Health Policy: Looking Back and the Road Ahead
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, 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. During the last strategic plan that spanned 18 months (January 2013-May 2014), 3P and the Health Policy team were busy with a continued high level of activity, constant emails and monthly calls, working diligently and tirelessly on behalf of all members. The next year will be no different with efforts focused on the strengths of the Academy: 1) Advocacy, 2) Annual Meeting, and 3) Quality Products (Clinical Practice Guidelines). The Board of Directors agreed to these strengths during the March 2014 strategic planning meeting. While Health Policy is under the Advocacy section of the strategic plan, the team overlaps and coordinates closely on many related activities with Government Affairs, Research and Quality Improvement, Education, Component Relations (BOG), with support from Member Services, Communications (including Marketing and Graphic Design), and Information & Knowledge Management units. The Health Policy team will continue to work closely with other team units within the Academy to collaborate to meet the measurements of success. Examples of collaborating with other teams to meet Academy goals include: Government Affairs—Provided input on the health policy language included in the SGR payment reform legislation, developing the AAO-HNS position. Research and Quality Improvement—Advocacy efforts with CMS resulted in the inclusion of four new adult sinusitis measures for PQRS reporting in 2014. Coding & Reimbursement—Provided input on the content of the AAO-HNSF Coding Workshops conducted by Karen Zupko & Associates. Component Relations (BOG)—Developed a 3P/BOG SEGR Communication Flow Chart outlining the socioeconomic issues that will be addressed at the local level by the BOG, or by 3P and the Health Policy team at the national level. During the course of the next strategic plan, which will cover a one-year period, from July 2014 to June 2015, 3P and the Health Policy team will help the Academy be a powerful voice in influencing legislative, political, regulatory, health policy, and third-party payer policies, seeking ways to increase member awareness of and involvement in these critical advocacy activities. Below are the two goals of the health policy unit with the main focus on the following actions as they assigned priority by the Board of Directors. This does not mean the 3P and the Health Policy team will not continue to provide other services. However, it does mean that activities under these goals will take precedence over other activities. Goal 1: Integrate health policy-specific priorities, using input from the 3P Workgroup, to maintain our visibility and credibility with national representatives regarding socioeconomic and federal regulatory issues. ACTIONS Advocate for relevant and validated quality and cost measures, and develop guidance on payer quality initiatives. Develop a more refined approach to CPT/RUC code participation, working more effectively with industry partners. Integrate priorities of quality knowledge products with code development and payer coverage needs. Analyze trends and developments in payment reform and influence the payment and delivery system reform. Goal 2: Advocate for appropriate reimbursement and fair policies with Medicare and private payers, providing members with information and guidance on reimbursement issues encountered at the state and local level. ACTIONS Provide guidance for members at the state and local level to advocate for appropriate payment. Develop guidance on coding and practice management resources to physician leaders. Provide coding guidance (i.e., ICD10 transition, new codes, etc.) and develop educational resources. The 3P and the Health Policy team look forward to working on these priority issues during the next year. Updates on the action items will be provided in a future Bulletin article. For questions, please email the Health Policy team at HealthPolicy@entnet.org.
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, 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.
During the last strategic plan that spanned 18 months (January 2013-May 2014), 3P and the Health Policy team were busy with a continued high level of activity, constant emails and monthly calls, working diligently and tirelessly on behalf of all members. The next year will be no different with efforts focused on the strengths of the Academy: 1) Advocacy, 2) Annual Meeting, and 3) Quality Products (Clinical Practice Guidelines). The Board of Directors agreed to these strengths during the March 2014 strategic planning meeting.
While Health Policy is under the Advocacy section of the strategic plan, the team overlaps and coordinates closely on many related activities with Government Affairs, Research and Quality Improvement, Education, Component Relations (BOG), with support from Member Services, Communications (including Marketing and Graphic Design), and Information & Knowledge Management units.
The Health Policy team will continue to work closely with other team units within the Academy to collaborate to meet the measurements of success. Examples of collaborating with other teams to meet Academy goals include:
- Government Affairs—Provided input on the health policy language included in the SGR payment reform legislation, developing the AAO-HNS position.
- Research and Quality Improvement—Advocacy efforts with CMS resulted in the inclusion of four new adult sinusitis measures for PQRS reporting in 2014.
- Coding & Reimbursement—Provided input on the content of the AAO-HNSF Coding Workshops conducted by Karen Zupko & Associates.
- Component Relations (BOG)—Developed a 3P/BOG SEGR Communication Flow Chart outlining the socioeconomic issues that will be addressed at the local level by the BOG, or by 3P and the Health Policy team at the national level.
During the course of the next strategic plan, which will cover a one-year period, from July 2014 to June 2015, 3P and the Health Policy team will help the Academy be a powerful voice in influencing legislative, political, regulatory, health policy, and third-party payer policies, seeking ways to increase member awareness of and involvement in these critical advocacy activities. Below are the two goals of the health policy unit with the main focus on the following actions as they assigned priority by the Board of Directors. This does not mean the 3P and the Health Policy team will not continue to provide other services. However, it does mean that activities under these goals will take precedence over other activities.
Goal 1: Integrate health policy-specific priorities, using input from the 3P Workgroup, to maintain our visibility and credibility with national representatives regarding socioeconomic and federal regulatory issues.
ACTIONS
- Advocate for relevant and validated quality and cost measures, and develop guidance on payer quality initiatives.
- Develop a more refined approach to CPT/RUC code participation, working more effectively with industry partners.
- Integrate priorities of quality knowledge products with code development and payer coverage needs.
- Analyze trends and developments in payment reform and influence the payment and delivery system reform.
Goal 2: Advocate for appropriate reimbursement and fair policies with Medicare and private payers, providing members with information and guidance on reimbursement issues encountered at the state and local level.
ACTIONS
- Provide guidance for members at the state and local level to advocate for appropriate payment.
- Develop guidance on coding and practice management resources to physician leaders.
- Provide coding guidance (i.e., ICD10 transition, new codes, etc.) and develop educational resources.
The 3P and the Health Policy team look forward to working on these priority issues during the next year. Updates on the action items will be provided in a future Bulletin article. For questions, please email the Health Policy team at HealthPolicy@entnet.org.