Published: August 12, 2014

State Legislative Sessions Wind Down

With most of the 2014 state legislative sessions now complete, the AAO-HNS thanks its member-volunteer “state-trackers”for their stellar job in monitoring legislative issues important to otolaryngology—head and neck surgery. However, it’s never too early to begin preparations for 2015. Join the growing team of AAO-HNS state-trackers by contacting the Government Affairs team at govtaffairs@entnet.org.

With most of the 2014 state legislative sessions now complete, the AAO-HNS thanks its member-volunteer “state-trackers”for their stellar job in monitoring legislative issues important to otolaryngology—head and neck surgery. However, it’s never too early to begin preparations for 2015. Join the growing team of AAO-HNS state-trackers by contacting the Government Affairs team at govtaffairs@entnet.org.

More from August 2014 - Vol. 33 No. 08

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Triological Society

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Ear, Nose & Throat Associates of New York, P.C.

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2014 BOG Awards Announced

Virginia Society of Otolaryngology-Head and Neck Surgery Receives BOG Model Society Award The Virginia Society of Otolaryngology-Head and Neck Surgery (VSO-HNS) is the recipient of the 2014 Board of Governors (BOG) Model Society Award. Spencer C. Payne, MD, governor, Patrick J. Gibbons, MD, legislative affairs representative, and Eric M. Gessler, MD, socioeconomic and grassroots representative, represent the society on the BOG. Among their many community-based outreach activities, last September VSO-HNS provided a free screening for head and neck cancer at the Richmond International Raceway prior to a NASCAR event. The event allowed VSO-HNS members to raise awareness of head and neck cancer and its risks, as well as the role of otolaryngologists in the diagnosis and treatment of head and neck cancer. Society members from around the state, including representatives from all four academic departments in the state, participated in the event. A total of 95 individuals were screened, and all individuals were provided with information regarding head and neck cancer risks and the role of the otolaryngologist. If indicated, the individuals were given recommendations for further follow-up or evaluation. Review of the screenings revealed 14 individuals required follow-up: ears (1), skin (1), oral cavity (5), neck (2), throat (2), vocal cords (1), sinus (1), and head (1). This past February, VSO-HNS representatives were well received by their state legislators. Cristina Baldassari, MD, and Kelley M. Dodson, MD, met with Delegate Patrick Hope to talk about expanding Medicaid and opening up the HPV vaccine to boys in Virginia. They expressed VSO’s interest in mandating the vaccine for boys. Delegate Hope advised he would like to convene a workgroup with all stakeholders and the Virginia Department of Health. Though VSO, the Medical Society of Virginia, and Virginia Chapter, American Academy of Pediatrics, testified in support, the bill was killed in subcommittee. In April, Dr. Dodson attended the HPV workgroup on how to communicate more effectively to the public the necessity of the HPV vaccine. BOG Practitioner Excellence Award The 2014 BOG Practitioner Excellence Award will be presented to Joseph A. Brennan, MD, Colonel, Medical Corps, U.S. Air Force, Fort Sam Houston, TX. Colonel Brennan has distinguished himself in the combat casualty care of wounded warriors in both Operation Iraqi Freedom and Operation Enduring Freedom (Afghanistan) as the de facto leader of military otolaryngologists, preparing them properly for the care of combat wounds to the face, head, and neck. Col. Brennan is arguably the most experienced combat head and neck surgeon in the U.S. military today. In his own right, he has cared for many wounded American and Allied military personnel in Iraq and Afghanistan, saving dozens of lives of true American heroes in these wars. He has brought back the surgical and clinical experience to teach other otolaryngologists to care for combat casualties, and is the lead editor of a military medicine textbook, Otolaryngology-Head and Neck Surgery Combat Casualty Care in Operation Iraqi Freedom and Enduring Freedom, which will be the guidebook for future combat care of head and neck wounds. His experience and teaching has already influenced civilian otolaryngologists in improving their care of traumatic wounds through his award-winning Triological Society paper on “Head and Neck Trauma in Iraq and Afghanistan: Different War, Different Surgery, Lessons Learned.” Col. Brennan is also the co-founder and current chair of the AAO-HNS Trauma Committee, which is rejuvenating the importance of trauma care in the practice of otolaryngology-head and neck surgery. Due to his leadership and experience, Col. Brennan was chosen as the chairman of surgery of the San Antonio Military Medical Center, the largest surgical department in the Department of Defense. He was also awarded the Ronald Speirs Award for Combat Medicine at Task Force Med, Bagram Theater Hospital, Afghanistan, October 2009. Col. Brennan is an otolaryngologist among otolaryngologists, and what he has done for combat casualties in Iraq and Afghanistan, as well as his practice of head and neck surgery in the military, deserves the appropriate recognition of Practitioner Excellence Award. Please join the BOG in honoring VSO-HNS and Dr. Brennan during the BOG General Assembly meeting, Monday afternoon, September 22, in Orlando, FL.

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REI/AAO-HNSF Humanitarian Trip to Ho Chi Minh City, Vietnam

Stanley W. McClurg, MD University of North Carolina Humanitarian Travel Grant Awardee Five patients in the examining room at the same time, extreme emphasis on footwear, but not so much on sterile instruments. These were some of the culture gaps I observed on a recent medical humanitarian trip to Ho Chi Minh City, Vietnam. On the plus side: We all got a tea break right before surgery. As a rhinology, endoscopic skull base, and allergy fellow at the University of North Carolina, I travelled to Vietnam February 28 through March 8 with a group under Brent Senior, MD, as part of REI Vietnam. We worked at multiple hospitals there, including the ENT hospital and Gia Dinh Hospital. I was able to give presentations to the physicians there on sinus surgery and some of my research on fluid dynamics of the nasal airway. It was a great opportunity for me to teach and also to see a different perspective on ENT and rhinology practices in another country. I personally performed four sinus surgeries and one endoscopic pituitary surgery with my neurosurgery colleagues. These included mostly endoscopic sinus surgery procedures for mucoceles, chronic sinusitis, nasal polyposis, septal deviation, and pituitary adenomas. I did take some of my own sinus instruments along, but overall, they had most of the appropriate instruments that were needed for sinus surgery. The monitors, facilities, and beds, however, were not optimal. The sterility practices were fairly odd, placing extreme emphasis on footwear, and not so much on actual sterile techniques for instruments. I do feel that the overall care that is being given at these hospitals is adequate, and at times superior to practices in the United States. There is a large emphasis placed on seeing as many patients as possible. This does provide care for the extremely large volume of patients, but it did appear that patients were not given adequate attention and focus at times. Patient confidentiality was also not high on their priority list. At some times, there were as many as five patients in the same room being examined. This just seemed like the normal way of doing things, and no one seemed to feel violated at all. Interestingly, they also put a high priority on making sure that everyone had a tea break prior to surgery, and once during the afternoon. My biggest misconception before the trip was the overall exceptional knowledge of endoscopic sinus surgery that the ENT doctors in Vietnam already had. They had a significant knowledge base, but were willing to learn new techniques. Many doctors were able to see me do sinus surgery, and learned many different and new techniques. I had many questions that were asked of me during the course, and feel that I made a true impact on their practice. I do feel that future focus on neurosurgical interventions would be beneficial for the people of Vietnam. We were able to take two neurosurgeons with us there, and the facilities and overall operative techniques of the neurosurgeons in Vietnam were suboptimal. Many of the ENT physicians there had never had any experience with endoscopic pituitary surgery, and this is an important area to address in future endeavors. I would definitely recommend this humanitarian trip to other ENT physicians. It is well established by Dr. Senior, and definitely provides an academic and immersive experience in a third world country. I would like to personally thank the AAO-HNSF Humanitarian Efforts Committee for the grant that was provided for my travels.

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Cameroon: A Model of Sustainability

Daniel Q. Sun, MD The red earth of Africa gripped me. It seemed to be everywhere—coating banana leaves larger than umbrellas and dusting roadside stands selling grilled goat. This was the dry season and we were in Cameroon. The fine red dust followed us from the south, where we landed, to the northwest—a place called Mbingo, situated in the Cameroon mountains that we would call home for the next two weeks. By working at the Mbingo Baptist Hospital (MBH), our mission was to provide otolaryngologic and, specifically, head and neck surgical training to general surgery residents there. My experience, however, was remarkable in so many ways. Shortage of health professionals is a pervasive problem in developing countries such as Cameroon, which has fewer than 30,000 doctors, nurses, and midwives per 10 million people according to a recent article in the New England Journal of Medicine. Subspecialty care is almost non-existent and general surgeons are called upon daily to do everything under the sun. Surgeons at MBH move from drilling burr holes for evacuation of a subdural hematoma in one patient to a C-section in another. Our team, led Wayne Koch, MD, has established a longitudinal partnership with the general surgery residency program at MBH and Everistus Acha, MD, a Cameroonian otolaryngologist, to provide head and neck surgical training to general surgery residents training at MBH. During the course of two weeks, we worked with Steve Kyota, MD, who is a general surgery resident in his third year of training, to perform nearly 40 operations, including five mandibulectomies, five maxillectomies, and 11 thyroidectomies. While it was gratifying to put our technical expertise to work, the greater impact lies in our ability to transfer our expertise into the hands of people like Dr. Kyota, who will hopefully go on to serve the communities around him. Indeed, during the course of our short time there, his progress in gaining a more in-depth appreciation for the anatomy, soft tissue skills, and principles of head and neck surgery was evident. In addition, we delivered educational lectures on airway management and physiological principles of hearing and balance. Dr. Acha’s expertise also allows us to be confident that we are leaving our post-operative patients in good hands, with an expert who will be able to monitor their progress and treat complications that arise. In addition to our clinical and educational projects, we also successfully carried out a pilot study on the prevalence of otitis media with effusion (OME) in the local pediatric population. After screening more than 80 children between the ages of 3 and 11 using otoscopy and tympanometry, we found the prevalence of chronic otitis media with effusion to be only about 3 percent, despite limited access to primary and tertiary care that renders most cases of otitis media and its complications unrecognized and untreated. Our findings stand in contrast to previous epidemiology studies in other developing regions of the world (but never in West Africa) that have identified rates of OME to be as high as 15 percent. As we expand our collaboration in Cameroon, we intend to build on studies such as this to investigate the differential burdens of disease and identify epidemiological and biological factors that will expand our understanding of the otolaryngologic disease processes we encounter each day. By working with local partners, focusing on building capacity through education and training, and developing avenues of research, we are excited about our efforts toward building a sustainable collaboration to advance subspecialty care in Cameroon. For young physicians in training such as myself, it also makes for a profound experience in personal and professional development, as I look outward at the inspirational community of people that have gathered in a beautiful village in the northwestern mountains of Cameroon to meet the challenges of building a healthcare system, and inward at what my patients have taught me about the indomitable human spirit and dignity that are at the core of my profession. Trip information: Name of training program: Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University School of Medicine Mission to: Mbingo, Cameroon Date of travel: February 6-21, 2014 Sponsoring organization: Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University School of Medicine, AAO–HNSF Humanitarian Travel Grant, Cameroon Baptist Convention Supervising Otolaryngologist: Wayne M. Koch, MD Local contact and hospital: Dr. Everistus Acha, Mbingo Baptist Hospital

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Determining Education Gaps and Needs in Continuing Professional Development

In order to ensure that our education activities address physicians’real-world practice needs, the Foundation must identify the education needs (knowledge, competence, or performance) that coincide with the professional practice gaps of our learners. A Gap Analysis process is underway that will determine key topics for future Foundation education activities. The Gap Analysis answers the overall question “Why is this topic important to our members?” The AAO-HNS Foundation’s Continuing Professional Development (CPD) mission states: We will enhance the quality of patient care and remain the premier source of otolaryngology education and knowledge. We will deliver resources and education activities that address gaps in care and improve the knowledge, competence, and practice of otolaryngologist-head and neck surgeons, residents, medical students, non-otolaryngologist physicians, allied healthcare professionals, and the public. As an ACCME-accredited continuing medical education (CME) provider, the Foundation is required to comply with several accreditation criteria. According to these criteria, the Foundation’s CME activities must be designed to change physicians’competence or performance, and/or patient outcomes. The simplest way to describe a professional practice gap is the difference between “what is current practice”and “what should be optimal practice.” The Foundation requires an organized and thoughtful assessment of the target audiences’practice gaps and education needs. Foundation staff coordinates with the Education Steering Committee and the Annual Meeting & OTO EXPOSM Advisory Committees to review, clarify, and determine the critical practice gaps to address in the annual education work plan. The Foundation utilizes a planning process that links identified professional practice gaps and education needs with expected outcomes (knowledge, competence, performance, or patient outcomes) in its provision of CPD activities. This analysis data is incorporated into the planning of all education activities. This process utilizes the ACCME model for CPD for physicians, which shows a cyclical process that includes: Begin with question in practice—data, information, analysis, synthesis, judgment Gain new knowledge—wisdom, strategy Develop new strategy to ultimately apply to practice Physician competence in practice Physician performance The eight Education committees, under the leadership of Sonya Malekzadeh, MD, and the Education Steering Committee are currently completing a formal Gap Analysis. This is critical to ensure we are offering the best education resources that focus on improved professional practices and patient outcomes.

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Imaging Committee Update

Gavin Setzen, MD, Chair Jenna Kappel, MPH, MA Director, Health Policy and Staff Liaison, Imaging Committee The following is an update on the continued efforts of the Imaging Committee on the behalf of members. AAO-HNS Imaging Committee Members Take on Leadership Roles at Imaging-Related Societies The Intersocietal Accreditation Commission (IAC) CT Division (IAC-CT) As a follow-up to the Academy’s submission of several nominees for the open seat on the Intersocietal Accreditation Commission (IAC) CT Division (IAC-CT), Rakesh Chandra, MD, from Northwestern University Feinberg School of Medicine, and Imaging Committee member, has been elected to the IAC CT board of directors. The CT board was impressed by Dr. Chandra’s level of expertise and knowledge and looks forward to working together to help further the mission and importance of IAC accreditation. The American College of Radiology Appropriateness Criteria® (AC) Expert Panels on Neurologic Imaging The ACR Committee on Diagnostic/Interventional Appropriateness Criteria invited AAO–HNS to select a new representative on the American College of Radiology Appropriateness Criteria® (AC) Expert Panels on Neurologic Imaging. To note, AC are evidence-based guidance used by providers in making the most appropriate imaging or treatment decision for a specified medical condition. The ACR feels the expertise of AAO–HNS members contributes to producing stronger, more relevant recommendations. The AAO–HNS greatly appreciates the opportunity to participate in the process of reviewing and updating relevant AC to otolaryngologists. In June, David Conley, MD, replaced Brian Nussenbaum, MD, as an AAO-HNS representative to the ACR AC Expert Panel on Neurologic Imaging. We greatly appreciate all the time and effort that Dr. Nussenbaum has given during the past several years in this role. Dr. Conley will work with the panel to develop and update topics for select neurological conditions. National and State Efforts Related to the In-Office Ancillary Services Exception (IOSE) Physician Community Urges Congress to Preserve Stark Law Exemption On a national level, on March 18, the AAO-HNS joined the Coalition on Patient-Centered Imaging (CPCI) in sending a letter to Congress urging preservation of the in-office ancillary services exception (IOASE) to the Stark law and rejection of the Administration’s budget proposal to restrict the IOASE. Leaders of the Senate Finance, House Ways & Means, and Energy & Commerce Committees received the letter. To view the letter, visit the Imaging Services webpage at http://www.entnet.org/content/imaging-services. State Advocacy Efforts in California Lead to Defeat of Bill to Remove Stark Law Exemption At a state level, in April the AAO-HNS was approached by the CPCI regarding a sign-on letter opposing California Senate Bill 1215, which would have removed the exemption for in-office advanced imaging. The Academy’s Government Affairs team moved quickly to receive support from the California Otolaryngology Society and San Diego Academy of Otolaryngology, as well as the AAO-HNS to sign on to the opposition letter. The California Medical Association also took action to oppose the bill. Thanks go to Board of Governors and California Otolaryngology Society leaders Marci Bothwell, MD,Christopher Bergeron, MD, and Steven Kmucha, MD, JD, for their local advocacy efforts. As a result of these actions, SB 1215 was defeated in the California Senate Business, Professions and Economic Development Committee and it is dead for the year. AAO-HNS Submits Comment Letters to Private Payers Regarding Restrictive Policies The Academy’s Health Policy team worked with the Imaging Committee and coordinated with the IAC to submit comments to Coventry/National Imaging Associates (NIA),Humana, and Blue Cross Blue Shield of Idaho opposing their policies that restrict the use of mini-CT scans and/or limit the ability for otolaryngologists to interpret and provide imaging services. The letters incorporate language from AAO-HNSF’s position statement on point-of-care imaging to support providers who utilize point-of-care imaging when medically necessary and appropriate, in order to improve efficiency in diagnosing and managing a patient’s condition. In addition, in response to Humana’s request for additional evidence in specific criteria where computer assisted navigation is needed, comments were submitted to Humana’s Medical Director with updated references added to the AAO-HNS/F position statement on Intra-Operative Use of Computer Aided Surgery. While their medical policy on Computer Assisted Surgical Navigation (CASN) currently does not provide payment for the service, Humana stated that they are willing to review any new information provided on this topic. While we are hopeful that these policies will be changed to allow for coverage, the Academy is appreciative of the open channels of communication with these payers.

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CPT for ENT: Coding for Flexible Laryngoscopic Procedures

Q: How do I code for percutaneous laryngeal injections using flexible endoscopic guidance? A: Percutaneous laryngeal injections performed using flexible laryngoscopy for guidance and needle placement should be reported using the unlisted laryngeal code 31599. In this setting, 31599 includes both the injection and the flexible laryngoscopy. Depending on which material is injected, you might be able to separately report the material with a HCPCS J code. CPT codes 31570 and 31571 are used to report injections performed using rigid, direct laryngoscopy and are not appropriate to use for injections performed using either flexible fiberoptic or flexible distal-chip endoscopic guidance. Q: What if the laryngeal injection is done through the flexible scope? A: Injections performed through the operating port of a flexible fiberoptic or flexible distal-chip laryngoscope are reported using the unlisted laryngeal code 31599. CPT Codes 31570 and 31571 are used to report injections performed using rigid, direct laryngoscopy and are not appropriate to use for injections performed using either flexible fiberoptic or flexible distal-chip endoscopic guidance. Q: Is flexible laryngoscopy using a distal-chip scope also coded with 31575-31578? A: Yes. While the optics and video sensor of a distal-chip flexible laryngoscope are different from (and generally superior to) those of a standard fiberoptic laryngoscope with attached video camera, the technique and physician work involved using the two instruments is identical. Hence, 31575–31578 are used to report flexible laryngoscopy performed using either a fiberoptic (with naked eye or video observation) or distal-chip flexible laryngoscope. The CPT for ENTs are AAO-HNS perspectives and opinions, but are not meant to serve as the absolute and only coding authority. Without the benefit of seeing the patient and the medical record, comments are opinion and guidance only. This is not intended to be a substitute for the judgment of the treating physician. For more AAO-HNS CPT for ENTs, visit http://www.entnet.org/?q=cptENT.

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ENT PAC

The countdown to this year’s mid-term elections has officially begun, with many exciting primary races having already concluded. ENT PAC, the political action committee of the AAO-HNS, financially supports federal Congressional candidates and incumbents who work to advance the issues important to otolaryngology–head and neck surgery. Since your AAO-HNS annual dues cannot be used for political purposes, ENT PAC was established to accept voluntary contributions enabling our members to speak with a collective voice. ENT PAC is a non-partisan, issue-driven entity that supplements the Academy’s legislative advocacy efforts and helps to increase the visibility of the specialty on Capitol Hill. To learn more about ENT PAC, visit our PAC website at www.entpac.org (log-in with your AAO-HNS ID and password) or email entpac@entnet.org for assistance.

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I-GO: Celebrating through Action

Last summer, the AAO–HNS rolled out its In-district Grassroots Outreach (I-GO) program to provide Academy members increased opportunities to meet with their federal legislators without the time-consuming and expensive travel to Washington, DC. As expected, the program was enthusiastically embraced by many of our members, which resulted in a successful first year.

2014 Mid-term Election Landscape Takes Shape

Following an exciting primary election season and with only a couple of months remaining before we head to the polls in November, much of the electoral landscape has taken shape. So, what are we left with? The answer is a handful of competitive races and an extremely interesting struggle for control of the U.S. Senate. Read on for a brief overview of the most competitive—or “toss-up”—federal races this year.* U.S. House of Representatives AZ-1 –Incumbent Ann Kirkpatrick (D) won her 2012 election with an unimpressive 49 percent. With a lackluster first election, paired with an expected low turnout in the mid-terms, Kirkpatrick has a tricky road ahead for re-election. AZ-2 –Rep. Ron Barber (D), who initially made his way to Washington in a special election to replace retiring Rep. Gabrielle Giffords, nearly lost his first full-term election in 2012 to GOP Air Force veteran Martha McSally. Having won that election by less than one percent, McSally may be well-poised to take the seat this year. CA-7–Upgraded to a “toss-up”race after an initial rating of “Lean D,”freshman lawmaker Ami Bera, MD, (D) faces Doug Ose (R). CA-36 –Freshman Rep. Raul Ruiz, MD, (D) was able to win this usually Republican seat in the 2012 elections, but may have trouble keeping it against State Representative Brian Nestande (R). CA-52 –Redistricting has morphed CA-52 into a fierce battle ground, and Rep. Scott Peters (D) will have a close race against challenger Carl DeMaio (R). CO-6 –Due to redistricting, CO-6 has essentially become a swing district.After an initial race rating of “Lean R,”pundits upgraded the race to a “toss-up”when former state speaker Andrew Romanoff announced he would challenge incumbent Rep. Mike Coffman (R). FL-18 –Having defeated then-incumbent Rep. Allen West (R) in a 2012 blockbuster election, Rep. Patrick Murphy (D) may face an equally difficult road to re-election this year. However, unpredictability in the GOP field, which won’t be finalized until a late August primary, may end up working to Rep. Murphy’s advantage. FL-26 –Without a top-of-the-ticket name like President Barack Obama to drive turnout,freshman lawmaker Rep. Joe Garcia (D) faces a tough road to re-election this year. However, and like other competitive races, a crowded opposing field may work in this incumbent’s favor. IA-3 –The retirement of Rep. Tom Latham added to this cycle’s handful of open-seat races, and with it brought an original rating of “Likely R.”However, the long and crowded GOP primary gave Democrat candidate Staci Appel ample time to develop her ground game and resulted in a race rating change to “toss-up.” IL-10 –Former Rep. Robert Dold (R) will serve as a big challenge to incumbent Rep. Brad Schneider (D). NH-1 –Having fought her way back to Congress in 2012,incumbent Rep. Carol Shea-Porter (D) looks to earn another consecutive term in this classic swing district. Shea-Porter will face former Rep. Frank Guinta (R) in a third consecutive race, assuming he achieves the GOP nomination in September,. NJ-3 –The retirement of Rep. Jon Runyan (R) adds this district to the list of open seats this year. On paper, Democrats might have a chance at flipping this seat. However, it’s the potential for Republican candidates to self-destruct in this area that deems this as a toss-up race. This open seat could go either way between Tom MacArthur (R) or Aimee Belgard (D). NY-21 –Following the retirement of Rep. Bill Owens (D) this open seat was labeled a “toss-up”early in 2014. Following crowded primaries for both parties, the field is now set with GOP candidate Elise Stefanik facing Democrat Aaron Woolf in November. WV-3 –Despite President Obama’s absence on the ballot this cycle, Rep. Nick Rahall (D) will still have a hard time holding off state Sen. Evan Jenkins (R). U.S. Senate Alaska–First term Sen. Mark Begich (D) faces a tough re-election as a Democrat in a heavily Republican state. After winning his seat by just 48 percent last cycle, he is expected to have the same challenges in this election. The Republican candidate will be determined in an August 19 primary. Arkansas–Sen. Mark Pryor (D) has thus far enjoyed relatively easy roads to reelection. However, the atmosphere in Arkansas is changing, and not in his favor. As the state becomes more conservative, Pryor may have a tough time holding back opponent U.S. Rep. Tom Cotton (R). Colorado –At first, it looked as though Sen. Mark Udall (D) would have an easy re-election. However, recent polls following the candidacy announcement of Republican challenger U.S. Rep. Cory Gardner show this will be a much tighter race than previously expected. Georgia–Open seat race due to the retirement of Sen. Saxby Chambliss (R). Following a protracted primary race that resulted in a run-off, U.S. Representative Jack Kingston (R) was finally named the Republican nominee in July. Points of Light CEO, Michelle Nunn, is the Democrat nominee. Despite Georgia’s status as a “red”state, Democrats have made good on their word to work hard to ensure the open seat remained competitive. Kentucky–One of the most talked about races this year is the very tight battle between Senate Minority Leader Mitch McConnell (R) and his Democratic opponent Allison Lundergan Grimes. McConnell handily defeated his primary opponent, but Grimes definitely poses a greater threat in the general election. Polling has shown this is going to be a close fight. Louisiana–Senator Mary Landrieu (D) has had to continuously work to hold her seat, and this term proves to be another battle. In Louisiana’s open primary system, all candidates appear on the ballot on Election Day. If no one achieves 50 percent of the vote, the contest is decided in a two-way run-off. To date, U.S. Rep. Bill Cassidy, MD, (R) is considered Landrieu’s most viable opponent. Michigan –Open seat due to the retirement of Sen. Carl Levin (D). Michigan usually trends toward electing Democrat candidates, but U.S. Rep Gary Peters (D) is proving to have a tough time against opponent Terri Lynn Land (R). Land has managed to keep herself relevant in this race via excellent fundraising. North Carolina–In her first bid for reelection, incumbent Senator Kay Hagan (D) faces a tough race from challenger Thom Tillis (R), the current Speaker of the North Carolina House of Representatives. This race is broadly considered one of the most competitive of the cycle. For more information about this year’s mid-term elections, visit our “Elections”webpage at www.entpac.org (log-in using your AAO-HNS Member ID and password). You can also view the list of ENT PAC-supported candidates/incumbents on the ENT PAC webpage. *Race ratings are attributed to the Cook Political Report.

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Hear What All the Tweeting Is About: Follow the Government Affairs Twitter Account – ONLINE EXCLUSIVE

Want to be the first to know what’s happening on Capitol Hill? If so, sign up for Twitter and follow the Government Affairs account @AAOHNSGovtAffrs. You’ll receive daily updates on legislative and political issues affecting the specialty, your practice, and your patients. Get “insider” knowledge on matters such as repeal of the flawed Sustainable Growth Rate (SGR) formula, scope-of-practice battles, and Graduate Medical Education (GME) funding. Get a sneak-peek of this fun (and fast) way to receive legislative and political updates by viewing our Twitter scroll at http://www.entnet.org/Advocacy.

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2014 BOG Candidates: Member-at-Large

Nathan A. Deckard, MD Philadelphia, PA What are your qualifications and what is your experience? I have had the opportunity to serve the Academy and the Board of Governors in a number of roles. I have been an active part of the Section for Residents and Fellows-in-Training (SRF) as the vice chair, the information officer/secretary for two terms, and was the representative to the Society of University Otolaryngologists. I have served as a journal reviewer and participated in Clinical Practice Guideline creation. I have also served on both the BOG Socioeconomic and Grassroots and Legislative Affairs committees and have attended the BOG spring and fall meetings for the past six years. These experiences have given me, as a recent graduate, a fairly uncommon understanding of the BOG and the Academy and their strategic plan and goals. Given the Academy’s strategic plan, outline and prioritize your goals for the Board of Governors. If chosen as Member-at-Large, I would prioritize member engagement/retention, with a focus among our young physician and resident sections. As a recent graduate and an involved member of these sections, I feel a particular tie to these groups. I would suggest utilizing the strength of the Young Physicians Section (YPS) and SRF to improve the engagement of their members in the Academy, encourage participation in Academy activities, and educate their members in establishing Academy membership early in their careers. Furthermore, as a specialist, I would like to continue to encourage Specialty Society Advisory Council (SSAC) communications to improve specialty involvement and engagement. Lastly, as a proud PAC member, I support recent efforts to improve resident participation and would work toward furthering this effort and furthermore to educate all of our members in the importance of advocacy with particular focus on the importance of percentage of PAC membership in our specialty. Spencer C. Payne, MD Charlottesville, VA What are your qualifications and what is your experience? I wrote an article for the Bulletin a few years ago titled “Decisions are made by those who show up”and it is by that motto I have lived. My involvement with the Academy spans the last 10 years during which I have served as Informatics officer and chair of the Section for Residents and Fellows-in-Training, member of several Academy committees including Medical Informatics, Young Physicians, Development, and Public Relations, and been the alternate for guidelines development for the ARS. For the past three years I have served as the Governor for the Virginia Society of Otolaryngology-HNS and sat on the BOG Rules and Regulations Committee. Locally for my hospital I serve on the ICD-10, Meaningful Use, and Quality committees. All of these experiences provide me a comprehensive familiarity with Academy, BOG, and the issues that affect practitioners such that I can excel at bridging the three. Given the Academy’s strategic plan, outline and prioritize your goals for the Board of Governors. The last few years have seen a regional reorganization of the Board of Governors in order to enhance the bidirectional communication between the Academy and member societies. We need to continue to leverage this infrastructure in order to facilitate the transmission of both the concerns AND successes of our members. I will bolster this network and employ the Academy’s new website to get the word “out”and “in” so that we can build on each other’s accomplishments, focusing on the positives while being mindful to negotiate the changing obstacles of our profession. I would also work closely with the Section for Residents and Fellows-in-Training as well as the Young Physicians Section to better cultivate and harness the enthusiasm with which they can better the specialty. Through mentoring and encouragement we can incentivize our younger membership to stand with us on the shoulders of the giants that have preceded us.

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2014 BOG Candidates: Chair-Elect

(Choose one) Cast Your BOG Vote BOG General Assembly Meeting 5:00 pm-7:00 pm Monday, September 22 LOCATION TBD Orange County Convention Center Susan R. Cordes, MD Ukiah, CA What are your qualifications and what is your experience? During my more than 10 years of service to the Academy, I have participated on many committees and have chaired and vice-chaired several others. In addition, I have chaired a Section (Women in Otolaryngology), and I completed a term as Member-at-Large of the BOG. As WIO Section chair, I was a non-voting member of the Board of Directors and participated in strategic planning for the Academy. I also serve on the BOG Executive Committee. Locally, I have been president and governor for my regional society, residency program director, and chief of service at a busy urban hospital. I am reliable, conscientious, and have a long history of dedication to otolaryngology and to the Academy. I am confident that my experience in leadership positions and my understanding of the Academy structure and function equip me very well to serve effectively as BOG Chair. Given the Academy’s strategic plan, outline and prioritize your goals for the Board of Governors. As healthcare and practice patterns change, I will ensure our BOG adapts and remains relevant to all otolaryngologists. One major area of concern is the increasing government influence on the practice of medicine. Therefore, on the advocacy front, I will further develop the I-GO and State Tracker programs while continuing attention to other important issues such as SGR, ACOs, scope of practice, ICD-10, and EMR. Because of our grassroots nature, the BOG can enhance member knowledge of Academy products such as guidelines, consensus statements, and quality improvement efforts and explore barriers and solutions to implementation. The regional network plan is now well underway, and as BOG chair, I will capitalize on that program to connect with Academy members. The BOG represents the voices of Academy members regarding these and other important issues, and I will ensure that those voices continue to be heard so that our specialty remains strong and united. David R. Edelstein, MD New York, NY What are your qualifications and what is your experience? My qualifications extend over 34 years and include the triad of hard work, common sense, and integrity. My experience in academic practice (as chairman and residency program director at Manhattan Eye, Ear, and Throat Hospital [MEETH] and vice chairman at Lenox Hill Hospital), private practice (as president of Manhattan Otolaryngology), and hospital practice (as chief of otolaryngology at MEETH and chief of nasal/sinus surgery at several hospitals) makes me sensitive to the interests of all otolaryngologists. I have been president of the New York Laryngological Society and the New York Otological Society and served on numerous hospital, institutional research, and medical boards (three as chair). My Academy service includes working on several committees including the hearing, infectious disease, development, geriatrics, history and archives, SIPAC, BOG Socioeconomic and Grassroots (as chair), BOG Nominating, and BOG Executive Committees. I am a longstanding member of the Millennium Society and Hal Foster Endowment society. Given the Academy’s strategic plan, outline and prioritize your goals for the Board of Governors. The greatest challenge facing otolaryngology today is physician indifference countered by a confusing national healthcare plan and loss of autonomy as physicians move to hospital employment. To address these challenges, I would work to develop a fully engaged membership by broadening the Academy’s appeal to residents and young physicians, increasing foreign recruitment, and improving outreach to older otolaryngologists (who have experience, time, and resources). I would expand the BOG regional representative system, of which I was a prime architect, reenergize less active state and local societies, and enhance polling of BOG societies to identify members’problems and needs more quickly. I would prioritize organizational efficiencies such as integrating the Academy’s regulatory, insurance, and payer advocacy functions. I would focus on educating members to be better advocates within their own medical centers as discussed in my Bulletin articles on how to become more effective hospital board, finance committee, and hospital reorganization members.

SAVE THE DATE: AAOIH Dinner

American Association of Otolaryngologists of Indian Heritage dinner Monday, Sept 21 6:30 -11:30 pm, Hyatt Regency Orlando Hotel, Room Florida A (International Tower.) For details or to reserve: dcmehta@aol.com or 914-953-6495

2014 Annual Meeting Exhibitors List

3rd Congress of European ORL-HNS Prague 2015/GURANT International #1361 www.europeanORL-HNSprague2015.comABLV—Academia Brasileira de Laringologia e Voz #1168 www.aborlccf.org.br Acclarent #1402 www.acclarent.com Acumed Instruments Corp. #1330 www.e-acumed.com Advanced Bionics #1321 www.advancedbionics.com Advanced Endoscopy Devices #620 www.aed.md Advanced Monitors Corporation #1164 www.admon.com ALCON #1602 www.alcon.com ALK Inc. #316 www.alk.net/us AllMeds EHR #1427 www.allmeds.com American Board of Otolaryngology #421 www.ABOto.org American Hearing Aid Associates #968 www.ahaanet.com American Journal of Rhinology and Allergy #1540 www.AJRA.com American Medical Endoscopy Inc. #321 www.straussurgical.com Amplivox #1719 www.amplivox.us Anthony Products/Gio Pelle #403 www.anthonyproducts.com Apdyne Medical Co. #869 www.apdyne.com ArthroCare #1702 www.arthrocare.com ASL-Sinus Dynamics-TAG #1138 www.aslrx.com ATMOS Inc. #1435 www.atmosmed.us Atos Medical #1261 www.atosmedical.us Audiology Management Group Inc. #1539 www.audiologymanagementgroup.com Auris Medical AG #439 www.aurismedical.com balanceback™ #308 www.balanceback.com BCCNS Life Support Network #320 www.bccns.org Beutlich Pharmaceuticals LP #1616 www.beutlich.com Beijing Delon Endoscope Camera #858 www.bjfxgd.com.cn Bertec Corp. #423 www.bertecbalance.com BFW Inc. #1232 www.bfwinc.com Bien-Air Surgery #1413 www.bienair.com BIOLASE #314 www.biolase.com Biomet Microfixation #527 www.biomet.com/microfixation Blue Tree Publishing Inc. #1441 www.bluetreepublishing.com Boston Medical Products #1124 www.bosmed.com Brainlab #610 www.brainlab.com Brazilian Association of ENT #1166 www.aborlccf.org.br BrilliENT #1803 www.tonsilfire-extinguisher.com Bryan Medical Inc. #538 www.bryanmedical.net CaptionCall #659 www.captioncall.com Carestream #714 www.carestream.com/ent-allergy Carl Zeiss Meditec #514 www.meditec.zeiss.com Carnegie Surgical LLC #1641 www.carnegiesurgical.com CBLPath #1548 www.cblpath.com Cenefom Corp. #1640 www.longtek.com.tw Ceredas #541 www.ceredas.com Chammed Co. Ltd. #862 www.chammed.co.kr Charleston Area Medical Center #1254 www.camc.org ChartLogic Inc. #1338 www.chartlogic.com Claron Technology #547 www.clarontech.com Clearwater Clinical #767 www.clearwaterclinical.com ClientTell #535 www.clienttell.net Clicon Corp. #653 www.clinicon.com Cobalt Medical Supply Inc. #1057 www.cobaltmed.com Cochlear Americas #815 www.cochlear.com Compass Asset Management LLC #868 www.compassam.net Cook Medical #729 www.cookmedical.com Covidien #1603 www.covidien.com/rms CryoLife #863 www.cryolife.com DePuy Synthes #1512 www.depuysynthes.com Designs for Vision Inc. #1417 www.designsforvision.com Doctus Equipamentos Medicos #622 www.doctus.med.br DocumENT Inc. #1359 www.DocumENT-EMR.com Dr. Fuji/ACIGI Relaxation #1449 www.drfuji.com Dr. Kim Co. #648 www.dr-kim.net Ear Nose & Throat Journal #1462 www.entjournal.com Ecleris #1026 & 1132 www.ecleris.com Ellman International #646 www.ellman.com Elsevier #621 www.elsevier.com Enovative Technology #1638 www.enovativetech.com Entellus Medical #602 www.entellusmedical.com Envoy Medical #1533 www.envoymedical.com EPIC Hearing Healthcare #1527 www.epichearing.com ETHICON #1513 www.ethicon.com Eyemaginations Inc. #1315 www.eyemaginations.com Feather Safety Razor Co. Ltd. #1818 www.feather.co.jp Fiegert Endotech Inc. #540 www.fiegertendotech.net Firefly Global #1633 www.fireflyglobal.comGE Healthcare #1606 www.gehealthcare.com General Surgical Company (India) PVT LTD. #552 www.gescoindia.com Genzyme a Sanofi Company #433 www.genzyme.com Global Medical Endoscopy #1253 www.globalmedicalendoscopy.com Global Surgical Corp. #1621 www.globalsurgical.com GN Otometrics #852 www.seilermicro.com Grace Medical Inc. #847 www.gracemedical.com Grason-Stadler #402 www.grason-stadler.com Greenway Health #520 www.greenwaymedical.com Health eCareers/ENT Careers Live! #1671 www.healthecareers.com HealthLoop #448 www.healthloop.com Healthworld International Inc. #1234 www.healthworldintl.com Hemostatix Medical Technologies #1347 www.hemostatix.com Henry Ford Hospital and Medical Group #1649 www.henryford.com Hill Dermoceuticals Inc. #1734 www.hillderm.com Hood Laboratories Inc. #1231 www.hoodlabs.com HRA Healthcare Research & Analytics #1439 www.hraresearch.com HUGER Endoscopy #1538 www.huger.cn ImThera Medical Inc. #526 www.imtheramedical.com InHealth Technologies #408 www.inhealth.com Inspire Medical Systems Inc. #1534 www.inspiresleep.com Insta-Mold Products #1134 www.instamold.com Instrumentarium #1332 www.instrumentarium-online.com Intelligent Hearing Systems #440 www.ihsys.com Interacoustics #1712 www.interacoustics-us.com Interamerican Assoc of Ped Otorhinolaryngology #1065 Intersect ENT #1547 www.PROPELOPENS.com Intersocietal Accreditation Commission (IAC) #1553 www.intersocietal.org Intuit Endoscopy LLC #539 www.IntuitEndoscopy.com Intuitive Surgical Inc. #508 www.intuitivesurgical.com Invictus Medical Innovations #866 Invotec International Inc. #1133 www.invotec.net Itamar Medical #323 www.itamar-medical.com J. Morita USA Inc. #1064 www.morita.com/usa Jaypee Highlights Medical Publishers Inc. #1732 www.jphmedical.com JEDMED Instrument Co. #1211 & 1302 www.jedmed.com Johns Hopkins Medicine Otolaryngology-HNS #1069 www.hopkinsmedicine.org/otolaryngology Kaiser Permanente #532 www.physiciancareers.kp.org/scal Kalelker Surgical Industries #966 www.kalelkersurgicals.com KARL STORZ Endoscopy America Inc. #820 www.ksea.com KARL STORZ Endoscopy-Latino America #720 www.karlstorz.com Kirwan Surgical Products Inc. #736 www.ksp.com KLS Martin #1610 www.klsmartinnorthamerica.com Kurz Medical Inc. #1521 www.kurzmed.com Laser Engineering #1125 www.laserengineering.com Leica Microsystems #855 www.leicamicrosystems.com LifeLine Sciences LLC #1363 www.tmjnextgen.com Lifestyle Lift #631 www.lifestylelift.com Lisa Laser USA #1341 www.lisalaserusa.com LumaDent Inc. #1352 www.lumadent.com Lumenis #829 www.lumenis.com Maico Diagnostics #1314 www.maico-diagnostics.com Marina Medical Instruments #1653 www.marinamedical.com McKeon Products Inc. #738 www.macksearplugs.com MD Logic EMR #1358 www.mdlogic.com MD Hearing Aid Inc. #1652 www.mdhearingaid.com MED-EL Corporation #1220 www.medel.com Medical Digital Developers #960 www.dscopesystems.com MediCapture Inc. #746 www.medicapture.com Medifix Inc. #1259 www.medifixinc.com MedInvent LLC #1637 www.nasoneb.com Mediplast AB #861 www.mediplast.com MedNet Locator Inc. #1746 www.mednetlocator.com MedNet Technologies #1226 www.mednet-tech.com Medtronic Surgical Technologies #1002 & 1202 www.medtronicENT.com Merz North America #414 www.radiesse-voice.com Microline Surgical #1056 www.microlinesurgical.com Micromedical Technologies Inc. #1238 www.micromedical.com Microsurgery Instruments Inc. #1068 www.microsurgeryusa.com Miltex an Integra Company #420 www.integralife.com Mizuho America Inc. #1728 www.mizuho.com Modernizing Medicine #647 www.modmed.com MTI Inc. #1018 www.mti.net Natus Medical Incorporated #1153 www.natus.com NeilMed Pharmaceuticals Inc. #1214 www.neilmed.com Neurosign Surgical #755 www.neurosignsurgical.comNeurovision Medical Products #867 www.neurovisionmedical.com New York Head and Neck Institute #658 www.nyhni.org NIDCD National Temporal Bone Registry #1635 www.tbregistry.com NP Screen Canada Inc. #1252 www.npscreen.com Officite #1340 www.officite.com Olympus America Inc. #703 www.olympusamerica.com OmniGuide #1158 www.omni-guide.com Ono & Co. Ltd #453 www.Kezlex.com.en Optim LLC #1258 www.optimnet.com OPTOMIC by BR Surgical #447 www.optomic.com Oticon Medical #1118 www.oticonmedicalusa.com Otodynamics Ltd. #759 www.otodynamics.com Otomed Inc. #1208 www.otomed.com OtoSim Inc. #1726 www.otosim.com OTOTRONIX #1147 www.ototronix.com Otto Trading Inc. #432, 1460 www.irestmassager.com Pan American Congress of Otolaryngology #1255 www.panamorl.com.ar/Ingles/homeingles.htm Parnell Pharmaceuticals Inc. #1617 www.parnellpharm.com Passy-Muir Inc. #533 www.passy-muir.com PENTAX Medical #836 www.pentaxmedical.com PeriOptix, A DenMat Co #305 www.perioptix.com PHACON GmbH #1354 www.phacon.de Phonak #1421 www.advancedbionics.com Physician Assistants in ORL-HNS #1362 www.entpa.org Plural Publishing Inc. #616 www.pluralpublishing.com PolypVac by Laurimed LLC #1805 www.polypvac.com Preceptis Medical #1627 www.preceptismedical.com Prescott’s Inc. #737 www.surgicalmicroscopes.com Regen Scientific #1736 www.regenscientific.com Reliance Medical Products/Haag-Streit #1034 www.reliance-medical.com Restech #637 www.bryanmedical.net RGP Inc. #1458 www.rgpdental.com Richard Wolf Medical Instruments Corp. #1739 www.richardwolfusa.com Rose Micro Solutions #302, 441, 1060, 1541 www.rosemicrosolutions.com SAGE #534 www.sagepub.com Samanghen Corporation #1809 www.entsafety.com SANOSTEC Corp. #1729 www.maxairnosecones.com Scopis GmbH #1647 www.scopis.com Seiler Precision Microscopes #626 www.seilermicro.com Shippert Medical Technologies Inc. #426 www.shippertmedical.com SinuSys Corp. #632 www.sinusys.com Sleep Source Alliance ENT #1453 www.sleepsource.us SMR #1721 www.globalsurgical.com/ENTHome.aspx Snap On Optics #1747 www.snaponoptics.com Somna Therapeutics #446 www.somnatherapeutics.com Sonitus Medical Inc. #747 www.sonitusmedical.com Sontec Instruments Inc. #1203 www.sontecinstruments.com Sophono Inc #452 www.sophono.com Soredex #660 www.soredex.com Spectrum Audiology #303 www.SpectrumAudiology.com Springer #1129 www.springer.com Starkey Hearing Technologies #1333 www.starkeyhearingtechnologies.com Stryker #1046 www.stryker.com Summit Medical Inc. #1446 & 1447 www.summitmedicalusa.com SupraMed Inc. #427 www.supramed.com SURGEX/Jullsurg #522 www.surgexmed.com SurgiTel/General Scientific Corp. #1607 www.surgitel.com Synovis Micro Companies Alliance Inc. #428 www.synovismicro.com Technical Products Inc. #1733 www.techproductsga.com Teleflex #1727 www.teleflex.com Teva Respiratory #1459 www.tevapharm.com The Doctors Company #753 www.thedoctors.com Thieme Medical Publishers #1412 www.thieme.com TIMS for Audiology #1812 www.cu.net/solutions/audiology TOSHIBA Head & Neck Ultrasound #763 www.headandneckultrasound.com Trinity Medical Pharmacy #438 www.trinitymedicalpharmacy.com United Endoscopy #1235 www.unitedendoscopy.com University Medical Center Hamburg-Eppendorf #769 www.voxel-man.com Veracyte #435 www.veracyte.com Vision Sciences #1247 www.visionsciences.com Widex USA #1353 www.widex.com Wiley #1546 www.wiley.com Wolters Kluwer Health #1516 www.lww.com Xoran Technologies Inc. #1327 www.xorantech.com Zumax Medical Co. Ltd. #638 www.zumaxmedical.com

FEATURE-IMG

OTO EXPO Is Your Stage for Excellence

The stage is set to welcome you to Orlando, FL, for your AAO-HNSF 2014 Annual Meeting & OTO EXPOSM. This event is tailored to your needs by featuring the most comprehensive display of the latest products and services available for advancing the specialty of ear, nose, throat, head and neck care. Education extends beyond the session rooms to the OTO EXPOSM show floor, where you can find a massive array of innovative tools and services to assist you in your professional growth. As in past years, the doors will open at 10:00 am on Sunday, September 21, when we expect to observe the familiar rush of conference attendees eagerly entering the EXPO to get their hands on the latest surgical equipment and instruments. That evening we are bringing the popular President’s Reception to the show floor. This reception honors the outgoing president and it will allow you the opportunity to collaborate with peers and explore the hundreds of companies exhibiting in the hall. Our exhibitors are prepared to share with you products and services such as surgical instruments, robotic surgical apparatuses, imaging equipment, medical devices, and EMR/EHR systems. Our brand new Hands-On Training sessions will include a two-hour training hosted by various members of the corporate community. These sessions will provide a limited number of Annual Meeting attendees the opportunity to use the newest technologies. Learn how to perform otolaryngologic procedures with today’s state-of-the-art technology. All Hands-On Training sessions will include how-to lessons and are sure to add to your Annual Meeting education experience. To maximize your time, we have changed our food offering by providing you with Daily Food Vouchers. There will still be a food court set up in the back of the hall, but instead of having meals available just from 11:30 am to 1:00 pm, this year we will have food stations available during the time the OTO EXPOSM is open, giving you more flexibility. Making another return will be the Product Theater where several of our corporate partners will be presenting their ENT products during show hours in 30-minute intervals. Be sure to attend these presentations to couple your CME credits with medical devices and product demonstrations by some of our leading manufacturers. When you come to your Annual Meeting & OTO EXPOSM, be sure to visit the OTO EXPOSM show floor. You’ll benefit from new resources and tools that you can put into practice right away. This is your event, your OTO EXPOSM, and your opportunity to gain invaluable experience to help you deliver excellent patient care.

How to Use the Rest of 2014 to Great Advantage – ONLINE EXCLUSIVE

Bob Blakely Director of Government Affairs and Marketing at AllMeds Inc. Within the span of eight weeks, two of healthcare’s biggest sources of heartburn in 2014 evaporated. In April, ICD-10’s rollout was delayed to October 2015, and in May, CMS announced intentions to make EHR incentives much easier to obtain in 2014. Most providers greeted both announcements with relief, as few were prepared for the looming changes. However, cynics predicted that few providers will proactively use the additional time and will again find themselves scrambling next year. Don’t do that. ICD-10: ICD-10 really is coming and it’s going to change everything. Much of what will go wrong is out of your hands, but physicians still control what occurs in their own practices and your EHR will be the local epicenter of the ICD-10 earthquake. Your EHR vendor should have nearly finished ICD-10 preparations before the delay. Make sure they haven’t put it on the back burner, but will deliver it in the coming months. Ask about transitional tools, training events, and support programs that are specifically designed to update your staff well before next October. And, plan for the worst: Ask if your EHR vendor has integrated with services that can seamlessly assist your billing team when ICD-10 issues inevitably disrupt your revenue cycle. EHR Incentives: 2014’s more relaxed guidelines will be gone in 2015. All participants will be required to use 2014-certified EHRs, tenured providers will fully move to Stage 2’s more rigorous Meaningful Use (MU) standards, and reporting periods will return to 12 full months. You can do plenty of things in the meantime to prepare for MU2015, but time is of the essence. Remember, you’ll have to be achieving MU on January 1, so there’s no margin of error next year. If your EHR vendor hasn’t already attained 2014 certification, make sure they’ll do so in the immediate future. Find out how and when they’ll implement your office with a 2014-certified solution. Finally, ask your vendor if they provide any services that include MU training and monitoring, which will be particularly critical for those moving to Stage 2. The double-dose delay to ICD-10 and MU Stage 2 certainly made 2014 a less onerous year for physicians and their staffs. But, it’s critical not to waste the extra time, as 2015 will deliver the challenges that were expected this year. Those who spend the intervening months in preparation will undoubtedly enjoy tremendous advantages over those who spend theirs procrastinating.

DeSonier-Photo

Annual Meeting Opening Ceremony Service Awardees

2014 Jerome C. Goldstein, MD Public Service Award Keith F. DeSonier, MD The Jerome C. Goldstein Public Service Award recognizes commitment and achievement in service, either to the public or to other organizations, when such service promises to improve patient welfare. Keith F. DeSonier, MD, is this year’s awardee chosen for promoting public health and his role in passage of patient and physician legislation. The award criteria might have been designed with Dr. DeSonier in mind—consideration of character, professional excellence and dedication, significant commitment to service, and recognized peer leadership. Dr. DeSonier exhibits all, yet these attributes are overshadowed by his accomplishments. After receiving his “MD”from Louisiana State University, New Orleans, Dr. DeSonier interned (1976-77) at Tripler Army Medical Center, Honolulu, HI. He followed with residencies in surgery at Darnall Army Hospital, and Brooke Army Medical Center, both in Texas. A residency in otolaryngology at Brooke led to a mini-fellowship in Head and Neck Surgery with Drs. John Conley and Robert Eberle at St. Vincent’s Hospital in NY. Dr. DeSonier became an otolaryngology-head and neck surgery residency program instructor at Brooke Army Medical Center. Later as assistant department chief there, he oversaw instruction of military surgeons during Desert Shield/Desert Storm. This award, marks Dr. DeSonier’s commitment to patients and peers by prompting legislation through his role within the Council on Legislation of the Louisiana State Medical Society (LSMS) and the Louisiana Medical Political Action Committee (LAMPAC). For Dr. DeSoniers’dedication and passion to his country, his devotion to his patients and their rights and his reinvigoration of the Louisiana Academy of Otolaryngology, this award is given. Distinguished Award for Humanitarian Service J. Thomas Roland, Jr., MD The AAO-HNSF Distinguished Award for Humanitarian Service is presented to John Thomas Roland, Jr., MD. Each year this honor is given to a member who is widely recognized for a consistent, stable character distinguished by honesty, zeal for truth, integrity, love and devotion to humanity, and a self-giving spirit. Dr. Roland was a Lt. Commander U.S. Public Health Service at the Fort Yuma PHS Indian Hospital and clinical director (1986–1988). He now is the chairman of the Department of Otolaryngology-Head and Neck Surgery at the NYU Langone Medical Center. His clinical focus is in otology/neurotology and skull base surgery. He is co-director of the NYU Cochlear Implant Center. During the last 10 years, he has participated in and financially supported many humanitarian trips, particularly to Uganda. There he has taught its residents and built a temporal bone learning lab. Mulago Hospital continues to benefit from returning residents, fellows, nurses, surgical techs, and nurse practitioners he inspired to teach others. Dr. Roland also regularly travels to Israel to assist with challenging cochlear implant surgeries and helped with development of a Jerusalem Cochlear Implant Center. He has implanted sponsored children at NYU from Guatemala, Trinidad, Nigeria, Uganda, and more recently Kosovo. When home in New York, Dr. Roland makes home visits and performs some procedures on weekends to accommodate patients’mobility constraints, needs, and their religious restrictions. Dr. Roland embodies all that the American Academy of Otolaryngology–Head and Neck Surgery Foundation Distinguished Award for Humanitarian Services represents. 2014 Holt Leadership Award Jayme R. Dowdall, MD The Holt Leadership Award is given to a resident or fellow who best exemplifies the attributes of a young leader—honesty, integrity, fairness, advocacy, and enthusiasm. Jayme R. Dowdall, MD, the 2014 Holt Leadership Awardee, has provided extensive volunteer service to the Academy and otolaryngology’s resident community, serving the Section for Residents and Fellows-in-Training (SRF) as public relations representative, vice-chair, chair, and immediate past chair. During this time, she received the Adam T. Ross, MD Leadership Excellence Award. Dr. Dowdall completed her residency at Wayne State University in Detroit where Robert J. Stachler, MD, encouraged her to attend the spring AAO-HNS BOG/JSAC meeting. After residency, she continued her training in a laryngology fellowship with Ramon Franco Sr., MD. Since then, she’s been an instructor in the Harvard Medical School (HMS) Department of Otolaryngology and medical director of the Voice Program at Brigham and Women’s Hospital (BWH). Her specialty involvement was established during her early career when she was elected resident liaison for both the Society of University Otolaryngologists in 2009 and the (CORE) Study Section in 2010. As the medical director for the Voice Program at BWH since 2012, Dr. Dowdall is focused on performing arts medicine, and the influence of gender on laryngeal disease. Dr. Dowdall’s commitment to young otolaryngologists is apparent as the BWH site director for the Harvard otolaryngology residents. Within the AAO-HNS Dr. Dowdall has been active with the Board of Governors (BOG) and in advocacy conferences, the CORE Study Section, and the Young Physicians Section (YPS). She is an inspiring leader, and the SRF reaped the benefits of her many years of service.

Sanjay R. Parikh, MD BOG Secretary

Academics vs. Private Practice: Who’s Suffering Most?

When I finished my fellowship and joined academics more than a decade ago, I was thrilled with the opportunity to teach residents, investigate research ideas, and have job security. The challenges of our changing reimbursement system—new quality measurements, RVU-based incentives, diagnostic codes (ICD-10 & ICD-11), and facility fees for my patients—are affecting my hospital-based practice and generating frustration with my choice of academia. Could it be easier in private practice? Six months ago, while exchanging practice pearls with friends at our state otolaryngology society conference, I heard how private practice is in distress, with the introduction of insurance exchange, increased overhead, EMR expenses, and competition with hospital-based employed otolaryngologists. During this energetic conversation, there was a moment where I felt there may be a growing divide among otolaryngologists where each user of a certain practice model looks at others as “the lucky ones.” Having attended the AAO-HNSF and ACS meetings during the last year, I see high frustration among surgeons. The confusion of a novel healthcare system has left many surgeons feeling excluded from decision-making, knee-deep in bureaucracy, and on their way to an early retirement. I sense a growing rift between private practice surgeons and those who are hospital-based. The issue is plain: How can a private practice survive as hospital systems buy out local otolaryngologists to secure their network and patient stream? Can a private practice endure without ancillary diagnostic and OR revenue that a hospital system already generates? While these questions are provocative, I’m not sure they address the bigger question: Can our American healthcare system survive without any change? The American healthcare system, as complex as it is, still yields the greatest surgical innovations and the largest volume of clinical research in the world. Our otolaryngology residency training system is internationally revered as foremost for efficiently and cost effectively covering the entire spectrum of otolaryngology-head and neck disorders. As you already know, the cost of our system per capita is enormous and growing. Unfortunately, surgeons are a targeted group for expense cutting through pending revaluation of CPT codes and quality-based payment restructuring. Fortunately, I am a member of the AAO-HNS, the only group battling at congressional levels for my vocation. So, as I reflect on my dialogues with colleagues about the frustration of practice, I’m not sure that either private practice or academic surgeons are suffering from a greater disadvantage. We are all faced with mutual adversity and the complexity of a generational movement in our healthcare system. As I look to the future, I will not view my colleagues as a source of frustration, but as my friends to lean on, as we brace together for a rocky road ahead. *Stay alert and connect: bog@entnet.org

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

Having the Proper Perspective

In response to the rapid changes in healthcare, reform of delivery and payment models, and the huge ripples affecting physician/patient relationships and practice models, attention has been paid to the physician’s individual satisfaction and how it may be changing. The American Medical Association (AMA) contracted a study from the Rand Corporation which concluded, not surprisingly, that “…[W]hen physicians perceived themselves as providing high-quality care or their practices as facilitating their delivery of such care, they reported better professional satisfaction.”1 The report goes on to state that barriers to providing such care and achieving that satisfaction can arise both from within the practice (lack of support of leaders and practice partners, internal conflicts) and be imposed from external sources (mandates, regulations, denials of coverage, utilization hassles, reporting burdens, EMRs, etc.). If you haven’t read this report, I strongly urge you to review its findings and ponder how it may relate to your situation. As I have read this report and heard it discussed at several strategic meetings, and listened and participated in the conversations regarding how to restore, improve, and augment physician satisfaction by facilitating physician’s desire to provide high quality care, I am reminded of the social and behavioral science literature on the role of norms and adaptation in the measurement of individual happiness. For the last century, progressive studies of human happiness have revealed results that are perhaps not intuitive. Using validated survey instruments, studies show that nations whose populations are relatively happy have higher rates of suicide than those with generally reported lower levels of happiness. Carol Graham, Senior Fellow at the Brookings Institute has written Happiness Around the World: The Paradox of Happy Peasants and Miserable Millionaires. Poor people in very poor countries report higher levels of happiness than poor people in wealthier countries with far more income and resources and a higher standard of living; “Because,”as Dr. Graham states, “average country income levels do not matter to happiness, but relative distances from the average do…” As we navigate the challenges of health care reform, we feel the stress and strain of being required to understand concepts that were not necessarily part of our medical training –management of systems and populations, assessing and stewarding global costs of care, balancing actuarial and longitudinal data with individual accountability for specific patient encounters and goals. In his book, David and Goliath, author Malcolm Gladwell reminds us of the concept of “relative deprivation,”a term coined by sociologist Samuel Stouffer during World War II, studying over half a million men over a wide range of comparative situations. He concluded that “…we form our impressions not globally, by placing ourselves in the broadest possible context, but locally –by comparing ourselves to people in the same boat as ourselves.” As we add new skills and abilities in leadership, followership, knowledge management, communications, collaborative team-based care, inter-professional education, and many others, it will serve us well to remember how incredibly blessed we are in our global outlook. Let’s use those advantages –technology, political freedom, financial resources, public respect, education, and collegial relationships to forge better systems of health care, reduce waste, improve patient outcomes, and advance public health. http://www.rand.org/pubs/research_reports/RR439.html

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

Quality and More

Last month in this column I talked about the new role the AAO-HNSF has taken in the development of quality measures and the stewardship of existing measures. The AAO-HNSF’s first measures project, with the ABO, which was facilitated by the AMA, produced two measures groups for Acute Otitis Externa (AOE) and Adult Sinusitis. And I have more to share. Data Registry Another major initiative for the Foundation in the quality arena is addressing the development of a data registry for otolaryngology. Many societies utilize their society-developed registries as a means for members to meet requirements for Maintenance of Certification (MOC) and CMS quality programs in addition to research related to their specialty. Developing a registry that could be useful to the majority of our members will be a large undertaking. Therefore, the Board approved under our strategic plan, the development of a task force to research and recommend how the Foundation should go forth with a registry project. A Presidential Invitation to the OTO EXPOSM This August issue features the listing of Annual Meeting Exhibitors for 2014 in Orlando. There are several new features in the OTO EXPOSM in 2014. The first is the President’s Reception will take place on the EXPO show floor from 6:00 pm to 7:30 pm on Sunday, September 21. I think this will allow attendees to enjoy the innovation and excitement of advances in our specialty in a social and collegial setting. Second, remember that the Annual Meeting will run from Sunday, September 21, through Wednesday, September 24, but the OTO EXPOSM will close at 3:00 pm on Tuesday, September 23. Other OTO EXPOSM changes include the Hands-On Demonstration and Training Lab, which are supported by the corporate community in conjunction with the American Academy of Otolaryngology–Head and Neck Surgery Foundation. Participating companies will provide all medical material supplies, tissue, and cadaveric specimens to provide unique hands-on learning environment experience. This is an exciting new venue that will provide attendees with additional, interactive learning opportunities. I hope that I can plan on seeing you there.