Published: November 4, 2015

Gaining public trust

Imagine that you are dependent on a system that you have been familiar with most of your life to provide preventative and life-saving care for you and your family. That system is now undergoing monumental, fast-moving changes that not even the architects or participants of the successor structure can define or explain to those who will be using it or making it work. Will you still have insurance coverage for you and your family? Will you be able to pay for the coverage and the dramatic increase in out-of-pocket costs you will be expected to pay? Well, this scenario does not require any imagination. This is what American patients are facing and will continue to face over the next three to five years.

By James C. Denneny III, MD, AAO-HNS/F EVP/CEO

dennenyImagine that you are dependent on a system that you have been familiar with most of your life to provide preventative and life-saving care for you and your family. That system is now undergoing monumental, fast-moving changes that not even the architects or participants of the successor structure can define or explain to those who will be using it or making it work. Will you still have insurance coverage for you and your family? Will you be able to pay for the coverage and the dramatic increase in out-of-pocket costs you will be expected to pay? Well, this scenario does not require any imagination. This is what American patients are facing and will continue to face over the next three to five years.

Dedicated physicians, otolaryngologists, and the associations built to aid and support their educational and scientific missions have spent, and continue to devote, countless hours and significant resources to endeavors designed to become the best at what they do and provide their patients the best care possible. Gaining and maintaining public trust, though, will be essential as the transition in the physician-patient relationship progresses. We also should be compelled to transmit this information to the public in a format that is easily understood. We tend to focus on our Members and their individual patients and medical conditions, but we also need to be cognizant of the needs of the general population at many levels.

While the focus will continue to be on defining and improving quality and patient outcomes, we should additionally be conscious of our ethical and social responsibilities as we pursue these goals. These responsibilities extend beyond pursuing the best care and treatment options to collaborate with other healthcare providers and industry, acknowledging substandard care, managing conflicts of interest, and policing ourselves. It is incumbent on us to act on these responsibilities in a transparent fashion understandable to the lay public. Our communications must take into account the educational disparity and cultural diversity that is the American patient population today. (Your Academy is dedicated to working with our Members to produce “plain language” patient information products that educate your patients across the spectrum of the diseases we treat. This is a fluid process that will continuously evolve with changes in medical knowledge as well as the patient base.)

As we strive to discover what is the optimal care in this team-based era we will need to work closely with groups that we are not accustomed to pooling resources with to ensure a continuum of care that the public deserves. There will clearly be some “bumps in the road” as the fine details of these alternative treatment and payment models are defined. Individual patients should not get caught in the middle during this process. A clear obligation as we move forward with clarifying best treatment regimens is the acknowledgment of the transition from previous less effective treatments to more effective treatments in an understandable and visible fashion to those seeking care. Transparency in how “best practice” is ascertained will be critical to the promulgation and acceptance of the new “quality-based medicine.” Entities such as clinical data registries that allow quality measurement and subsequent patient improvement programs will go a long way toward garnering our patients’ trust going forward.

Dealing with a significant change that is currently taking place and will continue well into the future presents a challenge not only on the scientific front, but the ethical front as well. Individual physicians and organized medicine as a whole must remain vigilant and champion change that is directly beneficial to our patients. Technological advances and systemic changes have the potential for significant conflicts of interest that can adversely affect the system as a whole from both the care and cost perspective. Times such as this demand that our ethical standards rise to the top of our thinking and activities.

Acknowledging our legacy

I am very excited to tell you about a new program that we kicked off at this year’s Annual Meeting. We will begin honoring a “Legend in Otolaryngology” in our Annual Fund development plan. An individual who has made significant contributions to otolaryngology as a scientist and leader as well as a contributor to the advancement of our specialty will be chosen each year and honored at our Annual Meeting. The first recipient of this honor is M. Eugene Tardy, Jr., MD. You can read about him in this issue of the Bulletin.

 

 

More from November 2015 - Vol. 34, No. 10
AAO-HNSF publishes methodology for developing clinical consensus statements
Since 2010, the American Academy of Otolaryngology—Head and Neck Surgery Foundation (AAO-HNSF) has published five clinical consensus statements (CCSs) in Otolaryngology–Head and Neck Surgery, including: Diagnosis and Management of Nasal Valve Compromise (2010); CT Imaging Indications for Paranasal Sinus Disease (2012); Tracheostomy Care (2012); Pediatric Chronic Rhinosinusitis (2014); and this month Septoplasty with or without Inferior Turbinoplasty (2015). The CCS development manual supplement also appears in this month’s issue. The manual describes the methodology used by the AAO-HNSF to promote rapid and consistent development of CCSs when the evidence is lacking for development of a clinical practice guideline (CPG). A CCS integrates structured expert opinions with the existing literature to try and provide some clarification on points that are quality improvement opportunities related to a particular topic. In contrast to CPGs, which are based primarily on high-level evidence, clinical consensus statements are more applicable to situations where evidence is limited or lacking, yet there are still opportunities to reduce uncertainty and improve quality of care. Much like the AAO-HNSF Clinical Practice Guideline Development Manual, Third Edition: A Quality-Driven Approach for Translating Evidence into Action, which has now been cited 119 times, the goal of the Clinical Consensus Statement Development Manual is to provide readers with the detailed methodology used by the AAO-HNSF to develop its clinical consensus statements. Publication of the manual facilitates transparency of the AAO-HNSF process and also provides a tool for other organizations to replicate our process. In summary, the AAO-HNSF utilizes a modified Delphi Survey Method to develop its CCSs. The Delphi Method involves using multiple anonymous surveys to assess for objective consensus within an expert panel. This rigorous and standardized approach minimized bias and facilitated content expert consensus. While the CCS development manual contains specific practices relevant to the AAO-HNSF, we believe that the principles explained therein will be a valuable tool for our Members, the subspecialty societies, and to external organizations as well. Comparison of key characteristics of consensus statements vs. guidelines* Characteristic Clinical consensus statement Clinical practice guideline Primary output Statements of fact based on best evidence and expert consensus Recommendations for action based on best evidence and explicit consideration of benefits, harms, values, and preferences Level of evidence Observational studies and expert consensus; higher levels of evidence when available Systematic reviews and randomized controlled trials; lower level evidence as needed for research gaps Size of development group 8 to 10; possibly more 15 to 20 Composition of development group Otolaryngologists; content experts a majority; may include other disciplines as needed Multidisciplinary, including consumers; content experts a minority; includes all stakeholders in the target audience Perspective of development group member Member serves as a content expert based on individual knowledge and experience Member advocates for the discipline or constituency they were appointed to represent Time frame 6 to 8 months 12 to 18 months Meeting venues Conference calls and electronic mail In-person meetings, conference calls, and electronic mail External review Limited review by relevant stakeholders Extensive review by all stakeholders, including open public comment *From the AAO-HNSF Clinical Consensus Statement Development Manual (2015). (In press)
2016 committee application opens November 1
Want to get more involved with your Academy? Apply to become a committee Member! The 2016 application cycle will open on November 1 and close on January 1, 2016.
Call for 2016 AAO-HNS election candidates
The Nominating Committee of the Academy is calling for recommendations of individuals to be considered for an AAO-HNS elective office.  Academy Member(s) must be in good standing, have proven leadership qualities, be active in the Academy, be familiar with the strategic direction of the Academy, and be able to dedicate the necessary time to serve.
teamwork
Teamwork
The following are the committee rosters of the Academy and Foundation, grouped by their clusters. These are all Members, unless otherwise noted who were appointed to terms October 1, 2015, as well as those continuing their service. The number following each name indicates the end of their term.
capitol
Leadership opportunity: State Trackers for 2016
The AAO-HNS thanks its Member-volunteer State Trackers for their dedicated efforts during the 2015 state legislative sessions to effectively monitor issues and trends important to the specialty, your practices, and your patients.
Deadline for new tech applications
Looking to apply for a new or revised CPT code? As specified by the “AAO-HNS New Technology Pathway Requests Policies and Procedures” document (www.entnet.org/New-Tech-Policies-and-Procedures), the AAO-HNS New or Revised CPT Code Application is required to be submitted to the Academy 180 days prior to the AMA CPT Proposal submission deadline. The next Academy deadline is December 29, 2015.
mobileapp
Access information anywhere with Otolaryngology–Head and Neck Surgery app
Print, online, and mobile—research can and should be available in multiple formats to meet the varying needs of our readership. This is why Otolaryngology–Head and Neck Surgery is available to you through a free mobile app.
cameroon
Humanitarian mission trip to Cameroon
I recently had the opportunity of a lifetime to participate in a two-week otolaryngology mission trip to Mbingo Baptist Hospital, Cameroon, with my mentor, Wayne M. Koch, MD, in April 2015. Dr. Koch has a long-standing relationship wth Mbingo Baptist Hospital (MBH) and travels there a number of times a year.
Why are RUC surveys important?
Your help is needed. The Academy needs experts three times a year to fill out RUC surveys for the American Medical Association (AMA) Specialty Society/Relative Value Update Committee.
Development of a professional code of conduct in an academic otolaryngology departmentExpanded from the print edition
Otolaryngology departments are increasingly becoming aware of the critical importance of professionalism in the academic medical setting.1 Growing evidence is showing that lack of civility in the workplace harms patient safety, employee satisfaction, and the broader institutional mission. Literature from other medical departments and from fields outside medicine suggests that a formalized written code of conduct is an effective method of clearly codifying the culture for all members of the organization, and of improving professional behavior.2
volunteer2
There is an ‘I’ in team
At the heart of the word committee, both literally and figuratively, is the word commit. As former basketball coach Pat Riley said, “There are only two options regarding commitment. You’re either in or you’re out. There is no such thing as life in-between.” Ditto for a successful committee.
project535
Legislative Advocacy highlights from Annual Meeting
Another successful Annual Meeting & OTO EXPO(SM) has come and gone. In case you were unable to join us in Dallas, below is a brief overview of what you missed.
sujana
Those who can do more, volunteer
Most of us are used to a very specific type of work. Whether we are working in a clinic, a hospital, or an operating room, we are used to applying certain otolaryngologic skills every day. We learned those skills in medical school and in training, and keep them fresh with CME activities. We advance our careers because we become great at these skills. As a group, we are self-motivated and highly capable learners. Otolaryngology residency applicant personality types1 show us to be primarily extroverted, thinking, and judging. We become, and stay, busy in our practices and in our families.