforts in the education arena and both Education and Guidelines leadership believe these combined efforts will increase the uptake and implementation of the guidelines.   Recorded CPG miniseminars from 2013 Annual Meeting  & OTO EXPOSM Miniseminar: AAO-HNSF Clinical Practice Guideline on Bell’s Palsy Presenter: Lisa E. Ishii, MD, MHS Miniseminar: AAO-HNSF Clinical Practice Guideline on Tympanostomy Tubes in Children Presenter: Richard M. Rosenfeld, MD, MPH See these at www.entnet.org/onlinecourses.
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2013 Education by the Numbers
6  The number of topics covered in the General Otolaryngology Review Course held at the 2013 Annual Meeting. The course presented a concise review of general otolaryngology topics that provided attendees a starting point in preparing for recertification. Look for new review courses at the 2014 Annual Meeting. 1,016  The number of Coding and Reimbursement Workshop attendees across eight locations. This is an 18 percent increase in attendees over 2012. ICD-10 will be a focus of the 2014 workshops; in Dallas, Orlando, Las Vegas, Chicago, and four other locations. 125 The number of articles spanning four sections of the Home Study Course. Specialties covered this year included Head and Neck Surgery, Otology and Neurotology, Congenital and Pediatric Problems, and Clinical Competency Issues. 8 The number of issues of Patient Management Perspectives published. Titles included Adult with Rhinoplasty Consultation: The Mixed Non-Caucasian Rhinoplasty, Adult with Epistaxis and Adult with Recurrent Rhinorrhea, Adult with Multiple PET- Positive Lesions: Ethics and Decision Making at the End of Life, Child with Recurrent Throat Pain and Fever, Adult with Recurrent Vertigo, Adult with a Neck Mass, and Nasal Reconstruction. 21 The number of Online Lectures published in 2013. Topics include pediatric obstructive sleep apnea, balance problems in the elderly, endoscopic and robotic thyroid surgery, five new landmarks to make you a better sinus surgeon, chronic cough: hacking up a treatment algorithm, surgical management of eustachian tube disorders, and developing a quality control program for surgeons. These have joined the list of more than 120 online courses available in AcademyU®. 10 The number of Clinical Fundamentals topics presented at the 2013 Annual Meeting & OTO EXPOSM.These sessions satisfy the Clinical Fundamentals requirement of Maintenance of Certification®. Two of the courses are currently available online with eight more to follow in early 2014. Look for them in AcademyU®. 4,605 The number of Online Course Completions. Thousands of members take advantage of the Foundation’s free online education covering the breadth of the specialty;  all courses are available in AcademyU®. 3,204  The number of  AcademyQ® Knowledge Assessment app downloads. In addition, 400 individuals have purchased the full set of 400 high-quality, peer-reviewed questions with explanations and references. This is an ideal certification exam resource. 28,323 The number of ENT Exam Video Series views. This four-part video series is a great tool for teaching residents and medical students. The series, available on YouTube, depicts how to perform a thorough ENT Exam. All videos include images of normal anatomy, normal variances, and common abnormalities. 10 The number of Pediatric Otolaryngology Webinars available online. Sponsored by both AAO-HNSF and ASPO, they address topics such as respiratory papillomatosis, Down’s syndrome, speech assessment and resonance disorders, and seven more. Look for 10 new webinars in 2014. 200 The number of PAs and NPs at the ENT for the PA-C conference in April. The New York event provided attendees with excellent networking opportunities including hands-on workshops with concise content and small group settings. The 2014 conference will be in April in Pittsburgh, PA.
Choosing Wisely® Brochure on Oral Antibiotics for Ear Infections Now Available
From: Consumer Reports Share       Consumer Reports, a Choosing Wisely® campaign partner, has produced English and Spanish patient brochures from the AAO-HNSF’s list of procedures and treatments that patients and physicians should question. “Oral Antibiotics for Ear Infections: When You Need Them, When You Don’t” is now available as a patient/physician discussion resource at http://consumerhealthchoices.org/catalog/oral-antibiotics-for-ear-infections-aao-hnsf/.
2013
Jerome C. Goldstein, MD Public Service Award
The Jerome C. Goldstein, MD Public Service Award recognizes members for their commitment and achievement in service within the United States, either to the public or to other organizations, when such service promises to improve patient welfare. The 2013 recipient, Steven F. Isenberg, MD, is a marathon runner and founded Medals4Mettle (www.medals4mettle.org) in 2005, a 501c3 non-profit organization that awards endurance athletes’ finishers medals to struggling patients (mostly children) and others who demonstrate mettle, or courage, as they struggle through life’s challenging marathon. His efforts have resulted in awarding more than 25,000 medals worldwide in more than 100 hospitals. Dr. Isenberg’s commitment in service to others in the United States is outstanding and the AAO-HNSF is proud to honor him as the recipient of this prestigious award. Nominations for 2014 are now being accepted. Any Academy member in good standing is eligible to be nominated, or to nominate another member. Nominations must be submitted by January 30, 2014. The finalist will be selected on February 11, 2014. The recipient will be recognized during the 2014 Annual Meeting and OTO EXPOSM in Orlando, FL. Visit http://www.entnet.org/Community/Goldstein-Award.cfm for more information.   Nominations Deadline for World Chinese Academy Past Academy President K.J. Lee, MD, has announced a call for nominations to represent U.S. otolaryngologists on the Board of the World Chinese Academy of Otolaryngology—Head and Neck Surgery, Ltd. The World Chinese Academy is an International Corresponding Society, affiliated with the Academy. Nominees for the three U.S. positions must be otolaryngologists of Chinese descent. The position is open to qualified  board certified otolaryngologists of Chinese descent. If interested send a CV to KjleeMD@aol.com. The nomination period ends February 15, so act now.
OHS Member, Dr. Lanny Close
Otologic Anatomical Advancement in 18th Century England—Or The Lack of: The Case of Dr. William Cheselden
C. Eduardo Corrales, MD Albert Mudry, MD, PhD At the turn of the 18th century, no suitable atlas of anatomy existed in the English language. In 1713, William Cheselden (1688-1752) published the English manual of anatomy entitled The Anatomy of the Human Body. Contrary to the custom of his day, which preferred Latin (Contugno and Scarpa) or French (Guyot and Petit), Cheselden composed the entire book in English. A unique work, it spanned 93 years with 15 editions including one German edition and three American editions up to 1806. A huge success, the compendium became the preeminent anatomical reference textbook in English-speaking countries. It is largely an anatomical textbook filled with surgical techniques. Cheselden dedicated one chapter to the ear, describing its different anatomical features. In the first edition, Cheselden notably mentions four middle ear ossicles: malleolus, incus, stapes, and officulum quartum; four auditory muscles: externus tympani, obliquus, internus, and stapidis; a description of a tympanic membrane with a small opening; and hearing through the Eustachian tube. In the second edition, he modified the nomenclature of the malleolus to malleus and the officulum to orbicular ossicle, and named the auditory muscles obliquus internus or trochlearis, external oblique, external tympanic, and stapedial. He demonstrated bone conduction through the teeth and discussed the opportunity to perform a myringotomy to improve hearing, which he ultimately performed it on dogs in 1722. He added a “valve” covering the aperture of the tympanic membrane in the third edition. Virtually no modifications to the ear chapter appeared in subsequent editions. Especially interesting are his later editors and publishers in charge of his book. This article primarily demonstrates that Cheselden and his subsequent editors did not critically analyze the otologic knowledge of their time, emphasized by the lack of description of most otologic advances made in the 18th century. Key otologic advances included: A detailed description of the cochlear scalae (Valsalva, 1704); Catheterization of the Eustachian tube through the mouth (Guyot, 1724); The first surgical opening of the mastoid (Petit, 1774); Catheterization of the Eustachian tube through the nose (Cleland, 1744); The first artificial perforation of the tympanic membrane (Bresson, 1748); A description of inner ear fluid (Cotugno, 1760); The inner ear filled with two different fluids (Scarpa, 1789); and A description of the membranous labyrinth (Scarpa, 1795). Possible explanations include: Most treatises of the time were published in French, Italian, or Latin; virtually all otologic advances were published in non-English languages. His treatise was largely a general surgery reference textbook and otology was not a formal surgical specialty. He may have been exposed to secondary references such as Duverney’s Treatise of the Organ of Hearing (1683). Most otologic advances were made in laboratories that combined anatomists, physiologists, and pathologists, and this combination of scientists was mainly to be found in France, Germany, and Italy. Lack of interest of Cheselden and subsequent editors in otologic anatomy may be a reason for lack of otologic advances described in his treatise. Cheselden was undoubtedly one of England’s greatest surgeon-scientists in the 18th century. He was an innovator, skilled politician, and medical illustrator. His compendium spanned 93 years as the anatomical reference book in English-speaking countries. Interested in Our History? Join or renew your membership in the Otolaryngology Historical Society (OHS)—check the box on your Academy dues renewal or contact museum@entnet.org. Save the date—the OHS annual meeting and reception, 6:30 pm-8:30 pm, September 22, in Orlando, FL. Present a paper at the OHS meeting-contact museum@entnet.org. May 15 is the deadline.
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PQRSwizard
Act now to avoid the 1.5% CMS penalty and become eligible for a 0.5 percent incentive! PQRSwizard deadline for 2013 reporting is March 13, 2014. The AAO-HNSF has partnered with CE City to provide members with a web-based solution for reporting PQRS measures to the Centers for Medicare and Medicaid (CMS). For a nominal fee, PQRSwizard offers a fast, convenient, and cost-effective online registry to help collect and report quality measure data for the PQRS incentive program. Similar to online tax preparation software, the PQRSwizard helps guide you through the steps to rapidly collect, validate, report, and submit data to CMS for payment. The PQRSwizard is powered by the CE City Registry, a CMS qualified registry for PQRS reporting. On Tuesday, January 21, the AAO-HNSF and CE City will host a webinar providing an overview of PQRS and the PQRSwizard. The webinar will be from 7:00pm-9:00pm ET. Register for the webinar now at https://www2.gotomeeting.com/register/420063778 The webinar will highlight the following: Incentive payments available for successful reporting Quality measures available for PQRS reporting How PQRSwizard can communicate with your EHR PQRS penalities Learn more about the PQRSwizard: https://aaohns.pqrswizard.com/default.aspx Learn more about PQRS: http://www.entnet.or/Practice/qualityimprovement/cmsPQRS.cfm and http://www.cms.gov/PQRS Please contact the AAO-HNSF Quality Improvement staff (qualityimprovement@entnet.org) if you have any questions regarding PQRSwizard, the PQRS program, or registering for the webinar.
AIUM/AAO-HNS Establish Accreditation Training Guide for Head and Neck Ultrasound
For the past year, negotiations and formal documentation have passed from our Ultrasound Review Board to the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) and the American Institute for Ultrasound in Medicine (AIUM). The Review Board consists of four individuals who have been part of the ACS Head and Neck Ultrasound Courses for several years and are experienced in both performing ultrasound and teaching it to residents and post-graduate physicians. This Board has been a working group and will be expanded as the accreditation project advances. The end result has been a joint approval from both organizations for an accreditation of the facilities where clinicians and residents, who have had sufficient exposure and experience in head and neck ultrasound, can practice. The precise timing of implementation is still undetermined, but should be within the next six months. This process has evolved to add credibility to those who take the initial step of enrolling in the American College of Surgeons Post-graduate Head and Neck course during the AAO-HNSF Annual Meeting, ACS Annual Congress, and identical exported courses. Some individuals have complained that as non-radiologists they are unable to receive reimbursement for their service of “point-of-care” ultrasound and future requirements from government agencies will certainly demand that we are qualified to apply this important craft. With that simple introduction, we would like to outline the process as follows: Training Guidelines Completion of an ACGME-approved residency in otolaryngology, general surgery, and radiology (either Board certified or eligible) Documentation of one of the following: Completion of the ACS Post-graduate Course in Head and Neck Ultrasound. An equivalent course may by acceptable to the Review Board if the course content and experience is in keeping with the ACS course. Completion of a residency in which sufficient practical experience and didactic lectures and skill sets may be considered for accreditation. The resident must keep an accurate log of performance of 100 ultrasound examinations from each of six designated head and neck areas. The resident must successfully complete the 100 question ACS test and then will not be required to enroll in the formal ACS course. After completing one of the above requirements the clinician must have a minimum of six months of hands-on experience along with an identified experienced mentor for consultation. During this minimum interval time or maximum of two years the candidate must demonstrate direct application of 100 ultrasound examinations. Validation of competency—de-identified images and reports from 20 ultrasound cases taken from three of six head and neck areas must be submitted to an amplified Review Board and then maintain a minimum experience with 50 ultrasound examinations per year. Accredited individuals are required to obtain a minimum of 12 AMA PRA Category 1TM credits in head and neck ultrasound every three years. This is a brief introduction and the AIUM website will be the primary resource for best understanding the details of submission. The cost will be modest and all submissions will be to AIUM under the evaluation by our Review Board that is soon to be constructed of competent otolaryngologists with significant ultrasound experience and education. The AAO-HNS and ACS will help us to alert its members when the process is to begin. Please do not query or try to rush the process as its construction is complicated and must be ideally configured before it becomes public. This is a very exciting opportunity for our membership and is likely to stimulate the involvement of residency programs that do not yet teach or provide ultrasound. Ultrasound Review Board Robert A. Sofferman, MD, emeritus professor of surgery, University of Vermont School of Medicine, Review Board chairman Lisa A. Orloff, MD, professor of otolaryngology-head and neck surgery, Stanford University Merry E. Sebelik, MD, associate professor of otolaryngology-head and neck surgery, University of Tennessee Medical Center Russell B. Smith, MD, professor of otolaryngology-head and neck surgery, University of Nebraska Medical Center The American Institute of Ultrasound in Medicine (AIUM) is very pleased to have collaborated with the American Academy of Otolaryngology-Head and Neck Surgery in developing the Practice Guideline for the Performance of Ultrasound Examinations of the Head and Neck, along with the “Training Guidelines for Physicians Who Evaluate and Interpret Ultrasound Examinations of the Head and Neck.” As a multi-specialty, modality-driven society, the AIUM appreciates the value of collaboration, and we commend the AAO-HNS and Robert Sofferman, MD, in particular for their initiative and leadership in helping to bring this to fruition. These guidelines will help serve as a measure of quality and will help to promote patient safety. Carmine M. Valente, PhD, CAE  CEO, American Institute of Ultrasound  in Medicine (AIUM)
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Oral Head And Neck Cancer Awareness Week (OHANCAW®)—April 20-26
Editor’s Note: The OHANCAW website is a great resource for Academy Members. You will find great background resources to share in your community, and organizational tools for participation. The following is reprinted from its website. What? A week that is organized by grass roots groups of individuals that are knowledgeable about cancers of the head and neck region. The week is organized at the discretion of these “local” directors and officers and customized to the resources and needs of their location. The week may include news releases, public service announcements, talks at middle schools, free cancer screenings, cancer survivor banquets, walk-a-thons, and research conferences. Why? Head and neck cancers include cancers of the following areas: Mouth Throat Voice box Skin Sinuses Saliva glands Thyroid gland How? You can be the first to start OHANCAW® in your hometown.  Sign up at http://www.kintera.org/site/c.8hKNI0MEImI4E/b.6281225/k.BDD9/Home.htm. Most people who start an event in their hometown have no idea how to begin. Here are the simple steps: Develop a timeline. Once you decide to begin and sign up on the website, you are ready to go. In fact, each participant will be provided the ability to create a webpage with information, images, and videos with links to your site through Friends Asking Friends. Identify what events you would like to participate in from the following list: News and media release Talks at middle schools by survivors and healthcare professionals Walk-a-thon Free cancer screenings Survivor events (banquet, silent auction, reception) Mayoral and/or gubernatorial official announcements Now, it is time to gather your volunteers which brings us to: Who? Physicians-otolaryngologists, head & neck surgeons, radiation and medical oncologists, consider these resources to help your event: Cancer survivors Friends and family of cancer survivors Public relations and marketing department Nurses Speech pathologists Dieticians Social workers Dental hygienists Dental assistants Dentists, oral & maxillofacial surgeons, maxillofacial prosthodontists Students-medical, dental, speech and language pathology, undergraduate Where? The locations of each event may be different. Some of the places these events have occurred since the inaugural year of 1998 include: Clinics Hospitals Offices Malls Churches Barber shops and salons Cancer centers Dental schools Medical schools Health fairs NASCAR races Major league (and minor league) baseball games When? April 20-26, 2014 or any time of your choosing! Many groups around the U.S. and abroad organize these events during OHANCAW®, or on a day, date, or week of their choosing. Although the broadest exposure is during OHANCAW®, many people and organizations cannot schedule the event due to other conflicts. Thus, many are organized during other weeks or even months of the year. More information at: http://www.kintera.org/site/c.8hKNI0MEImI4E/b.6281225/k.BDD9/Home.htm. Patient Information
Ken Yanagisawa, MD, Vice Chair, BOG Socioeconomic & Grassroots Committee
OHANCAW—A Worthy Investment
“OHANCAW.” “Say what?” “OHANCAW! It stands for Oral Head And Neck Cancer Awareness Week.” Otolaryngologists remain at the forefront of the surgical specialties in involvement in important endeavors to help our patients, especially critical during these turbulent times. One area that has provided a valuable opportunity for every otolaryngologist to contribute to our specialty and our patients’ well-being has been OHANCAW, yet another healthcare acronym, but one that projects potential hope and improvement. Each year, a week in April is designated the Oral Head and Neck Cancer Awareness Week. This year it’s set for April 20-26. This special week represents a time to increase public awareness about head and neck cancer, and is spearheaded by the Head and Neck Cancer Alliance, formerly known as the Yul Brynner Head and Neck Cancer Foundation. After Yul Brynner was diagnosed with a vocal-fold lesion by George Sisson, MD, in the 1980s, he created the Yul Brynner Foundation in 1984 to educate the public about the dangers of tobacco and increased risks of throat cancer. Jerome C. Goldstein, MD, was the inaugural chairman of the Board of Directors, with other early board members including Robert H. Ossoff, MD, DMD; Peter D. Costantino, MD, John M. Lore, MD, Roger Ebert, and Larry Gatlin. In 1988, an annual Head and Neck Cancer Awareness Week was created to improve education and awareness. In 1997, the Head and Neck Cancer Alliance joined forces with the Yul Brynner Foundation, and Terry A. Day, MD, was named president of this organization that promotes early detection and prevention of head and neck cancer. In 2001, the week awareness moniker was changed to OHANCAW. Nationally and internationally, OHANCAW includes free head and neck cancer screenings, lectures, walk-a-thons, news releases, and conferences. Throughout the years, the number of screening sites and patients screened has grown, with a total of 363 free screening sites, and 11,392 people screened in 2013. Of these, 191 were referred for immediate consultation for suspected neoplasm, and 1,331 referred for further follow up, for a total of 1,522 potential lives saved due to early detection. Within our state of Connecticut, we have grown from one site several years ago to 10 sites/screenings in 2013. The event, the opportunities, and the rewards are shared at our semi-annual Connecticut ENT Society meetings with encouragement for increased involvement. Numerous physicians have stepped up and voluntarily established screenings at most of our state hospitals, and these screenings—that can last all day or even just a few hours in the late afternoon or early evenings—attract many interested patients. Patients understand medical screenings…especially free screenings. The screening concept is currently deeply ingrained with breast cancer, prostate cancer, and gastrointestinal screenings commonplace. Head and neck cancer is not well understood. It is incumbent upon us as otolaryngologist-head and neck surgeons to help improve this knowledge gap. Patient education during screenings can range from tobacco cessation counseling to better understanding symptoms or findings that should raise concerns. The relationship of HPV and oral sex continues to intrigue patients, and this is a forum for us to share information as we clinicians continue to gain better understanding about this disease. When physicians are engaged and interested, the www.OHANCAW.com website provides an invaluable wealth of information. The physician screening sites are listed alphabetically by state; all the necessary forms including patient screening forms, patient information sheets, and pointers and “how to get started” presentations are readily accessible; lists of necessary screening supplies and personnel requirements are included. The Education tab lists two valuable documents, “What Is Head and Neck Cancer?,” and “50 Facts about Head and Neck Cancer,” which can be distributed to all screening participants. Our local Connecticut hospitals that have embraced this type of screening offered public relations assistance and advertising to publicize the events. We would often discuss with the hospital organizers thoughts, ideas, and suggestions that have worked with previous screenings to help them coordinate and organize their own. Sharing these experiences has yielded greater collegiality amongst the hospitals and the providers. In this day and age of practice challenges filled with EHR headaches, ever increasing regulation and decreasing reimbursement, it is often difficult to find worthwhile side endeavors. However, the few invested hours it takes for an individual physician to offer a valuable community service such as staffing an OHANCAW screening can be uplifting and so appreciated by our patients. And when/if a disease is caught earlier in its developmental course, it has for ever altered the life of a grateful patient.
David R. Nielsen, MD AAO-HNS/F EVP/CEO
Assessing Education: What We Do and Why We Do It
“Medical education is a lifelong process embracing premedical experience, undergraduate education, general clinical training, specialist or vocational training, subspecialty training, and continuing medical education.” [BMJ. 1999 May 8; 318(7193): 1280].” With the need to teach an increasing body of knowledge and skill, and give more training in a fixed amount of time, medical education—undergraduate, graduate, and continuing—is evolving. As Dr. Waguespack’s column states, traditional “continuing medical education” is now more correctly described as “continuing professional development (CPD),” involving not just the acquisition of new knowledge and facts, but also the integration of that knowledge into practice, the changing of behavior, and the documenting of the improvements in patient care and outcomes. Our educational methods should change in concert with our needs; thus it is essential to strengthen the influence and effectiveness of the AAO-HNS Foundation’s CPD programming. With that in mind, how do we assess what we need? Where do we begin to effectively support medical students, GME, CPD, otolaryngologists, other physicians, physician assistants, nurses, audiologists, SLPs, and others who need otolaryngology education programming? Gaps: What Do We Mean? The answer requires a robust system of ongoing measurement of learner needs in regard to education and performance improvement. One of the most important recent changes in our requirements for accreditation by the ACCME is identifying gaps in care and ensuring that our educational programming addresses these gaps. Gaps in clinical care can include gaps in knowledge, in dissemination of knowledge, in implementation in practice, in documentation, and in reporting and comparing/benchmarking improvement. Therefore, even with new emphasis on education and changing practice behavior through evidence-based guidelines and performance measures, one can easily see that knowledge-based medical education still remains a foundational component, and some form of didactic and instructional programming will always be needed. A strategic issue to consolidate and enhance the otolaryngology practice gap analysis and needs assessment process was included in the 2013 AAO-HNS/F strategic plan. Beginning in late 2012 and continuing into 2013, Foundation Education Leadership embarked on an initiative to collect gap analysis and needs assessment data for the Foundation’s CPD function. Gap Analysis and Needs Assessment In accordance with our CPD Guidelines the Foundation utilizes a planning process that links identified professional practice gaps and education needs with expected outcomes (knowledge, competence, or performance) in its provision of CPD activities. This analysis data is incorporated into the planning of all education activities. Professional practice gaps are identified through: Environmental scans of research reports, Peer-reviewed journals, Healthcare quality assurance data, Research abstracts, Activity evaluation summaries and member surveys, ABMS/ABOto certification and maintenance of certification requirements, and Evidence-based clinical guidelines development. Various member needs assessment surveys are conducted on an ongoing basis in an effort to gauge whether existing education and knowledge products are meeting the learning needs of our members. They include: Education Needs Survey with Education Committee members (biannually). Course Participant Survey on quality and effectiveness of education activities (biannually). Overall Membership Survey assessing their perceptions of the Foundation’s CPD program and how it can better meet their education needs (biannually). Target Audience Focus Groups. The Gap Analysis and Needs Assessment Initiative Process requires first that we survey and conduct a SWOT (strengths, weaknesses, opportunities, and threats) analysis with the members of the Foundation’s Education Steering Committee and specialty education committees—roughly 250 individuals via online survey. Second, we gather and analyze existing member/participant usage and evaluation data from current education activities, demographic data, and web-based analytics. Information collected as part of the 2012 Voice of the Member Survey, 2012 Section for Residents and Fellow Survey, and the recent Residency Program Directors Survey along with data collected by Research and Quality Improvement staff used to develop clinical practice guidelines and to establish research priorities will be reviewed and analyzed. Third, we distribute a membership-wide education needs survey to assess perceived practice gaps and education needs in order to plan more focused education activities. Otolaryngology education and the Academy/Foundation programming continue to evolve to provide comprehensive, traditional and point-of-care, mobile, real time access to the information, skills, techniques, and processes that will advance quality and safety, and ensure that we continue to provide the best possible care to our patients.
Richard W. Waguespack, MD AAO-HNS/F President
A Renewed Commitment to Education
This January issue of the Bulletin offers a bonus. Take note of the latest opportunities from the Academy’s Foundation for professional development. You likely realize what we often referred to as CME in the past has changed dramatically during the last five years, broadening the once static formula of pedagogic learning to a full program for professional development and performance improvement. This expanded approach to ongoing learning adds not just knowledge, but quality to the learning environment. The goal of this focus shift is to keep us up to date, and, more importantly, to make us better physicians and improve patient care. To give context to the array of options in this year’s “resources publication,” Sonya Malekzadeh, MD, and the Education Steering Committee contributed a feature section to this Bulletin that details the program’s growth. The need to assess the gaps in otolaryngology education practice that began in earnest in 2012 examined current products and programs through a comprehensive needs assessment and SWOT (strength, weakness, opportunity, threats) analysis. This past year, it included the robust whole-membership education survey that is expected to become a biannual event. Lastly, each education resource was specifically evaluated by individuals who had directly participated in the activity, rolling Annual Meeting programming into this study. It considered critical course topics, education design and format, and types of media best used to educate the members. Simply put, the objectives of the combined research efforts were to: Develop an action plan to improve the member’s 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 their practice of otolaryngology-head and neck surgery. This comprehensive program assessment and program revision is grounded in the tradition of the Academy’s Foundation history. For more than 80 years, our members have worked to benefit the ongoing professionalism of its members. The AAO-HNSF’s Commitment to Education Around 1931, our Academy began developing summaries from the courses given during its annual meetings. These proved to be popular with attendees and then led to the publication of monographs and atlases. Both the monographs and the atlases were revised two more times in the following years, establishing their ongoing value. In 1938, as suggested in Member Harry Gradle, MD’s “stop-gap” plan for inadequate instruction to residents, packages of such manuals and atlases were proposed in the “slightly shocking” format of a correspondence course, known as the Home Study Course. The Home Study Course began the formal offerings of this organization to continuing education. With a $12,000 Carnegie grant, the society produced its first instructional film, “Embryology of the Eye,” in 1949, followed in 1951 with “Embryology of the Ear.” During the subsequent years, despite some early trial-and-error effort, this organization has remained the trusted resource in maintaining the vital knowledge that is required to maintain our professional commitment to patient care. You continue to tell us in numerous ways that this Foundation’s value is firmly grounded in its reputation to provide for your education needs. What We Know Now As a result of the extensive work of the last 18 months, the Foundation 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 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 influence lifelong learning and patient outcomes in a meaningful way. Through this initiative, three critical needs 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 to focus on the quality of education activities.