Published: May 1, 2014

Hot Dogs, Hamburgers, and Politics

The summer months are near, which means lots of picnics, parades, and local gatherings. Members of Congress are notorious for making “appearances” at such events. Don’t let them just walk in parades and eat hot dogs at the county fair. Take advantage of this great opportunity to meet your elected officials and raise the visibility of key legislative issues affecting your patients and the specialty. Unable to attend these public events? Consider scheduling a private meeting with your lawmakers at their Congressional district office. Or better yet, invite them to visit your medical practice. The next scheduled Congressional “work period” is May 10-18. Email govtaffairs@entnet.org today to learn more about the In-district Grassroots Outreach (I-GO) program and to request help in scheduling your meetings!

The summer months are near, which means lots of picnics, parades, and local gatherings. Members of Congress are notorious for making “appearances” at such events. Don’t let them just walk in parades and eat hot dogs at the county fair. Take advantage of this great opportunity to meet your elected officials and raise the visibility of key legislative issues affecting your patients and the specialty. Unable to attend these public events? Consider scheduling a private meeting with your lawmakers at their Congressional district office. Or better yet, invite them to visit your medical practice. The next scheduled Congressional “work period” is May 10-18. Email govtaffairs@entnet.org today to learn more about the In-district Grassroots Outreach (I-GO) program and to request help in scheduling your meetings!

More from May 2014 - Vol. 33 No. 05

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Thyroglossal Duct Cysts, Elephantitis, and More: The Different Sides of Walter E. Sistrunk

Amit A. Patel, MD Otolaryngology History Society (OHS) Treatment of the thyroglossal duct cyst was revolutionized by Walter Ellis Sistrunk, MD, of the Mayo Clinic in 1920 and the development of the procedure that now bears his name. Since that time, the procedure has remained, for the most part, unchanged and is the gold standard for treatment of thyroglossal duct cysts. Dr. Sistrunk was also a consummate general surgeon, who made contributions not only to thyroid surgery, but also to fields as diverse as oncologic breast surgery and vascular surgery. Born in Tallahassee, AL, in 1880, Dr. Sistrunk received a degree in pharmacy from the Alabama Polytechnic Institute in 1900. From there, he attended TulaneMedicalCollege, graduating in 1906. He began his career in private surgical practice in New Orleans and Lake Charles, LA. He moved to the Mayo Clinic in 1911 as an assistant in the department of pathology. There he published a landmark paper on intestinal parasites in which he demonstrated that the incidence of amebiasis was more widespread in the United States than had previously been thought. This paper was cited for more than two decades as a preeminent paper on parasitology. In 1912, from the Mayo Clinic’s department of parasitology, Dr. Sistrunk moved to its department of surgery and in 1918 he was appointed as assistant professor. In 1921, he published his most famous work on the surgical treatment of cysts of the thyroglossal duct tract. He discovered the key to avoiding recurrence was removal of the entire epithelial-lined tract extending to the base of the tongue. The procedure is so efficacious that it has remained essentially unchanged in the last century and rightly bears his name. Dr. Sistrunk also made significant advances in the surgical treatment of chronic lymphedema or elephantiasis. He modified an earlier operation known as the Kondoleon operation, in which large swaths of tissue are removed from the edematous limb to provide relief from symptoms. While this procedure is rarely performed today, contemporary physicians noted Dr. Sistrunk’s contribution to the point where some literature refers to the Kondoleon operation as the Sistrunk operation. Dr. Sistrunk continued his work and research at the Mayo Clinic until 1929, when he moved to BaylorUniversity, returning to his native South after his son died in an accident. His rich contributions to the fields of surgery and medicine cannot be underestimated. In a larger sense, however, it is important to remember that physicians should not be pigeonholed into their medical eponyms. For example, Theodor Billroth is remembered for his surgical treatment of peptic ulcer disease, but, lest we forget, he performed the first total laryngectomy. Similarly, George W. Crile is known for his contributions to neck dissections, but we should also remember that he performed the first successful blood transfusion. We should not do away with eponyms altogether, however, as doing so would dismayingly cause us to lose a sense of connection with the history of our field.

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AAO-HNS Members May be Eligible for FACE

AAO-HNS Member Gregory W. Randolph, MD, FACE, who has worked closely with the AACE for many years presenting at their meetings and serving in leadership positions, has been dedicated to establishing otolaryngologist—head and neck surgeon eligibility for the FACE designation. He and fellow Academy supporters named here are pleased to extend the following information to you in concert with ACE and AACE colleagues. The Fellow of the AmericanCollege of Endocrinology (FACE) designation is achievable by otolaryngologist-head and neck surgeons who provide a high standard of excellence, achievement, and quality of patient care given to their patients with endocrine disorders. Physicians eligible to receive this honor must be members in good standing of the American Association of Clinical Endocrinologists (AACE) for at least three years. As such, otolaryngologist-head and neck surgeons seeking FACE distinction should apply for AACE membership if they meet certain criteria, such as 50 percent or more of their practice being dedicated to thyroid and parathyroid disorders. FACE recipients are honored with induction into the College at the ACE Convocation, which takes place during the AACE Annual Meeting. Fellows can then use the FACE post-nominal title to denote the honor. AACE is eager to engage the otolaryngologist-head and neck surgeon community, which already has a great history of collaboration. In fact, Dr. Randolph has earned the FACE credential for his contribution to the management and treatment of thyroid cancer. He is also currently chair of the AACE Endocrine Surgery Committee and AHNS Endocrine Surgery Committee and a former AAO-HNSF International Coordinator and Endocrine Surgery Committee Chair. With this experience, he will welcome your interest. He has found that many AACE members focus on diseases of the thyroid and parathyroid glands and work well in partnership with head and neck surgeons. AACE and ACE Jeffrey I. Mechanick, MD, FACP, FACE, FACN, ECNU; president, AACE Daniel Einhorn, MD, FACP, FACE; President, ACE R. Mack Harrell, MD, FACP, FACE, ECNU; president-elect, AACE Jeffrey R. Garber, MD, FACP, FACE; immediate past president, ACE AAO-HNS/F Richard W. Waguespack, MD; president James L. Netterville, MD; immediate past president AAO-HNS Endocrine Surgery Committee Ralph P. Tufano, MD Lisa A. Orloff, MD David L. Steward, MD Brendan C. Stack Jr., MD, FACE David J. Terris, MD Mark L. Urken, MD

Out of Committee: The Cochlear Implant: Past, Present, and Future of a Game-Changing Device

From the Drugs and Devices Committees The development and use of the cochlear implant has been one the most significant advances in otolaryngology in the last century. It has truly revolutionized what we as otolaryngologists can offer to our patients with the most significant cases of hearing loss. While this “game-changing” medical device now stands in the limelight, its conception and early development was met with much resistance from recognized leaders in our field and great opposition from the deaf community, which considered it “genocide” to their culture. The early work of Volta, Djourno, Eyries, and others eventually led William House to successfully implant a single electrode device into the cochlea of a human patient in 1961. Shortly thereafter, Blair Simmons and Robin Michelson placed multichannel implants. Subsequently, decades of dedication by surgeons, scientists, audiologists, and speech pathologists have enabled countless deaf children and adults to hear. Current implants allow recipients to gain sufficient open set speech to talk on a telephone, be mainstreamed to enter schools with hearing children, and use speech to function and communicate well in various professional and social settings. Studies have shown that many implant users perform at or near the level of normally hearing peers on certain speech testing batteries. The magnitude of these achievements is reflected in the awarding of the prestigious Lasker-DeBakey Clinical Medical Research Award to Graeme Clark, Ingeborg Hochmair, and Blake Wilson in 2013 for their efforts in the development of cochlear implants. Despite these successes and numerous studies that have shown that cochlear implants are both clinically and cost effective, the overall utilization rate of this device in the United States is estimated at an astoundingly low 6 percent. Specifically for children in the U.S., the utilization rate is a much more favorable 50 percent of those who would qualify based on their audiological profile, largely due to the positive effects of the implementation of Universal Newborn Hearing Screening in 1999. Nevertheless, this still fails to compare to the 90 percent utilization rates in certain areas in Europe. Several factors may be contributing to this low utilization rate. The first is that there is a low general awareness of cochlear implants and their potential benefits by both the public as well as primary care physicians. This poor understanding of candidacy and outcomes by referring providers may be a critical hurdle in getting the majority of patients who could benefit from an implant into the office of an otolaryngologist who can offer services. In addition, while there have been some positive changes from the early days of cochlear implantation, political resistance from organizations such as the deaf community, National Association of the Deaf, and the Autism Free America groups continue to exist. Lastly, financial issues limiting hospitals and clinics continue to play a major role. With the metric of “quality of care” being on the forefront of healthcare governing bodies, hospital administrators, and the public, the development of widely accepted “best clinical practice” guidelines may provide a means to improve our ability to reach a greater proportion of the patients who could benefit from a cochlear implant. With the focused efforts of groups such as the recently incorporated American Cochlear Implant Alliance, we stand stronger to make progress on this front. Despite these challenges, the number of patients receiving cochlear implants continues to grow and indications for surgery are further expanding. Initially a therapy offered only to adults with bilateral profound hearing loss, later it was approved for children two years and older in 1990 by the FDA. Today, children 12 months, and even younger in some cases, are gaining hearing with surgery. In addition to the lower limits of age, the increasing benefits of surgery outweighing the risks have permitted the audiological criteria for candidacy to evolve allowing for patients with less severe levels of hearing loss to qualify for implantation. While the standard adult candidate is someone who is considered to have little or no benefit from hearing aids based on speech recognition testing with scores of less than 50 percent on the ear to be implanted and less than 60 percent in the non-implanted ear or in the binaural condition, there has been much research demonstrating the benefits of cochlear implantation in patients with residual low frequency hearing. Hearing preservation techniques and hybrid implants providing electrical and acoustic stimulation have been used for years in Europe. These devices are currently in the final stages of approval by the Food and Drug Administration. This would provide individuals in the United States with high frequency sensorineural or “ski slope” hearing loss the opportunity to improve their communication function with a cochlear implant. In addition, currently there is much investigation in the areas of cochlear implantation for single-sided deafness and a therapy for tinnitus that may soon further expand the use of this innovative medical device. Future technologies are aimed at enhancing sound quality, improving safety and reliability, and reducing costs. Incorporating technologies such as drug-eluting electrode arrays to reduce trauma from surgery, repairing damaged tissue biologically with stem cells, and developing new, more effective materials may provide avenues to bring the function of cochlear implants to the next level. With these ongoing efforts, we likely do not yet know the limits yet of this game-changing device.

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Is PSQI Vulnerable?

Rahul K. Shah, MD George Washington University School of Medicine Children’s National Medical Center, Washington, DC Of course this is a rhetorical question—the modern patient safety and quality improvement, following the clarion call from the Institute of Medicine, is based on robust data, methodology, and outcomes. As such, it was an absolute surprise to many involved in PSQI (Patient Safety and Quality Improvement) research and initiatives that there was fraud and deceit amongst us. I will try to summarize what is reported in the lay press about Dr. Charles Denham, MD, who at the time of a Justice Department settlement co-chaired a prominent committee, the NQF Safe Practices Committee, at the National Quality Forum. Please research this yourself to obtain the most accurate information. As members may recall, the Academy has physician and staff representation at the major quality organizations and associations, including (but not limited to) the Ambulatory Quality Alliance (AQA), National Quality Forum (NQF), AMA’s Physician Consortium for Performance Improvement (PCPI), and the Surgical Quality Alliance (SQA). It is a prescient decision for the Academy to be participating and involved in these organizations for more than a half-decade as we are well represented in the national landscape and able to adjust to changing influence. For example, if we were to plot the influence of these societies during the past many years, we would see evolving influence based on national priorities. Hence, the allegations of fraud of Dr. Denham hit close to home for our membership, as we are participants in the NQF. The government alleges, while Dr. Denham co-chaired the NQF Safe Practices Committee, that a company he owned was provided contracts by CareFusion to promote its product, ChloraPrep. The product is used for surgical antisepsis, however the company was promoting its use off-label, which is not allowed. The allegation from the Justice Department was that the committee that Dr. Denham co-chaired was subjected to his influenced and that he personnally profited from payments from CareFusion. CareFusion was fined $40 million by the Justice Department. The story and the accompanying blog posts Wachter’s World are worth reading; indeed my co-chair of the AAO-HNS/F PSQI committee, David Roberson, MD, even opined on the post! My point being that this downfall, the first of such impact in the PSQI movement, has brought out many of our most respected safety experts to voice their sentiments. I do not personally know Dr. Denham, but have heard him speak a few times. He is a gifted messenger and certainly a patient advocate. Nevertheless, the point of the column this month is to demonstrate that even a field as purely motivated as patient safety and quality improvement is susceptible to fraudulent behavior. We must remain vigilant as Academy members and ensure that just because a group with good motives that is led by experts presents a claim or action does not a priori and without evidence make that claim substantiated. Academy member and journal editor, Richard M. Rosenfeld, MD, MPH, has done a tremendous job of asking the difficult questions about statistics, correlations, and causations when I have seen him at scientific meetings. This level of scrutiny is what we as individual Academy members can do with regards to statements from quality and safety organizations. We must not simply rollover and accept these mandates—the onus is on us as practicing providers to see the data and understand the rational for such measures. I have seen our membership in action and am confident that we always do push for the data and transparency. In summary, the modern patient safety and quality improvement movement since the 2000s is not a fraud—the data is robust, medicine is embracing proven quality and scientific methodologies, and the outcomes of actual lives saved is exciting. However—caveat emptor: If a product sounds too good to be true, if an initiative has results that are not rational, and if someone seems conflicted—then double-check, as you may be right! If you can spare some time, these articles outlined below reinforce the absolute need for every organization engaging in these types of activities to have solid disclosure policies addressing of conflicts of interest. References http://online.wsj.com/article/BT-CO-20140109-709237.html, accessed March 9, 2014. http://community.the-hospitalist.org/2014/01/30/patient-safetys-first-scandal-the-sad-case-of-chuck-denham-carefusion-and-the-nqf/, accessed March 9, 2014. http://www.forbes.com/sites/michaelmillenson/2014/02/14/the-money-the-md-and-a-12-million-patient-safety-scandal/, accessed March 3, 2014. Editor’s Note: Please read Dr. Denham’s statement that can be found within the Wachter’s World article (http://community.the-hospitalist.org/2014/01/30/). Specifically it appears in the commentaries from a February 22, 2014, 7:41 pm reader. 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.

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Accessing Big Data for Research?

A New Resource for AAO-HNS Members Secondary data analysis can be an efficient research tool for identifying large numbers of cases for study without the time needed to collect primary data. For these reasons, there is increasing interest in secondary data analysis within the field of otolaryngology. The AAO-HNSF Outcomes Research and Evidence-based Medicine (OREBM) Committee is pleased to announce that there is a new resource available to members on the AAO-HNS/F website. If you are conducting or looking to conduct research and are interested in using large datasets, there are many options available. But how do you decide which one is best for your purposes and your budget? Under the guidance of Jennifer J. Shin, MD, SM, and Melissa A Pynnonen, MD, committee members and volunteers provide a list of existing datasets that may be appropriate for otolaryngology research. Each dataset is unique, with its own advantages, disadvantages, and nuances. To help newcomers identify a dataset that may be relevant for a particular research question, a basic overview of each dataset, example publications, and links for obtaining further information are provided. Some of the information presented includes: patient ages; practice setting, date range available; examples of publications; information about access; cost estimate(s); contact/website information; ease of use; and some pros/cons to using the data set for analysis. Datasets for inclusion were selected based on recommendations from members of the OREBM Committee. Databases included on the site: Kids’ Inpatient Database (KID) MarketScan® Commercial Claims and Encounters and Medicare Supplemental and Coordination of Benefits MarketScan® Health and Productivity Management/MarketScan® Health Risk Assessment The National Ambulatory Medical Care Survey (NAMCS) National Cancer Database (NCDB) NationalHospital Ambulatory Medical Care Survey (NHAMCS) Nationwide Emergency Department Sample (NEDS) Nationwide Inpatient Sample (NIS) SEER-Medicare State Ambulatory Surgery Databases (SASD) State Inpatient Databases (SID) Surveillance, Epidemiology and End Results (SEER) This list is not meant to be exhaustive, but rather a primer and foundation for members interested in beginning secondary data analysis in otolaryngology. The list will be reviewed periodically and updated as appropriate. Special thanks to Emily F. Boss, MD, MPH; Amy Y. Chen, MD, MPH; Seth M. Cohen, MD, MPH; Dane J. Genther, MD; Eric J. Kezirian, MD, MPH; Frank R. Lin, MD; Gordon Sun, MD; and Bryan K. Ward, MD, for sharing their knowledge of these databases and assisting with this project. We hope members find this to be a valuable resource and that it will help to facilitate new studies within the field of otolaryngology. To access the site, visit http://www.entnet.org/EducationAndResearch/Research-Databases.cfm. If you have suggestions for additional databases or outcome instruments to be included on these sites or supplemental information that may be helpful, please let us know. Email Stephanie L. Jones, director of Research & Quality Improvement, at sljones@entnet.org. Outcome Instruments Did you know that the OREBM Committee also developed a web resource that presents key outcome instruments in otolaryngology-head and neck surgery? The site can assist the clinician looking to learn more about these tools and implement them in their practice or educate the more seasoned researcher who wants to stay up-to-date on the key tools and supporting literature. Learn more at http://www.entnet.org/EducationAndResearch/outcomesTools.cfm.

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Coding Update: New CMS G-Code/Modifier Requirements for Therapy Services

Michael Setzen, MD Immediate-Past Coordinator for Practice Affairs; Manderly Cohen, MS CCC-SLP, and Jenna Minton, Esq., Senior Manager of Health Policy For CY 2013, CMS finalized several key changes to reporting requirements associated with the provision of therapy services, and beginning on January 1, 2013, it implemented a claims-based data collection strategy to collect data on patient function. This policy encompassed a wide array of therapy services, including the Medicare Part B outpatient therapy benefit, therapy services under the Comprehensive Outpatient Rehabilitation Facility (CORF) benefit, and “incident to” services furnished by physicians or nonphysician practitioners, and included services furnished in hospitals, critical access hospitals (CAHs), skilled nursing facilities (SNFs), CORFs, rehabilitation agencies, home health agencies (when the beneficiary is not under a home health plan of care), and private offices. CMS defines the term “therapists” as all practitioners who furnish outpatient therapy services, including physical therapists, occupational therapists, and speech-language pathologists in private practice and those therapists who furnish services in the institutional settings, physicians, and nonphysician practitioners (including physician assistants, nurse practitioners, and clinical nurse specialists, as applicable). Under this policy, claims for therapy services must now include non-payable G-codes and modifiers, which will allow the agency to capture data on the beneficiary’s functional limitations at various points during the provision of therapy. For therapy services being furnished that are not intended to treat a functional limitation, the therapist should use the G-code for “other” and the modifier representing zero. A specific example of how this would apply in otolaryngology is when performing FEES/FEESST or providing therapy, including speech-language evaluation and treatment services for Medicare Part B beneficiaries, providers must report outcomes on claim forms. To facilitate this reporting, CMS established non-payable G-codes for reporting on claims for Medicare Part B beneficiaries receiving therapy services. Each non-payable G-code listed on the claim form must be accompanied with a severity/complexity modifier. The modifier represents the functional impairment on a 7-point severity/complexity scale. G Codes When billing FEES/FEESST CPT codes, specifically 92610 Evaluation of oral and pharyngeal swallowing function, 92612 Flexible fiberoptic endoscopic evaluation of swallowing by cine or video recording, and 92616 Flexible fiberoptic endoscopic evaluation of swallowing and laryngeal sensory testing by cine or video recording, where only an evaluation was performed and the patient will not be seen for therapy at the same facility, all three swallowing G-codes must be used when billing for the evaluation (G8996, G8997, and G8998) in addition to the appropriate severity modifier for each code. Click here for a full list of available G-codes for reporting therapy services. Severity Modifiers Note: Corresponding National Outcomes Measurement System (NOMS) Functional Communication Measures [PDF] levels are listed here. Use of NOMS can assist with G-code and severity modifier selection, but is not required by CMS. Members seeking additional information can access a full summary of this issue at http://www.entnet.org/Practice/CMS-News.cfm.

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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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Stay Informed: 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.

On the Frontlines: State Legislative Tracking

A number of 2014 state legislative sessions are still in high gear. AAO-HNS members are a key resource for tracking state legislation and communicating to policymakers its influence on the specialty, physician practices, and patients. Join the growing team of AAO-HNS state trackers by emailing govtaffairs@entnet.org to receive daily or weekly legislative tracking updates. If you identify legislation needing Academy action (e.g., letter, action alert, testimony), simply fill out the online State Action form at www.entnet.org/Advocacy or contact us at the above email address regarding the legislative proposal.

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Abbreviations, Acronyms, and Committees You Need to Know to Be an Effective Advocate for the Specialty

Capitol Hill Powerhouses HELP—U.S. Senate Committee on Health, Education, Labor, and Pensions. The committee has jurisdiction over multiple legislative issues, including some healthcare proposals. E&C—U.S. House Committee on Energy and Commerce. The committee has principal jurisdiction over healthcare issues and related agencies, including the Department of Health and Human Services and the Centers for Medicare & Medicaid Services. Finance—U.S. Senate Committee on Finance. The committee has principal jurisdiction over matters relating to taxation and funding for programs such as Medicare and Medicaid. W&M—U.S. House Committee on Ways and Means. The committee is the chief tax-writing committee in the U.S. House of Representatives, with jurisdiction over all taxation, tariffs, Social Security, unemployment benefits, Medicare, and welfare programs. Coalition Concoction CHHC—Congressional Hearing Health Caucus. CHHC is a bipartisan caucus of members from the U.S. House and Senate committed to supporting the needs of people with hearing loss and other auditory disorders. The AAO-HNS is a member of the Friends of the CHHC. DHHA—Deaf and Hard of Hearing Alliance. DHHA is a coalition that seeks changes to federal public policy to help improve the quality of life for people who are deaf, hard of hearing, or have hearing loss. The AAO-HNS is a member of DHHA. HCLA—Health Coalition on Liability and Access. HCLA is a national advocacy coalition working to advance medical liability reform at the federal level. The AAO-HNS serves on the HCLA Board. PARTNERS—Tobacco control coalition led by the Campaign for Tobacco-Free Kids. The AAO-HNS is a member of this coalition effort. Who’s Who in Government CBO—Congressional Budget Office. CBO produces independent analyses of budgetary and economic issues to support the Congressional budget process. CBO “scores” proposed bills to help lawmakers understand the cost or savings associated with a legislative proposal. CMS—Centers for Medicare & Medicaid Services. CMS is a federal agency within the U.S. Department of Health and Human Services. It is responsible for administrating the Medicare program and working with states on administrating their Medicaid programs. MedPAC—Medicare Payment Advisory Commission. MedPAC is an independent federal body established by the Balanced Budget Act of 1997. It is responsible for advising Congress on topics within the Medicare program, and, more specifically, on issues dealing with payments to private health plans participating in Medicare and health providers that serve Medicare beneficiaries. Other Alphabet Soup ACA—Affordable Care Act. ACA is the healthcare reform law established in 2010. Some refer to the law as Obamacare. CR—Continuing Resolution. A resolution made by Congress to continue funding for a program if the fiscal year ends without a new appropriation in place. HIT—Health Information Technology. Software and computer systems to make medical records electronic, reducing paperwork, and redundant forms. Federal and state governments are implementing policies to encourage the adoption of HIT while promoting quality initiatives and protecting patient privacy. IPAB—Independent Payment Advisory Board. The IPAB is an unelected government body established under the ACA. It is charged with the responsibility for reducing the rate of growth in Medicare without affecting coverage or quality. The Board is scheduled to implement its first proposal in 2015 (likely to be delayed). The AAO-HNS supports repeal of the IPAB. MIPS—Merit-Based Incentive Payment System. A concept included in the bipartisan, bicameral SGR repeal legislation (H.R. 4015/S. 2000). Beginning in 2018, the MIPS would establish a streamlined and improved incentive payment program that would focus the fee-for-service system on providing value and quality. The program would consolidate the three existing incentive programs, continuing the focus on quality, resource use, and meaningful electronic health record (EHR) use with which professionals are familiar, but in a cohesive program that avoids redundancies. MLR—Medical Liability Reform. MLR is a critical healthcare reform issue in the U.S. and a legislative priority for the AAO-HNS. Proponents of MLR are working to implement or amend legislation to reduce or cap excessive liability insurance costs for physicians while ensuring fair compensation for patients injured by negligent actions. PAC—Political Action Committee. PACs allow individuals with shared interests the opportunity to pool their voluntary donations to make contributions to federal candidates on behalf of the entire group. PACs represent a legal and ethical way to participate in the election process. ENT PAC (www.entpac.org) is the political action committee of the AAO-HNS. SGR—Sustainable Growth Rate. The SGR formula is a flawed expenditure target against which healthcare costs are compared. Generally, if annual healthcare costs fall below the target, Medicare reimbursement rates are increased. Conversely, if annual healthcare costs exceed the target, Medicare payment rates are decreased in order to reduce costs. Since healthcare costs tend to grow faster than the rate of inflation, the flawed formula has historically triggered annual Medicare physician payment cuts, which have typically been averted by Congressional action. The AAO-HNS supports H.R. 4015/S. 2000, legislation to repeal the SGR. TIA—Truth in Advertising. The AAO-HNS and others in the physician community support state and federal efforts to implement TIA legislation requiring all healthcare providers to inform patients of their credentials and/or level of training in patient communications and marketing materials. Truth in advertising is an important component of providing patients with the best possible care.

J. Pablo Stolovitzky, MD

The Candidates for President-Elect Outlined Their Platforms: An Early Look

During the February/March AAO-HNS/F Leadership Forum, The BOG hosted its yearly event for candidates for president-elect to introduce themselves and lay the groundwork for their official platforms and statements to the membership. This year’s candidates, Sujana S. Chandrasekhar, MD, and J. Pablo Stolovitzky, MD, readily engaged the audience displaying their mutual strengths of loyalty, zest for a challenge, and specialty pride. According to the Bylaws, in advance of the presentation, the Nominating Committee selects three questions that the candidates address both live during this forum and also more formally in their official statements that are fully published in the June Bulletin. By coin toss, Dr. Stolovitzky began the exchange. This year, Drs. Chandrasekhar and Stolovitzky responded to one question from the audience as well. It was presented by the Immediate Past BOG Chair Denis Lafreniere, MD: “How would you expand the reach of the Academy while improving non-dues revenue?” To see the full perspective of these Members, read the full transcript and audience response.

AAO-HNSF Partners with International Guideline Central for Tools

Recently, the Academy Foundation formed a partnership with International Guideline Central (IGC). IGC is a producer of evidence-based quick reference guides in both paper pocket card and mobile/web application formats for healthcare professionals. AAO-HNSF has joined with IGC to help develop full text clinical guidelines into quick reference tools. The Foundation-endorsed pocket cards and apps serve as quick reference tools that feature highlights of the AAO-HNSF-developed clinical practice guidelines (CPGs). The IGC relationship will allow AAO-HNSF to 1) Increase the dissemination of its CPGs to a much broader audience and 2) Provide quick reference tools in both the pocket card and app format to its members. The CPG guideline development group leadership, Foundation staff, and the IGC medical director collectively develop the content to be included in the pocket card and app from the AAO-HNSF guidelines. The guideline apps and pocket cards feature diagnosis, assessment information, treatment options including their associated levels of evidence, and other recommendations from the AAO-HNSF CPGs. The pocket cards and apps are a tool for providers for point-of-care decision-making and quality improvement. The app is free to download, with pocket cards and digital applications available to purchase separately. The mobile app is available for iPhone, iPad, or Android. The mobile app features a dynamic toolbar, which has a word search capability, zoom, bookmark feature, and change font feature. The desktop application features interactive content, intuitive page turn, key word search, full screen and slideshow viewing, high quality zoom, annotation, comments, bookmarks, and individual and multi-user license. To access the app, visit https://www.guidelinecentral.com/ashp13/ on your mobile device. The website will detect what app is appropriate for you and direct you to download the app. Once you download and register for a free account you will be given a free pocket card in the My Guidelines tab in the app as a sample. The following guidelines are slated for publication into pocket cards and apps over the coming year: Bell’s Palsy, Tympanostomy Tubes, Sudden Hearing Loss, and Tonsillectomy, with additional AAO-HNSF CPGs to follow.

Thank You for Participating in the 2014 AAO-HNS Socioeconomic Survey

The Health Policy team extends a thank you to members who participated in the 2014 Socioeconomic Survey this past March. Your participation is greatly appreciated, as it is essential for statistically meaningful results. The Socioeconomic Survey has been disseminated every three years through the Academy’s Health Policy team since 1997, which allows the Health Policy team to gather information on members’ practice patterns, the healthcare environment, and future trends in otolaryngology-head and neck surgery. This data enables the Academy to provide members with useful benchmarking tools. The survey is the most recognized otolaryngology-specific data available and allows the Academy to identify key issues and policies affecting members, particularly as they relate to practice productivity, revenue, and operations. The 2014 survey was unique in that it was the first year the Academy incorporated questions regarding alternative payment models, member-recommended electronic health records (EHR) vendors, and important information on relative value units (RVUs) generated annually by practices and individual physicians. Aggregate results will be published in the September Bulletin, and will also be on display at the 2014 Annual Meeting in Orlando, Florida, September 21-24. We encourage all members to take the time to view the results and thank you again for your volunteerism!

The Doctors Company Offers Unique Combination of Benefits to AAO-HNS Members

The American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) has partnered with The Doctors Company, an Academy Advantage Premier Partner, to provide Academy members with an exclusive medical malpractice insurance program since 2003. As the nation’s largest physician-owned medical malpractice insurer—insuring 1,100 otolaryngologists nationwide—The Doctors Company has insight into the broad range of claims in otolaryngology. The Doctors Company is fiercely committed to defending, protecting, and rewarding the practice of good medicine. Backed by the financial strength of $4 billion in assets and a membership of 74,000 physicians, The Doctors Company offers AAO-HNS members a unique combination of coverage features, aggressive claims defense, and unrivaled protection. Qualified AAO-HNS members receive a program discount of 5 percent and a claims-free credit of up to 25 percent. AAO-HNS members also have access to industry-leading patient safety tools and programs, including free live and web-based CME, on-site surveys, and informed consent resources. In a recent survey, nine out of 10 members of The Doctors Company said they were satisfied with the company’s extensive patient safety resources. Visit www.thedoctors.com/patientsafety to learn more. The Doctors Company sets the standard for aggressive defense, beginning with the promise never to settle a claim without a member’s consent, where permitted by law. This relentless defense also includes Litigation Education Retreats, which help members facing claims to master defense tactics, and educational videos showcasing actual claims experiences at www.youtube.com/doctorscompany. The Doctors Company has the national perspective and local expertise to identify emerging trends and protect physicians with innovative coverage solutions. CyberGuard® protects doctors against cyber liability claims, today’s fastest-growing threat. MediGuard® provides doctors with legal representation for administrative actions. Both products are offered as part of the company’s core medical malpractice policy. Created in 2007, the Tribute® Plan is a benefit that rewards The Doctors Company’s members for their loyalty and their dedication to superior patient care with a significant financial award at retirement. How significant? The highest award to date to an otolaryngologist and AAO-HNS member was $33,554. Among the more than 1,000 otolaryngologists with Tribute balances, the average balance is currently $11,850 and the maximum balance is $60,585. Learn more about this groundbreaking benefit at www.thedoctors.com/tribute. Join your AAO-HNS colleagues as a member of The Doctors Company—find out how affordable superior medical malpractice coverage for otolaryngologists can be at www.thedoctors.com/quote.

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ICD-10: Help Is Here

While the Academy acknowledges that recent legislation has delayed ICD-10 until October 1, 2015, it is critical that Members continue preparation efforts to meet this deadline. CMS has repeatedly confirmed it will be moving forward with ICD-10. ICD-10 is projected by CMS to provide a multitude of benefits and data that will lead to increased long-term efficiency in the healthcare industry. However, its short-term costs are anticipated to be disruptive, especially for the unprepared. With the ICD-10 transition, use of the new codes will require a significant level of involvement from otolaryngologists themselves and will require many of our members to revamp documentation processes. Physicians will now have to focus on adding further specificity and detail to their documentation. As a result, your Academy has been urging you to prepare for the transition over the past year and will continue to encourage members to test their systems for readiness until October 2015 Academy Efforts ICD-10 is one of the most significant challenges facing physicians today. Noncompliance and lack of preparedness could result in significant financial burdens for practices. Regardless of your current level of preparedness, it is critical that all physicians focus on the impending transition. As with all changes and especially with a change this substantial, the Academy offers members valuable support and services. Some resources the Academy has developed include an ear, nose, and throat (ENT)-specific sample superbill with common ICD-10 codes; a list of the “Top 200” most commonly used ICD-9 codes in an ENT practice and pertinent ICD-10 crosswalks; AAO-HNS/F Coding Workshops focusing on ICD-10 preparedness at various locations across the country by Karen Zupko; and several Bulletin articles drafted by various ICD-10 experts. Notably, the Academy has promoted an ICD-10 Miniseminar at the Annual Meeting for the past three years and has made several presentation materials publicly available on the Academy’s ICD-10 website. CMS Efforts CMS has already explored acknowledgement testing during the first week of March and, based on its analysis of the results, will be exploring offering other weeks of acknowledgement testing. Acknowledgement testing allows all providers, billing companies, and clearinghouses the opportunity to determine whether CMS will be able to accept their claims with ICD-10 codes. Despite not originally planning on going through full end-to-end testing, CMS has additionally scheduled end-to-end testing for a small sample group of providers during the summer of this year. End-to-end testing includes the submission of test claims to CMS with ICD-10 codes and the provider’s receipt of a Remittance Advice (RA) that explains the adjudication of the claims. Some of the goals of end-to-end testing include: Providers or submitters are able to successfully submit claims containing ICD-10 codes to the Medicare Fee-for-Service (FFS) claims systems. CMS software changes made to support ICD-10 result in appropriately adjudicated claims (based on the pricing data used for testing purposes). Accurate RAs are produced. To assist with testing efforts, CMS has worked to update some of its National Coverage Determinations by converting relevant ICD-9 codes to their ICD-10 equivalent, found at http://www.cms.gov/Medicare/Coverage/CoverageGenInfo/ICD10.html. CMS is anticipated to post scheduled testing dates to its website at the end of May, so stay tuned to the Academy e-newsletter and the Health Policy Update for future updates. The Academy continues to work to develop internal resources, repurpose any publicly available ICD-10 resources, and ensure members are well informed about ICD-10. For resources focusing on the ICD-10 transition, visit http://www.entnet.org/Practice/International-Classification-of-Diseases-ICD.cfm. Do you have any recommendations for ICD-10 resources that your Academy should work to develop? Please email healthpolicy@entnet.org.

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Health Policy 101: Working for You

The Academy’s Physician Payment Policy (3P) Workgroup is the senior advisory body to Academy leadership and staff on issues related to socioeconomic advocacy, regulatory activity, coding and reimbursement, and practice services or management. 3P and the Health Policy staff work to ensure that members’ interests are appropriately represented. 3P oversees the review and content for the Clinical Indicators and the Position Statements, and provides resources to members such as template appeal letters and CPT for ENT coding guidance articles. Coordination with other Academy committees, subspecialties, and medical specialty societies are critical to 3P’s success. Health Policy has two coordinators, who are also the Physician Payment Policy (3P) Workgroup co-chairs. James C. Denneny III, MD, coordinator for Socioeconomic Affairs. Dr. Denneny oversees all coding and payment issues related to Medicare and the Academy’s efforts to influence the CPT coding and Relative Value System (RVS) through work with the Academy’s Members and Advisors on the AMA’s CPT Editorial Panel, the Relative Value Update Committee (RUC), and the RUC’s Practice Expense Subcommittee. He works closely with the Health Policy department to achieve these directives. Dr. Denneny is on the Socioeconomics Committee of the Board of Governors of the American College of Surgeons (ACS) and the Executive Committee of the Board of Governors of the ACS. These positions offer synergistic opportunities to increase cooperation and build coalitions among the surgical societies as we navigate an increasingly hostile landscape for physicians, particularly surgeons. Jane T. Dillon, MD, MBA, coordinator for Practice Affairs. Dr. Dillon is responsible for developing and maintaining programs that support and provide practice management-related answers to health policy issues. She spearheads collaborative efforts with other specialty societies on priority payer reimbursement issues related to private national insurance policies, publication of the 2014 Socioeconomic Survey, and provides input on any health policy related health policy educational programs for the Annual Meeting. In addition, the coordinator for Practice Affairs is responsible for publishing periodic practice management articles for the Academy’s monthly Bulletin. Stay tuned for upcoming articles focused on these issues. Dr. Dillon works closely with Dr. Denneny to ensure high quality programs for delivery to both the Board of Directors and members. Finally, they both work collaboratively with other Academy leaders from Research and Quality, the Board of Governors, and Socioeconomic and Grassroots Affairs (SEGR) Committee (see related article on page 9), and the Board of Directors to review potential prospective payment models for possible use by otolaryngology-head and neck surgeons in the future. More Examples of Health Policy Efforts for Members Regulatory Advocacy: Cerumen Removal Academy Works to Resolve Concerns Related to CMS 2014 Payment Policy for Removal of Cerumen (69210) In February, the Academy conducted a conference call with CMS regarding its reimbursement policy for cerumen removal, CPT 69210, after hearing from Academy members who had experienced issues with billing 69210 using the -50 modifier. Per CMS instruction on the call, this reimbursement policy that only pays for one unit regardless of whether the service is performed bilaterally will remain in place through CY 2014 as an interim value for the service, which was included in the Final Medicare Physician Fee Schedule (MPFS) for 2014. Based on CMS’ guidance, the Academy recommends that members NOT report 69210 using modifier -50, as MACs are denying these claims entirely and not paying for even one unit reported. This requires providers to reprocess the denied claim, which takes additional time and administrative effort. CMS has stated it will not issue a transmittal to providers at this time, and has asked the Academy to share this coding directive with members. We are working with the Agency to provide them with concrete data related to the percentage of time 69210 is provided bilaterally, in hopes that this will allow them the necessary evidence to revisit this payment policy in CY 2015. As the dialogue continues with CMS, we will keep members apprised of our progress on these advocacy efforts via the weekly e-news, monthly HP Update, and printed Bulletin. Please email us with any questions at healthpolicy@entnet.org. Private Payer Advocacy: Sinus Ostial Dilation and Imaging Services Academy Continues Efforts to Expand Coverage of Balloons for Dilation of Sinuses and Reverse Experimental/Investigational Coverage Decisions for Computer Assisted Surgical Navigation (CASN) The Health Policy team recently sent comment letters to more than 10 private payers in an effort to change their respective medical policies regarding the use of balloons as a tool in the standard approach to sinus ostial dilation. The letters highlight the recently revised and updated position statement on “Dilation of Sinuses, Any Method” (e.g., balloon, etc.), which incorporates updated references, most notably three recently published randomized control trials (RCTs). View the updated position statement at http://www.entnet.org/Practice/Balloon-Dilation.cfm. The Academy submitted comments to the Humana Medical Director regarding their medical policy on Computer Assisted Surgical Navigation (CASN), which does not currently provide payment for the service. We responded to Humana’s request for additional evidence with the new references included in our newly updated position statement on Intra-Operative Use of Computer Aided Surgery. Practice Management Coding Corner The Academy offers members a wealth of coding and practice management resources, which are available to you at http://www.entnet.org/practice/codingResources.cfm. We also recommend checking the coding resources provided by the AMA and ACS. (The AMA CPT Network can be accessed at https://commerce.ama-assn.org/store/content/cptnetwork?node_id=nn407. NOTE: Due to concerns regarding liability, the Academy is unable to provide members with individualized advice on billing and coding issues. Socioeconomic Survey The Health Policy department oversees the distribution and analysis of the AAO-HNS Socioeconomic Survey, which was distributed to members in March. This effort, overseen by Dr. Dillon as coordinator for Practice Affairs, collects information on members’ practice patterns, the healthcare environment, and future trends in otolaryngology-head and neck surgery. Results of the survey will be on display at the AAO-HNSF 2014 Annual Meeting & OTO EXPOSM in Orlando, Florida, September 21-24. CMS Quality Reporting Initiatives Fact Sheets This is a pivotal year for physicians as the CMS has begun applying penalties across three of its quality initiatives. In 2015, physicians will be subject to financial penalties, known as payment adjustments, for the first time for the Electronic Health Record (EHR) Meaningful Use Incentive Program and Physician Quality Reporting System (PQRS). The 2015 EHR and PQRS penalties are based on participation and reporting in 2013. Penalties also increase for failing to participate and meet the e-Prescribing (eRx) Incentive Program reporting criteria in 2013. To help you understand the reporting requirements for these quality initiatives, the Academy’s Health Policy department has created one-page fact sheets for each of the CMS initiatives. These fact sheets follow this article and include a brief overview of the program; provide information on how you and your practice can successfully meet the reporting criteria, earn incentives, and avoid payment reductions; and direct you to additional resources to help you. For information on all of these programs, visit the Academy’s CMS Quality Initiatives webpage at http://www.entnet.org/Practice/CMSpenalties.cfm. For more on additional Health Policy activities, see the table below. Health Policy Abbreviations 3P Workgroup—AAO-HNS Physician Payment Policy (3P) Workgroup AMA—American Medical Association ASC—Ambulatory Surgical Center CAC—Medicare Contractor Advisory Committee CPT code—Current Procedural Terminology CMS—Centers for Medicare & Medicaid Services EHR/EMR—Electronic Health/Medical Record OPPS—Hospital Outpatient Prospective Payment System ICD-9/ICD-10—International Classification of Diseases, with n = 9 for Revision 9 or 10 for Revision 10; with CM = Clinical Modification; and with PCS = Procedure Coding System. MAC—Medicare Administrative Contractor MPFS—Medicare Physician Fee Schedule MU—Meaningful Use PQRS—Physician Quality Reporting System RUC—Relative Value Scale Update Committee RVU—Relative Value Unit VBM—Value-Based Payment Modifier Health Policy Glossary Resource: http://www.cms.gov/apps/glossary/default.asp?Letter=A&Language=English Fact Sheets Electronic Health Records Incentive Program Electronic Prescribing Incentive Program Physician Compare Program Physician Quality Reporting System Value Based Payment Modifier

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On Volunteering and Philanthropic Giving

Sujana S. Chandrasekhar, MD At AAO-HNS/F headquarters, a long glass wall highlights otolaryngologists and their families who have donated substantial sums. They and other donors support the breadth of activities. Otolaryngology colleagues volunteer their time and energy to: write articles for the Bulletin, serve on Academy/Foundation committees, write Clinical Practice Guidelines and Consensus Statements and provide content for teaching materials. How do they find the time? Why do they contribute? Should you join them? They are busy clinical otolaryngologists like you and me, whose professional and personal lives are brimming with activities. I know because plenty of committee phone calls are taken by Academy members at their kid’s soccer games, on their way to family events, from overseas on humanitarian missions, or just trying to squeeze in a haircut at day’s end. Some have partners; some have children; some care for adult relatives; some don’t. All have a passion for volunteering to enhance otolaryngology care. No-one has the time, really, in their schedules. But they make the time and manage it so that they can give 100 percent to their practice, 100 percent to their family, and 100 percent to the Academy. The really interesting question is, why? I am in solo private practice with a husband and four children. My oldest will be starting college in the fall. Our family relies on both incomes. When I talked to a colleague about the Hal Foster, MD Endowment, he initially couldn’t understand how or why I would divert monies from my family. But then he looked into it, and he donated, too. Are we just crazy? Well, maybe, but research actually shows that Spending Money on Others Promotes Happiness (Dunn EW, Science, 2008). There is also sizeable evidence that charitable giving also makes the giver prosperous. The Social Capital and Community Benchmark Survey (SCCBS, 2000) of 30,000 observations from 41 communities and 29 states showed that a $1 increase in charitable giving leads to an average $3.75 increase in household income (Brooks AC, J Econ & Fin, 2007). In addition, givers were 25 percent likelier to report excellent or very good health, while 50 percent of non-givers self-reported health as fair or poor. Okay, but what about that most precious commodity, time? The SCCBS showed that volunteers were 29 percent likelier to self-report health as excellent or very good, while non-volunteers were 71 percent likelier to say fair or poor. And volunteers may even live longer. (http://www.nationalservice.gov/pdf/07_0506_hbr.pdf) When people give their time or money to a cause they believe in, they become problem solvers, which makes them happier than bystanders and victims of circumstance. (Brooks, NY Times, 2014) There is a virtuous cycle: happy, healthy, successful people are more likely to give and volunteer, and simultaneously, charitable people are more likely to be happy, healthy, and wealthy. So, if you’re considering volunteering your time and/or giving to the AAO-HNS/F, jump on in—the water’s fine and it just might be good for your health, too.

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Experience the Annual Meeting

Your Academy Is Host to the World Welcome! Benvenuto! Bienvenida! Boa vinda! Herzlich wilkommen! Hos geldiniz! Karibu sana! Mabuhay! Selamat Datang! Soyez le bienvenue! For more than a century, the American Academy of Otolaryngology—Head and Neck Surgery Foundation has stood at the forefront in developing innovative, evidence-based quality education for otolaryngologist-head and neck surgeons and otolaryngologic healthcare professionals worldwide. Through the Annual Meeting & OTO EXPOSM, the AAO-HNSF sets the highest standards for otolaryngology education. Academy president Richard W. Waguespack, MD, welcomes U.S. and non-U.S. otolaryngologists alike, noting, “Our Academy mission is worldwide through its members. Aside from the 75 state and local societies in the U.S., there are 54 international corresponding societies around the world. Not only do these societies contribute to the Academy’s mission, they are also messengers of higher standards of medicine in the specialty for the nations of the world.” The AAO-HNSF extends a special invitation to otolaryngology professionals worldwide to join us in Orlando, Florida, for the 2014 Annual Meeting & OTO EXPOSM. Now in its 118th year, the AAO-HNSF Annual Meeting is the largest gathering of otolaryngologist-head and neck surgeons in the world, providing unparalleled access to groundbreaking research, new guidelines, and the latest advances in the specialty. With all the AAO-HNSF has to offer, it’s no wonder that Annual Meeting attendees unanimously report that the knowledge they take from the meeting positively influences their practices. 2013 Annual Meeting Attendees Report Alfred Sassler, MD, Cincinnati, OH “It is always good to learn about new research and new trends that may challenge what we thought to be true.” Michael Siegel, MD, Detroit, MI “I have attended 22 AAO-HNS Annual Meetings, and each one is better than the last.” Tripti K. Brar, MBBS, DNB, of New Delhi, India, reports, “The miniseminars and scientific sessions were highly informative and covered a vast array of topics. I took not only a lot of knowledge from the meeting, but also had the wonderful opportunity to establish professional relationships.” Kapil Sikka, MBBS, MS, DNB, also of New Delhi, India, especially appreciated the high quality of the instruction courses: “The Academy helped the fellows in training like me immensely by allowing the provision of complimentary instructional course tickets, which I utilized to maximum benefit by attending a large number of courses.” Andrew Scott, MD, Boston, MA Pediatric Otolaryngologist; Assistant Professor, Tufts University School of Medicine “I have already used the information in my clinical practice.” Exchange ideas and recharge your bond with our profession’s promise—all while discovering the latest innovations and resources for future growth. Use the connections you make and the knowledge you gain as a positive force in your career and for the health of your patients. Leading-Edge Medical City This year’s Annual Meeting will take place in Orlando, found in the “Sunshine State”—Florida. With countless entertainment, dining, and shopping options combined with year-round sunshine, Orlando is the perfect event destination. Orlando was recently ranked by the Healthcare Convention & Exhibitors Association as the No. 3 destination for medical meetings. With the arrival of the Lake Nona Medical City, Orlando is preparing for the medical meetings of the future. Inspired Attractions Orlando certainly knows how to entertain, with seven of the world’s Top 20 theme parks in one destination, not to mention nearly 100 additional attractions. After walking the tradeshow floor, a leisurely escape to a world of imagination and fantasy will leave you feeling refreshed and inspired. Whether seeking to reconnect with childhood nostalgia or experience leading-edge innovations in ride technology, these latest additions are truly one of a kind. Just as an example and opening this summer at Universal Orlando Resort, the new Harry Potter-themed area will allow fans to ride the Hogwarts Express train and experience the British countryside just as the characters did in the book and movie series. Dining and Entertainment Districts Orlando is a true culinary hot spot with award-winning restaurants and celebrity chefs that cater to guests from across the globe. There’s an extensive menu of fine-dining establishments, international eateries, casual cafés, and chic wine bars for just about any taste or budget. Looking for an upscale steakhouse or a night of dancing? What about a jazz club or a new neighborhood bistro? Or want to check out where the locals wine and dine? Orlando has it all. The destination’s distinctive dining and entertainment districts include the Convention Area, Restaurant Row, Winter Park, Downtown, Universal/CityWalk, and Disney/Lake Buena Vista. Unparalleled Education Dates to Remember May 5—Registration and Housing Opens July 11—Early Registration Discount Deadline August 22—Advance Registration Discount Deadline September 21-24—AAO-HNSF Annual Meeting & OTO EXPOSM The 2014 Annual Meeting education program will allow participants to hear from thought-provoking leaders on the most pressing issues currently confronting otolaryngology professionals. Last year, 87 percent of attendees indicated they would make changes in their practice based on what they learned at the Annual Meeting education sessions. Learn how to turn challenges into opportunities to advance patient care. Divided by specialty tracks, the education program allows you to create your own customized experience: Business of Medicine/Practice Management Clinical Fundamentals (Instruction Course only) Facial Plastic and Reconstructive Surgery General Otolaryngology Head and Neck Surgery Laryngology/Broncho-Esophagology Otology/Neurotology Pediatric Otolaryngology Rhinology/Allergy Sleep Medicine Scientific Program The Annual Meeting’s Scientific Program is composed of Scientific Oral Presentations, Miniseminars, and Scientific Poster Presentations. The Scientific Posters will be on display throughout the conference during registration hours. The Scientific Oral Presentations and Miniseminars are included in the price of a full conference registration and take place starting at 10:30 am on Sunday and from 8:00 am to 12:00 pm Monday through Wednesday. Scientific Oral Presentations—A series of five-minute oral presentations that will take place within either 50- or 80-minute topical sessions that focus on cutting-edge clinical and translational basic research aspects of otolaryngology. Miniseminars—Presentations, case studies, and/or interactive discussions that will provide an indepth, state-of-the-art look at a specific topic. Scientific Posters—About 400 posters will be on display in Hall C. Instruction Courses Experts in the field of otolaryngology and other healthcare professionals present Instruction Courses. Early registration for these one- or two-hour courses increases the possibility of receiving your first-choice selections and saves you money. Instruction Course fees are $50 an hour and $70 an hour for hands-on courses, if you register before August 22. Instruction Course fees increase after the advance registration deadline to $70 an hour, and to $90 an hour for hands-on courses. There are four types of Instruction Courses: Didactic Lecture—Course will be presented in a large audience lecture setting. Audience Polling—Presentation would include the opportunity for audience members to respond to polling questions. Hands-On—Hands-On courses are classroom set and limited to 40 participants. Mini-Course—Mini-Courses promote informal discussion with the free exchange of information. These courses will be limited to 25 participants. Credit Hours AAO-HNSF designates this live activity for AMA PRA Category 1 Credit™. Physicians should claim credit commensurate with the extent of their participation in the activity. Scientific Program maximum: 13.5 credits Instruction Course maximum: 15 credits Credit is awarded to physicians when documented by the submission of the 2014 Annual Meeting & OTO EXPOSM Evaluation. New Beginnings in 2014 The 2014 Annual Meeting lives up to its cutting-edge reputation with a series of exciting enhancements to the program crafted by the two program committees. Offering a richer experience for the participants, these enhancements compliment the traditional program our attendees have honored throughout the years. One of the most exciting revisions that will affect your travel plans is our change to the OTO EXPOSM and education program hours. Always respectful to your time out of the office and striving to maximize your experience, the OTO EXPOSM has been shortened to three influential days. The exhibit hall will now be open starting at 10:00 am on Sunday with its traditional grand opening and will close its doors at 3:00 pm on Tuesday afternoon. The education program also has undergone an overhaul. Concluding at noon on Wednesday, the last day of the Annual Meeting will feature a morning program of Miniseminars, Oral Presentations, and Instruction Courses. This last day of the meeting is sure to be a whirlwind of activity with more opportunities to enrich your experience than ever before. The Scientific Program features more opportunities for interaction. Now 25 percent of the Miniseminars will use audience response technology allowing you to respond to presenters’ questions and instantaneously view your colleagues’ answers. A few other highlights from the program include: The Martha Entenmann Tinnitus Research Center, Inc.: Abraham Shulman, MD and Barbara Goldstein, PhD; “Tinnitus Treatment Modalities and Neuromodulations: State of the Art 2014.” Moderated by Michael Hoffer, MD; and presented by Michael D. Seidman, MD; Abraham Shulman, MD; Richard Tyler, MD; Berthold Langguth, MD; and Tobias Kleinjung, MD, will speak to the neurobiology for all clinical types of tinnitus that is emerging and reflecting advances in the basic science and neuroscience of brain and brain function and the cochleovestibular system. As tinnitus types begin to be objectively identified in treatment, modalities can be applied in a more precise manner. The goal of this Miniseminar this to examine new and existing tinnitus specifically, in reference to how to apply these techniques of the different tinnitus types. Surgery, intratympanic treatment, neuromodualtion, and magnetic stimulation will all be examined allowing the participants to understand the cutting edge of tinnitus therapy. “The HPV Head and Neck Cancer Epidemic: What You Need to Know,” moderated by Christin G. Gourin, MD and presented by Maie St. John, MD, Eduardo Mendez, MD, MS, Harry Quon, MD, and Mariam N. Lango, MD, will address the HPV-associated head and neck cancer as an epidemic striking a younger and healthier population without the usual risk factors for head and neck cancer. Most patients have an excellent prognosis following treatment with surgery or chemoradiation, and the sequel of long-term morbidity from treatment are of increasing concern as patients are expected to live long enough to experience complications. Failure to identify a subset of high risk patients at risk for metastasis, recurrence, and decreased survival can lead to under treatment and poor outcomes. This Miniseminar will discuss the epidemiology, workup, treatment, and surveillance of HPV+ head and neck cancer. The Instruction Course program includes three MOC Review Courses—”Head and Neck Surgery,” “Rhinology,” and “General Otolaryngology.” These extended courses, two- and three-hours long, meet MOC Part III requirements. The program also features a Clinical Fundamental track complying with MOC Part III requirements to meet your recertification needs. Responding to your requests for additional hands-on opportunities, we’ve added an additional hands-on room this year that will give you ample time to interact with expert faculty while participating in cutting-edge demonstrations. “ACS Ultrasound Course: Thyroid and Parathyroid Ultrasound Skills‐Oriented Course” with Robert A. Sofferman, MD, course director, will take place from 8:00 am-4:30 pm Saturday, September 20. Additional fees apply. Bringing the Best Together Because our meeting is the largest gathering of otolaryngologists worldwide—about 40 percent of physician attendees are international, coming from 90 or more countries—we do all we can to make it user-friendly for our many international visitors. Guyan A. Channer, MD, of Kingston, Jamaica, says, “I was particularly impressed with the meeting’s technological resources, where I seamlessly pre-planned my daily schedule using wireless apps and made contact with various manufacturers.” Professor Yongxiang Wei, MD, of Shenyang, China, adds, “Professional website, free Wi-Fi, accommodations, information and food services, traffic, technique support for audios and videos et al., were all very well organized.” Education Program Is Truly International International presenters are a huge part of the meeting’s educational program: a stated goal of the meeting is “to develop a broader understanding of approaches used in the practice of otolaryngology-head and neck surgery in countries outside the U.S.” International submissions for miniseminars and oral and poster presentations participate on an equal footing in the peer-reviewed process. Our Scientific Program is a venue for the many international presenters for both oral presentations and posters. The program provides a platform for new collaborative activities, such as our participation in the Cochrane Collaborative on Evidence Based Medicine. OTO EXPOSM—A Better Mousetrap As the adage says, “Build a better mousetrap and the world will beat a path to your door,” so specialists from around the world flock to our OTO EXPOSM to examine, test, and compare the myriad products and services on display. Hideaki Moteki, MD, PhD, of Matsumoto, Japan observed, “In the OTO EXPO, there were a huge number of booths and products, and I was very excited about seeing advanced products that I had never seen before.” Experience It for Yourself In sum, no other otolaryngology meeting in the world compares to the number and variety of attendees that the Annual Meeting attracts. With its multidisciplinary focus, the education offered draws attendees from across the health spectrum and from around the world. They all belong to a worldwide community whose goal is to provide the best patient care. Your Academy is more than a national professional association; it is your global network working for the best ear, nose, and throat care. Join us in Orlando for this unrivaled experience. Reasons to Book in the Room Block and Not Online Fast, easy, and secure online booking Complimentary shuttle service between hotels not within walking distance to the convention center Top-notch service support No service fees to make your reservations Immediate confirmations—no waiting or wondering Update our reservations with no fees or penalties. Take time to explore the OTO EXPOSM during the NEW hours: Sunday, September 21 ……10:30 am-5:00 pm President’s Reception …………………..6:00-7:30 pm Monday, September 22 ……..8:00 am-5:00 pm Tuesday, September 23 ……..8:00 am-3:00 pm Exhibitors in the OTO EXPOSM help the physician and otolaryngology medical professionals reach the ever-growing assortment of otolaryngologic products and services. The OTO EXPOSM is an extension of the educational sessions, where attendees come for face-to-face interaction with product experts. Interested in Holding a Meeting or Reception at the Annual Meeting?Fill out a meeting space application today! Visit www.entnet.org/annual_meeting to find the application. Benefits to holding a meeting through AAO-HNSF: Published Events—Meeting/event is published online and in the final program read by all attendees Convenience—Ease of being able to meet near the con-ference activities Experienced— Experienced staff work with you on your meetings/events If you have any questions, please email alsa@entnet.org.

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The Transition Continues: Rollout of Socioeconomic Resources and Clarifying the BOG SEGR Regionalization Process

James C. Denneny III, MD Coordinator for Socioeconomic Affairs and Co-Chair Physician Payment Policy Workgroup David R. Edelstein, MD Chair of Board of Governors Socioeconomic Grassroots Committee As noted in last October’s BOG Bulletin article, the BOG Socioeconomic Grassroots (SEGR) Committee has modified its structure. As of January 1, 2014, the SEGR has begun implementing the new regionalization model. This plan divides the country into 10 regions following roughly the same lines of division as the Department of Health and Human Services (DHHS). There will be a representative from each region charged with keeping the BOG current on socioeconomic and grassroots-issues affecting that area of the country. This will be done primarily through regional reports at the fall and spring BOG meetings, conference calls, and direct communication with the BOG Executive Committee. This new structure also requires that the BOG SEGR regional representatives and leaders have an ongoing dialogue with the Academy’s Physician Payment Policy Workgroup (3P) leaders, whose primary focus is to address national socioeconomic issues affecting the membership. That dialogue will be achieved in two ways. First, representatives from the BOG SEGR committee have been included as part of the 3P workgroup to help facilitate communication on socioeconomic issues that may begin in one area, but require the input of both groups. Those leaders are Lawrence M. Simon, MD, (who also serves as the Academy’s Alternate CPT Advisor) and Robert J. Stachler, MD. Second, all 3P and BOG SEGR calls will include a standing agenda item to allow for reports from the BOG SEGR leaders to the 3P workgroup or from the 3P workgroup to the BOG SEGR regional representatives. To further this effort to streamline communication between the two groups, and to support the BOG transition to a regional representative structure for socioeconomic and grassroots issues, the Academy Health Policy team prepared a socioeconomic e-care package. This document is available to all BOG SEGR representatives, and members at large, to outline the wealth of practice management resources the Academy provides to members on our website. Resources include information related to common member inquiries such as requests for coding clarification related to changes to CPT codes, national reimbursement rates, payer denials, transitioning to ICD-10, and more. These materials will support the BOG SEGR representatives in responding to members’ local and state inquiries, as well as to assist members in furthering their relationships with payers and state OTO and medical societies in their regions and states. We have also developed the 3P/BOG SEGR communication flow chart, which was approved by 3P and the BOG chairs, and outlines the socioeconomic issues that will be tackled by the BOG at the local level, or by 3P and the health policy team at the national level. On behalf of Academy 3P leaders, BOG leaders, and staff, we are thrilled about this new organizational structure for the BOG and look forward to future collaboration on socioeconomic issues affecting otolaryngology-head and neck surgery. We hope this information and graphic are helpful in clarifying the roles of the BOG SEGR Committee and the 3P workgroup. Members with additional questions can email us at healthpolicy@entnet.org. Members can also access the resources mentioned above (flow chart and e-care package) at http://www.entnet.org/Practice/businessofMedicine.cfm.

Stacey L. Ishman, MD, MPHBOG Member-at-Large

Starting a Habit

In January (and many previous Januaries), I resolved to take better care of myself and exercise more. My research regarding the best way to establish a habit suggested that I should: Start small. Create a list of the benefits. Create a strategy. Set up specific goals and reward myself when I meet them. Consult a friend and do it together to stay motivated. As I sat at the AAO-HNS/F’s Leadership Forum and Board of Governors’ (BOG) meeting March 2-3, I reflected on the great education that the BOG provides and mused on the best way to help my fellow otolaryngologists establish the habit of participating in the BOG. What Is the BOG? The BOG was established in 1982 as a grassroots member network within the Academy. It is made up of local, state, regional, and national otolaryngology–head and neck surgery societies in the United States. And while members within this grassroots network were traditionally community otolaryngologists, it increasingly includes members from every practice setting. Moreover, the BOG functions as an advisory body for the grassroots organizations to the Board of Directors. Leadership Forum 2014 This year’s AAO-HNS/F Leadership Forum was coupled with the BOG’s spring meeting. The forum was designed to educate us on topics such as clinical practice guidelines, current federal and state legislative issues, alternative payment models, and transition to ICD-10 coding. Also new this year was the availability of free CME credit during the meeting for sessions that covered contract negotiation, the pros and cons of hospital employment, and ICD-10 implementation. As in previous years, the candidates for AAO-HNS President-elect spoke at the Candidates’ Forum and there was an opportunity to ask questions of both candidates directly. Establishing the Habit of BOG Participation The Board of Governors is here for all of us. We need to hear from otolaryngologists from every practice setting so we can focus our energies on the issues that are affecting our patients and our practices. Toward that end, I propose that we all… Start Small Involvement in the BOG may be as simple as attendance at a spring or fall meeting, answering the BOG polls distributed through your local association or assistance in tracking local legislation as a State Tracker. To become more involved, you can serve as a representative to the Legislative Affairs Committee or the Socioeconomic and Grassroots Committee, or as the governor for your local or state society. The BOG is especially recruiting people to help track legislation in the following states: Alaska, Hawaii, Idaho, Mississippi, Nevada, New Mexico, Oregon, Rhode Island, South Dakota, and Wyoming. List the Benefits Being one of the first to know what is happening with legislation affecting your livelihood. Free CME at the spring meeting. Free education on the business of medicine including ICD-10, and contract negotiations. Free education on how to participate and comply with CMS quality improvement initiatives such as PQRS, EHR Meaningful Use, Physician Compare, and the Value Based Payment Modifier. Receive guidance, support, and training on how to improve your interactions with local and national payers to achieve optimal reimbursement for your services. Training that can help you advocate at the hospital, state, and federal levels. Direct access to hear and question the Academy presidential nominees at the spring BOG meeting. Networking with other otolaryngologists Opportunities to share successes and challenges. Having fun. Create a Strategy and Set Goals Sign up to be a State Tracker: govtaffairs@entnet.org. Sign up for the ENT Advocacy Network to receive biweekly emails on healthcare legislation and politics; http://www.entnet.org. Submit a guideline topic you would like to see presented to the Guideline Development Task Force by emailing bog@entnet.org. Contact your local otolaryngology society to serve as a representative to the BOG. Just attend the fall BOG meeting—no need to have a title or agenda. Do It with a Friend Bring a resident, a partner, or your practice administrator. Or come alone and make a friend. The BOG is here to serve you. Please get involved and make Board of Governors participation a habit!

David R. Nielsen, MD, AAO-HNS/F EVP/CEO

The Lessons of Lifelong Learning

This month, you will find the traditional emphasis on the upcoming Annual Meeting & OTO EXPOSM that will take place September 21-24 in Orlando, Florida. While this annual event marks the highlight of the year for many of our members, and is rated one of the highest and most valued products or services the Academy provides to otolaryngologists from around the world, I’d like to add another perspective about the value of our exceptional meeting and the lifelong learning process to which it contributes. None of us practices medicine in exactly the same way we were taught during our residencies. While many foundational principles, values, and ethics are timeless and will never change, advances in understanding, new basic science, technological accelerators, and clinical approaches have positively altered what we thought we knew when we entered practice. Sometimes the new knowledge or clinical change occurs almost before the ink is dry on the publication of the previous knowledge. I came across one such example a few weeks ago as I participated in a unique and energizing conference at the Massachusetts Institute of Technology in Boston. The event was a “hackathon” designed to gather volunteer scientists, students, patients, health plans, teachers, and anyone else interested in improving healthcare into one room to express their “pain point” or perspective on what needed to improve and how we could think about changing it. Participants were granted 60 seconds to describe their “pain point.” After hearing from dozens of participants, tracks or themes began to congregate around possible common ideas. By the early afternoon on the first day, teams were beginning to form and discuss solutions and approaches. By the end of the day, specific proposals of defined groups started to formalize their proposals. On the second day, mentors from industry, academia, and public interest groups met with each team to assist them in the design, business modeling, and presentation of their proposals. Several hours of three-minute proposals were then heard in each track; judges questioned the presenters; and awards were given sponsored by those stakeholders who offered resources to bring these ideas to fruition. It was exhilarating to say the least! Winning awards included proposals to: Build shoes with tiny lights shining a point 12 inches in front of each step to encourage Parkinsonian patients to improve their gait. Create low cost lighting systems available to poverty-stricken areas of the world to treat jaundiced newborns. Create a database of 68 points from facial recognition software donated by the developer to diagnose rare genetic disorders afflicting 350 million people globally (ironic that 7,000 “rare disorders” collectively are not really rare at all, but afflict nearly 10 percent of the U.S. population!). In each instance, the proposals offered benefits to millions of patients, and the business models for start-up or proof of concept were only a few thousand dollars. Talk about a return on investment! Each presentation included published, accurate, statistically sound, documentation of need, proof of concept and relative benefit. As I thought of our own research and education programming, I considered how this approach was markedly different from how I was taught and how many clinician scientists still approach translational research today. For example, the explosion of genetic knowledge in the last decade overturns the notion (that most of us still believe) that our genes are “fixed” and make us what we are—even though we now have extensive evidence of how our experiences, exposures, diet, and even our behavior and attitudes can change our genetic makeup and what we pass on to successive generations. The study of epigenetics has dramatically affected what we previously thought we knew about genetics. I highly recommend a new book entitled Inheritance: How Our Genes Change Our Lives—and How Our Lives Change Our Genes, by Sharon Moalem. He is an MD/PhD geneticist and a best-selling author of a couple of other books, including Survival of the Sickest: The Surprising Connections Between Disease and Longevity. Inheritance is a fascinating read for any clinician, and especially for otolaryngologists as we deal with the facial, head, and neck manifestations of so many common and rare diseases. Dr. Moalem also just happens to be the developer of the facial recognition software—which he donated free to the Global Genes Project, a patient advocacy non-profit whose work it is to assist those with rare diseases to find their diagnoses and get appropriate care. So, what’s the point? Lifelong learning is essential. Basic foundations such as what we know about how our DNA affects our health are changing rapidly. We cannot afford NOT to attend the Annual Meeting & OTO EXPOSM, participate heavily in continuing education, and broaden our scientific knowledge. Simply engaging in education as a “check-off” for our CME, licensing, or MOC is not enough. As physicians, our native curiosity about biology, science, and health is our defining characteristic. And the journey of learning is a fascinating and joyous one of creativity, wonder, and growth. Come to the meeting in Orlando, share what you know, question what you don’t, and engage once again in the adventure of lifelong learning. See you there!

Richard W. Waguespack, MD AAO-HNS/F President

We Have You Covered

This issue features the work of our volunteer members in concert with AAO-HNS Health Policy staff on topics that you want to know about. This coverage begins with my thoughts and the Feature Section and Legislative Advocacy Sections deliver more relevant information. Also, this May Bulletin coincides with the opening of registration for the AAO-HNSF 2014 Annual Meeting & OTO EXPOSM. An exciting look at what it will offer can be found in the Preliminary Program that is in your mailing along with David R. Nielsen, MD’s pertinent observations here and a special section every month to highlight aspects of the much anticipated event that impacts your everyday practice. Changes Ahead There has never been another time in my professional career when so much change has occurred in the field of healthcare in such a short time. I know AAO-HNS members, who are working diligently on behalf of their patients, feel this—whether you’re in a small, rural community practice or in an urban academic setting. Meaningful Use, Quality reporting within the Medicare program, ICD-10, and the Affordable Care Act (ACA) have created resource intensive, overlapping regulatory changes that are affecting, and will for years, the way physicians do business. Positive outcomes depend on physicians’ readiness and willingness to adapt to these changes. More changes are likely as the AAO-HNS Membership and staff continues to work with other specialty societies and Hill leaders to permanently repeal the Sustainable Growth Rate (SGR) formula and develop longer lasting payment reform for a new Medicare payment system to incentivize the delivery of high-quality, efficient healthcare. The Health Policy staff, working with the Academy’s Physician Payment Policy (3P) workgroup, co-chaired by James C. Denneny III, MD, and Jane T. Dillon, MD, MBA, provides valuable services to members that empower otolaryngologist-head and neck surgeons to deliver the best patient care. Through services such as these listed, we work for you! 2014 Annual Meeting educational seminars transitioning to ICD-10 and alternative payment models, Tools like the ICD-10 Superbill and CMS Quality Fact Sheets, Advocacy to the AMA and CMS on CPT, the RUC, and reimbursement issues; Advocacy to the CMS and private insurance companies for fair and appropriate valuation, payment, and coverage of otolaryngology-head and neck services, Payer template appeal letters, CPT for ENT coding guidance articles, Position Statements and Clinical Indicators, Summaries of annual rule making and policy changes, Communications on annual ENT coding and reimbursement rate changes, Maintain the New Technology Pathyway to help integrate innovations into coding and reimbursement. 3P and the Health Policy team recognize that physicians today are facing numerous changes in coding and reporting requirements. Adherence and non-adherence to deadlines and requirements can significantly affect physicians’ practices. The value that 3P and the Health Policy team offer to members includes a single source for preparing for the changes, and peace of mind that despite these challenging times, AAO- HNS helps physician members continue to provide excellent patient care. Socioeconomic Survey 3P and Health Policy strive to do what is best for you and your patients. They continually need your feedback from all members and specialty societies as they interact with payers and regulatory entities. The 2014 AAO-HNS/F Socioeconomic Survey captured trend data from more than 1,000 members, reflecting the ever-changing healthcare environment and providing insight on the future of the specialty. The results of the survey will be on display at the AAO-HNSF 2014 Annual Meeting & OTO EXPOSM in Orlando, Florida, where I look forward to seeing you all and welcome the next AAO-HNS/F president. 3P WorkgroupsChairs James C. Denneny III, MD, Coordinator for Socioeconomic Affairs Jane T. Dillon, MD, MBA, Coordinator for Practice Affairs (also Alternate RUC Panel Member) Michael Setzen, MD, Immediate-Past Coordinator for Practice Affairs RUC Team Wayne M. Koch, MD, AAO-HNS RUC Advisor John Lanza, MD, AAO-HNS RUC Advisor Alternate Jane Dillon, MD, AAO-HNS RUC Member Alternate Peter M. Manes, MD, AAO-HNS RUC Trainee Charles F. Koopmann, Jr., MD, MHSA, RUC Panel Member, CPT Assistant Editorial Board Member Bill Moran, MD, Immediate-Past RUC Practice Expense (PE) Subcommittee Chair CPT Team Bradley F. Marple, MD, AAO-HNS CPT Advisor Lawrence M. Simon, MD, AAO-HNS CPT Advisor Alternate Richard W. Waguespack, MD, Advisor for Triological Society, Immediate-Past Coordinator for Socioeconomic Affairs Lee Eisenberg, MD, Past CPT Panel Member and CPT Representative to RUC, Past Government Relations Coordinator Quality Expert Emily Boss, MD, MPH Payment Models Expert Robert Lorenz, MD, MBA