Published: December 10, 2015

Knowns, unknowns of 2016

As a very tumultuous 2015 comes to a close for otolaryngology and medicine in general, we are all asking, “What will 2016 bring?” There are a lot of unknowns across the spectrum of physician activities including quality measurement, reimbursement, continuing education and certification, and the overall configuration of the healthcare delivery system. As you can note in our Annual Report contained in this Bulletin, the Academy has been very proactive in trying to respond to these potential changes and provide our Members the means to offer the best patient care in the future.


dennenyAs a very tumultuous 2015 comes to a close for otolaryngology and medicine in general, we are all asking, “What will 2016 bring?” There are a lot of unknowns across the spectrum of physician activities including quality measurement, reimbursement, continuing education and certification, and the overall configuration of the healthcare delivery system. As you can note in our Annual Report contained in this Bulletin, the Academy has been very proactive in trying to respond to these potential changes and provide our Members the means to offer the best patient care in the future.

While it is impossible to accurately predict what 2016 will bring, certain trends will likely continue. We will be watching closely as the rules of engagement are announced and opportunities are created both in the private and public sectors. Let’s look at things we know, as well as areas that are not as clear.

What we know

The MACRA (Medicare Access and CHIP Reauthorization Act) legislation that replaced the SGR formula will greatly accelerate quality measurement and patient outcomes reporting, and in turn, payment reform. This act has codified the role of qualified clinical data registries (QCDRs) and clearly directed payment reform toward Alternative Payment Models (APMs), targeting a 50 percent participation rate in APMs by 2018 and 75 percent by 2022. An alternative track involves the Merit-based Incentive Payment System (MIPS), which will require reporting on quality measures, resource usage, meaningful use, and performance improvement. CMS is targeting ultimately 75 percent of payments to flow through the APMs and a residual 25 percent of payments on a fee-for-service basis. There is a clear advantage to be able to participate in an APM.

What we don’t know

CMS has recently received comments relating to APMs and MIPS and will use these to help formulate the operational parameters for these programs. In the meantime, it is not clear how specialists such as otolaryngologists can participate broadly in an APM outside of an accountable care organization (ACO). The Academy, along with other specialties, continues to aggressively pursue opportunities for our Members to participate in APM methodology. We are committed to preserving the opportunity to practice successfully without being institutional employees and will carry on exploration into organizational structures, such as specialty-wide associations, that can leverage our clinical acumen.

What we know

Quality will be integral to the practice of medicine on an accelerating basis. Both payment and participation will be dependent on the ability to demonstrate and improve the quality of patient care. This will spill over into Maintenance of Licensure (MOL) and into the evolution of Maintenance of Certification (MOC). Our Members will need to identify and exhibit these metrics across the breadth of the specialty to participate in all of these activities. The American Board of Medical Specialties (ABMS) is encouraging collaboration between specialty boards and associations, and the Academy has had multiple productive discussions with the American Board of Otolaryngology (ABOto) about MOC partnership strategies. RegentSM, our clinical data registry, will be an indispensable vehicle for participating Members to reach these goals.

What we don’t know

The private insurance market is also evolving, with considerable interest by the insurance companies for increased interaction with physician groups and societies. Most of this activity is with primary care providers, but there is significant interest in defining “quality care” across many fields in medicine and will require the expertise of specialty societies. The Academy is building relationships with several interested insurers focusing on our quality program and registry. How quickly the private and public sectors will evolve is unclear, but the momentum indicates it will be much more rapidly than we’ve seen previously. There can be no question that as the change evolves it not only is confusing to us but to our patients too, and we must be leaders in making sure patients are not left out.

A limiting factor might be how quickly the current multiple data systems can be truly interoperable. We are seeing unprecedented cooperation from many EHR vendors in private and academic settings to help move the quality needle forward.

What will we do?

We will continue to work with our specialty societies, private practitioners, and academic otolaryngologists in the ABOto to pursue our goals and take advantage of the opportunities that will arise over the next several years.

 

 


More from December 2015/ January 2016 - Vol. 34, No. 11

edelstein
BOG will ‘bring home the Academy’ to you
By David Edelstein, MD, BOG Chair Hockey fans know that each year the winners of the Stanley Cup get a chance to touch the Cup when the winning team gets to “Bring Home the Cup.” This is an exciting moment for local fans, and I remember being taken by my dad many years ago to see the Cup firsthand when the Bruins won it. Seeing the Cup makes the win tangible and the moment memorable. Just as the Bruins brought home the Stanley Cup to the Boston of my youth, the Academy’s Board of Governors (BOG) can help “bring home the Academy” to you. Some people have the mistaken idea that the Academy’s and Foundation’s only function is to run the Annual Meeting once a year. Although the recent meeting in Dallas was a success, it represents only a small part of what the AAO-HNS/F does for you every day. A lot goes on at the Academy during the year about which you need to be informed. Hence, one of the major goals of the BOG this year is to “bring home the Academy” by helping Academy Members and local BOG governors stay up to date on what the Academy is doing by providing handouts and slide shows on a quarterly basis highlighting topics of interest to local societies. The BOG serves an important role in ensuring that the day-to-day issues you face in your practice remain front and center on the Academy’s agenda. For example, this past year the BOG’s Legislative Affairs Committee collated reports on issues of local concern from 110 otolaryngologists in 42 states and organized 40 local In-district Grassroots Outreach (I-GO) meetings with federal lawmakers. Similarly, the Socioeconomic and Grassroots (SEGR) Committee heard presentations on socioeconomic issues affecting our specialty from all 10 regions of the country. Appropriately, part of SEGR stands for “grassroots” (GR), and the Committee will be conducting two polls for 2015-2016 regarding feedback on the Affordable Care Act (polling in December 2015) and ICD-10 (polling in March 2016). The BOG’s Rules and Regulations committee was recently renamed Governance and Society Engagement in keeping with its new mission to help energize local societies and build a framework to develop new state societies where none exist. Did you know that there are five states with no local societies? The newly named committee will help to build virtual societies with Internet-based platforms for these states so that otolaryngologists can talk about local problems, especially in those geographic areas where in-person meetings are not easily accomplished. Spring Leadership Meeting  The BOG also helps organize the Academy’s annual conference on leadership, scheduled for March 18-21, 2016, in Alexandria, VA. The AAO-HNS/F 2016 Leadership Forum & BOG Spring Meeting is open to any Academy Member, in addition to BOG governors and local society representatives. The conference program includes exciting luncheon speakers on such topics as where medicine is going, how to be a leader in medicine, and the current political environment on medical issues in Washington, DC. In addition, there will be many interesting panels on building leadership skills; on how to write a business plan; how to write a letter to insurance companies; RegentSM, the Academy’s new ENT clinical data registry; and how to set your career pathway. We hope that your local BOG governors help you to reconnect with the AAO-HNS and that the “bring home the Academy” project enables you to find ways in which the Academy can be useful to you every day. See you in March!