In 2016, we ensured our long-term sustainability, our brand, and our relevance to our Members and the public, retaining high-quality leadership and staff in touch with and adaptable to the changing needs and environment of our Members. The following milestones illustrate that we provided exceptional stewardship of AAO-HNS/F assets, enhanced industry support, and nurtured a culture of philanthropy.
SUSTAINING THE VALUE OF THE BRAND
Communications provided marketing, editorial, design, and content development support for all major Academy and Foundation initiatives including the new ENT clinical data registry, RegentSM, the Annual Meeting & OTO EXPOSM, Global Affairs, and Clinical Practice Guidelines.
As the result of a comprehensive review of flagship publications, Communications planned and developed long-term initiatives that will assist the Academy to communicate and engage with Members, the healthcare community, and the public in new and innovative ways. To that end, the open access journal, OTO Open, launches in January as does a new personalized weekly newsletter. New publishing contracts for the Bulletin and Otolaryngology–Head and Neck Surgery will be finalized in the coming weeks.
Communications highlights, which reflect the leadership and contributions of the Media & Public Relations Committee; journal Editor in Chief John H. Krouse, MD, PhD, MBA; and Bulletin Editor James C. Denneny III, MD, for this year include:
Created and marketed this year’s theme: Value 4U: You Care for Patients. We Care for YOU.
Conceived, filmed, and co-produced “How Do You Say Otolaryngology?” video for the Opening Ceremony of the Annual Meeting & OTO EXPOSM in San Diego, CA.
Responded to more than 80 interview requests.
Recognized health observance months/weeks and produced downloadable multi-media materials and content for individual and practice participation.
Provided up-to-the-minute content with the AAO-HNS brand for the patient licensing program.
Generated a 35.33 percent increase in the last year in unique visitors to ENTConnect, resulting in 171,369 page views. Visits to the Open Forum increased by more than 400 percent.
Expanded online circulation as a pilot project with targeted, timely patient information content, broadening value to Members and healthcare consumers.
Introduced the new quarterly “Practice Profile,” spotlighting different types of practices, their challenges, and the value AAO-HNS provides.
Added revenue with supported eblast of each issue’s table of contents.
Otolaryngology–Head and Neck Surgery:
Commenced the Resident Reviewer Development Program, pairing residents with experienced peer reviewer mentors, providing guidance and practice for the next generation of peer reviewers.
Produced 13 new podcasts for a total of 91; 32,257 podcast downloads in the past year (9,756 more than in the previous 12 months).
Published special focus sections: Patient Safety and Quality Improvement (December 2015, May 2016, and November 2016).
Published a special issue: “40 under 40” in October 2015; the issue is composed of articles whose first authors were residents or young physicians at time of submission.
Unique visitors: 6.8 million (up 12 percent since August 2015)
Sessions (total visits): 8.1 million (up 12 percent since August 2015)
Page views: 10.3 million (up 11 percent from August 2015)
Trending: “Find an ENT” tool increased traffic by 60 percent (556,000 potential patients)
AAO-HNS FOUNDATION DEVELOPMENT
The Development Coordinator, committee, and staff strive to create a culture of philanthropy within the Academy membership, communicate the importance of annual giving and its impact on the specialty, and prioritize exemplary stewardship of the gifts that have been so generously donated to the AAO-HNS Foundation (the foundation).
Development efforts this year focused on raising awareness about the foundation and how donor gifts are used to support the specialty, today and tomorrow. New branding was introduced to emphasize the philanthropic aspect of the foundation, using the tag line where dues stop and philanthropy begins. Communication about what is the foundation, why donate to the foundation, and ways to donate to the foundation was developed and added to the website.
The foundation’s donor recognition club, the Millennium Society, had 273 members in 2016, including three new members at the lifetime giving level, six new members at the Sustainer level and 20 new members included in the Millennium Society who were not included in the previous year. As a way of thanking donors for their generosity, a special lounge at the Annual Meeting is created exclusively for donors who are part of the Millennium Society. At this year’s Annual Meeting in San Diego, we welcomed 109 donors in the lounge and hope to increase that number in Chicago!
Strategic goals were met for the year with a 10 percent increase in the number of donors and increases in the dollars raised both for the Annual Fund and the Hal Foster, MD Endowment. Donations to the Annual Fund for FY16 were $157,000, used to fund CORE grants, travel grants, humanitarian and international programs, and other programs, not supported by dues or fees, to improve quality and patient care. Endowment donations were just under $200,000, invested to generate earnings to support foundation programs in future years.
The “Legends of Otolaryngology” fundraising program honoring an otolaryngologist who has made significant contributions to the specialty, kicked off in San Diego, where the first legend to be honored, M. Eugene Tardy, Jr., MD, delivered the inaugural Legends lecture: “‘Mosquetors Verry Trublesum,’ the Fascinating Medical Travails of the Lewis and Clark Expedition.” Dr. Tardy did not disappoint. Approximately 500 guests filled the room, all of whom we hope will consider a donation to the Annual Fund, of any amount, in honor of Dr. Tardy and what he means to the specialty.
We thank all donors who have made a charitable gift to the foundation. These donors are the bedrock of providing the funding needed to support the AAO-HNS Foundation’s programs today and ensuring the future of the specialty for generations to come.
ANNUAL MEETING SPONSORSHIP & INDUSTRY SUPPORT
Key components to the success of creating Value 4 attendees of the Annual Meeting are the partnerships developed with industry.
Through the efforts of the Global Education, Meetings, and Strategic Partnership Business Unit, the financial support from industry has increased by 22 percent compared to last year. We were able to offer more and enhanced sponsorship opportunities at the 2016 AAO-HNSF Annual Meeting & OTO EXPO. The total financial support was $705,000.
Some of the additional and enhanced sponsorship opportunities included:
Introduced electronic banner ads and highlighted listings in the meeting mobile app to provide the opportunity for the attendees to interact with the sponsor.
Provided additional exposure to industry partners throughout the convention center and a number of hotels within walking distance of the convention center.
Provided the opportunity to receive support for food and beverage for the attendee breaks.
The sponsorship and support included three components, which are Corporate Marketing and Sponsorship, Corporate Sponsored Education Initiatives, and Unrestricted Grants.
AAO-HNS ACADEMY ADVANTAGE
The Academy Advantage program continues to provide Members with special discounts on products and services to assist in providing relevant solutions to the challenges Members and their medical practices are facing. Following are the Academy Advantage trusted companies that participate in the program, which in return provides financial support for AAO-HNS/F mission and objectives.
The Doctors Company – Medical Liability Insurance
Health eCareers: online Career Board and Career fair at the Annual Meeting
Officite – Website Design/Marketing
AllMeds: Electronic Health Record (HER) and Practice Management Solutions Services
Rendia (formerly Eyemaginations): In-Office Patient Education
Optum™: Coding Resources
FINANCIAL REPORT FISCAL YEAR 2016 (FY16)
Expense savings of almost 23 percent more than absorbed a 4 percent shortfall in revenue leading to a positive contribution to net asset reserves for the fiscal year July 1, 2015 – June 30, 2016 (FY16). Significant savings were realized in staff related costs, including consolidating 10 management positions into seven, and in consulting expense, where contingency budgets were in place that were not necessary to use. Contributing to the shortfall in revenue was lower than expected Annual Meeting attendance in Dallas and lower membership retention, budgeted at 94 percent but realized at 92 percent. While a break-even budget had been planned, a positive (unaudited) $3.6M variance from the break-even operating budget was realized for the fiscal year.
Investment and other non-operating activity netted a loss of $1.1M, mainly due to unrealized losses related to investments. Combining operating and non-operating activity, the combined (unaudited) contribution to reserves for FY16 was $2.5M.
While there was a positive addition to net asset reserves for the year, there was a $1.3M use of reserves to fund certain non-recurring items. The Board designated net asset reserves be used to fund: $900,000 of start-up costs to design, create and build Regent℠, the first otolaryngology specific data registry; $107,000 for costs to relocate and build-out new space in the headquarters building for the John Adams History Museum; and $305,000 for annual debt service related to the purchase of the headquarters building.
As of June 30, 2016, unrestricted net asset reserves were $18.8M, of which approximately $3.5M was designated by the Boards of Directors to be used for specific purposes in future years. Restricted net assets were $6.4M, divided between those that are available for spending as directed by the donor, $1.8M, and those that form the corpus of the Hal Foster, MD Endowment, $4.6M, and are to be retained into perpetuity. Approximately $390,000 of FY16 programing was funded by restricted net assets and endowment earnings.
For a copy of the independent audit of AAO-HNS/F’s FY16 financial statements contact CHanlon@entnet.org.
The budget for the current fiscal year July 1, 2016 – June 30, 2017 (FY17), was approved by the Boards of Directors in May 2016. Again, a break-even budget is planned, where revenue and expenses both equal approximately $19M. A few significant changes distinguish the current year budget from the prior year: meeting and exhibits revenue is based on an increase in registrants for the Annual Meeting in San Diego, investment interest and dividends are no longer budgeted to be used for operations, and reliance on the use of net asset reserves to fund the start-up of Regent℠ is limited to funding only consulting costs. These changes were made to factor into the budget the expense savings operationalized in FY16, and prior years. They reduce the dependency on net asset reserves and investment activity to fund operations and special projects. As an intended consequence of these changes, the level of year-end positive variances is expected to diminish over time as operating revenues are used for expenses in place of using net asset reserves and investment income.
A balanced budget is required to comply with the debt covenants of the headquarters building financing. The budgeting process is integrated with the AAO-HNS/F strategic plan and involves the efforts of elected leadership, the Boards of Directors, Executive Committee, and the Finance and Investment Subcommittee.
Leadership and staff continue to be prudent stewards of the organization’s financial resources as decisions and strategies for the organization are developed going forward. Recognizing that without revenue growth, expenses will eventually exceed revenue due to inflation alone, conservative spending, even where a positive variance may be realized, continues to be the approach of management.
AMERICAN ACADEMY OF OTOLARYNGOLOGY – HEAD AND NECK SURGERY/FOUNDATION
Unaudited (Rounded) Consolidated Statement of Revenue and Expenses
For the 12 Months Ended June 30, 2016
Meetings and Exhibits
Product and Program Sales
Corporate and Individual Support
Investment Income – Interest and Dividends
Use of Donor Restricted Net Assets
Use of Board Designated Net Assets
Salaries and Benefits
Communications and Software
Printing and Production
Consultants and Professional Fees
Change in Unrestricted Net Assets from Operations
Realized and Unrealized Net Loss on Investments
Unrealized Loss on Interest Rate Swap Agreement
Non-operating Other Revenue
Change in Unrestricted Net Assets from Non-Operating Activities
Total Change in Unrestricted Net Assets
$ 2,540,000 Value. Lately everyone is insisting on it, from value-based healthcare to value-added mobile data family plans. With so many options available to us, we’re right to insist on value, including in our professional association memberships.
AAO-HNS offers value-added benefits that help Members achieve excellence and provide the best ear, nose, and throat care.
The American Academy of Otolaryngology—Head and Neck Surgery provides value for our Members through professional and public education, research, and health policy and legislative advocacy. As a membership organization, the Academy exists solely for the benefit of our Members and advancement of the specialty. The value of membership extends far beyond efforts to provide clarity in these uncertain times.
As a Member, you have access to exclusive programs and resources designed just for you. Whether you practice general or subspecialty otolaryngology, and regardless of your practice setting, there are Academy resources just for you. We exist for you.
BOG’S ‘BRING HOME THE ACADEMY’ WORKED TO BRING HOME VALUE
The theme of this year’s Board of Governors (BOG) activities was “Bring Home the Academy.” The campaign was launched to help increase awareness of the BOG’s critical role as the grassroots arm of the AAO-HNS, highlighting the numerous resources available for state/local/regional otolaryngology societies and their representatives to the BOG. New toolkits and slide presentations were developed and a virtual society platform was created to help Members “Bring Home the Academy.”
Membership by the numbers
(as of October 20, 2016)
11,884 members; 93% retention rate
880 new and reinstated Members
69% Fellows, board certified
17% Members, not board certified
9% International members
PRIMARY SUBSPECIALTIES BY THE NUMBERS
49% General Otolaryngology
11% Head and Neck Surgery
10% Facial Plastic Surgery
9% Pediatric Otolaryngology
1% Sleep Medicine Value4U—the Academy has delivered on its promise to provide you with the tools and resources you need to be successful, especially in today’s ever-evolving healthcare environment and heightened delivery of quality care.
120th AAO-HNSF Annual Meeting & OTO EXPOSM
This year the Program Advisory Committee and Instruction Course Advisory Committee introduced a broad range of changes designed to enhance the world’s premier gathering of otolaryngologists. These changes enriched your overall experience and expanded your education opportunities.
ANNUAL MEETING BY THE NUMBERS
227 Instruction Courses
28 International Symposia
12 Masters of Video Surgery Presentations
4 Guest Lectures
1 New! Legends Lecture
429 Scientific Oral Presentations
267 exhibiting companies
8,568 visits to the OTO EXPOSM
26.5 Continuing Medical Education Credits available for each physician
21,137 Continuing Medical Education credits provided
5,948 installations of the Annual Meeting Mobile App
2017 AND BEYOND
The newly formed Annual Meeting Program Committee is charged with designing an enriching educational experience focusing on all otolaryngology specialty areas. Join us in Chicago, IL, for the 2017 Annual Meeting & OTO Experience℠, September 10-13 and mark your calendar now for the 2018 Annual Meeting & OTO Experience℠ in Atlanta, GA, to be held October 7-10. We promise continued improvement, more value, and cutting-edge education.
You can be part of the 2017 Annual Meeting by submitting an abstract or session proposal for consideration. Save the dates and watch the Annual Meeting website for updated information.
The Annual Meeting & OTO EXPO℠ continues to develop each year and this year was no different. Some new components of the Annual Meeting & OTO EXPO℠ included:
Registration badges were not mailed to attendees. Instead, satellite registration areas were established in the lobbies of the two largest meeting hotels, the Hilton Bayfront and the Marriott Marquis, on Saturday, September 17. Badges could also be picked up at Registration in the San Diego Convention Center.
Badges contained RFID tracking devices. RFID readers were installed above education session entrances and the collected data was then automatically recorded for CME credit hours. Completion of session evaluations was still required to earn CME.
No tickets or additional registration fees were needed to attend Instruction Courses, Miniseminars, International Symposia, Masters of Surgery Video Presentations, and Scientific Oral Presentations.
The Annual Meeting mobile app offered more features and more program information than in previous years.
Recordings and webcasts of selected education sessions can now be purchased through AcademyU®.
Four Pre-Conference Workshops were offered on Saturday, September 17: Salivary Endoscopy, Thyroid and Parathyroid Ultrasounds, Simulation Experience with the UCSD, and Business of Medicine.
A Community Giveback Program on Saturday, September 17, offered free hearing screenings for underserved families through the San Diego Neighborhood House Association.
Women in Otolaryngology (WIO) Sunrise Yoga was offered on Sunday, September 18, and 47 individuals participated.
The OTOs on the Run 5K race on Monday, September 19, had 121 participants.
Lunch with the Experts was an opportunity to meet otolaryngology legends and subject matter experts.
Attendees were able to earn up to four AMA PRA CME Category 1TM credits by viewing posters during designated hours.
We are pleased to report that we had 5,053 professional registrants this year, a 7.56 percent increase from last year. Attendees came from all over the world, spanning more than 94 different countries. We are also thrilled to report that we had 1,078 abstract submissions this year.
This year’s “Best in Show” poster winner was “Novel Gene Delivery for a Light-Driven Optogenetic Auditory Implant,” Sumi Sinha, BS; Maria J. Duarte, BS, BA; Elliott D. Kozin, MD; Ariel E. Hight, MS; Alyson B. Kaplan, BA; Shreya Narasimhan, MS; Christian Brown, PhD; Daniel J. Lee, MD.
Exhibit booth winners were: Island Booth: Medtrobotics, booth 2435; Single Booth: Optim, booth 2511; Inline Booth: Preceptis Medical, booth 1621.
The AAO-HNSF would like to extend a special thanks to the Program Advisory Committee led by Eben L. Rosenthal, MD, and the Instruction Course Advisory Committee led by Sukgi S. Choi, MD, for their leadership, commitment to professional growth, and innovation.
The 2017 Annual Meeting Program Committee (AMPC) will be led by Mark K. Wax, MD. The Program Advisory Committee and Instruction Course Advisory Committee will be combined into one committee, AMPC.
ACADEMYU® BY THE NUMBERS
360 Webcasts from the 2016 Annual Meeting
4,041 individuals who claimed CME credit
103,588 CME credits awarded
5 NEW Faculty Development modules
20 NEW ENT for the PA-C webcasts
5,145 Home Study Course Completions
304 record number of attendees at the 2016 ENT for the PA-C Conference
85 percent of Residency Programs subscribed to Home Study Course
15 specialty societies represented on the Otolaryngology Comprehensive Curriculum Work Group
20 members of the newly formed Simulation Education Committee
13 NEW Annual Meeting Expert Series (AmX) published in AcademyU
43,550 education activity views in AcademyU
56 Education teams developing new online resources
NEW IN ACADEMYU
AmX: Fifteen new Annual Meeting Expert Series (AmX) online activities based on 2016 Annual Meeting presentations and faculty interviews. Each includes a case scenario to form a complete, interactive look at timely and relevant topics.
SIM @ AM: The newly formed Simulation Education Committee hosted two outstanding events at this year’s Annual Meeting & OTO EXPO℠. These included a Simulation Experience to the University of California San Diego Simulation Center, where participants engaged in a variety of hands-on simulation scenarios. The Simulation Reception and Showcase brought 28 demonstrations from multiple countries to discuss and share various simulation projects in otolaryngology.
AcademyQ: Four hundred new questions are being added to the current 800 questions to make up the third installment of the AcademyQ knowledge assessment app.
ACADEMYU IS VALUE 4U
Education has been a cornerstone of the Academy since its inception. As the current mission statement articulates, the Academy provides Professional Education so our Members can achieve excellence and provide the best patient care. AcademyU® exemplifies this commitment in that we care for you, so you can care for your patients.
With the launch of the new AcademyU this year, a new focus on value was introduced to ensure sustainability of the AAO-HNSF Education program; to provide higher quality education products through technology and innovation; and, most importantly, to demonstrate to Members the economic and learning value of Foundation education products.
The economic value of AcademyU can be found in the following:
30 percent Member discount on AcademyU activities; Member residents often receive an additional 30 percent discount.
HSC+ allows residents to access to AcademyU for a reasonable annual fee.
Individual Home Study Course sections are available for purchase.
COOL courses are free to medical students completing otolaryngology rotations.
SPAO members receive discounts on the ENT for the PA-C webcasts.
Patient Management Perspectives are available for individual purchase.
Annual Meeting attendees receive six free 2016 Annual Meeting webcasts.
AcademyQ CME offers CME credit for specialty-specific bundles.
Education provided by the Foundation for AcademyU is developed by content experts across all eight specialties through the work of the Education Committees under the leadership of the Education Steering Committee. These content experts are friends and colleagues sharing their knowledge and expertise with their fellow otolaryngologists.
New this year, all the education activities offered by the Foundation—from Annual Meeting to online education—were based on Member-identified education and learning needs. We addressed the most current and cutting-edge topics for providing the best patient care.
More than 80 percent of Members feel that the Education Program:
Increases knowledge of current research advances
Improves competence in performing diagnostics and treatment
Enhances practice skills for high quality healthcare
In 2014, Members spoke and the Academy listened when you told us what your ideal learning resource would be. You wanted it to be accessible, self-paced, interactive, easily digested, and customized. With the launch of the new AcademyU, this new learning platform has offered many features that meet each of these characteristics:
Accessible: AcademyU’s responsive design is accessible on all devices.
Self-paced: AcademyU Learning Platform is available 24/7; activities can be started and stopped as you wish.
Interactive: COOL courses and Patient Management Perspectives Self-Assessments provide case-based scenarios to test your skills.
Easily digested: AcademyU has a robust search function for easily finding the education topic you are looking for.
Customized: Activities in AcademyU include practice gap-based education across eight specialties.
With more than 800 activities in the new AcademyU—all discounted for Academy Members—the value of Foundation professional education is clear to see.
RICHARD V. SMITH, MD, AAO-HNSF COORDINATOR FOR EDUCATION, TALKS ABOUT THE FIRST YEAR OF THE NEW ACADEMYU:
AcademyU has clearly been a success. We have seen consistent use of AcademyU across all Members. When I have spoken with those who have used it, they have all expressed their comfort with the platform and its user friendliness. Exciting additions this year include Annual Meeting Webcasts from 2014, 2015, and 2016.
New items in resident education include HSC+, a new pricing plan to allow residents access to the AcademyU catalogue. Five new Faculty Development eCourses are now available to assist all Members with enhancing their teaching skills. OTOSource, the Comprehensive Curriculum being developed, is well underway and will serve as an outline for all stages of one’s career, but may be particularly pertinent to those in training.
All in all, there are many exciting changes and new products available from Foundation Education. We look forward to continued innovation and hope to be the main source of high quality education content for our Members well into the future. Throughout the year, the Academy’s legislative and grassroots efforts act as the voice of the specialty on Capitol Hill and in the state houses. The Academy’s legislative advocacy work ensures lawmakers are knowledgeable about the issues affecting otolaryngology and understand how pending proposals could impact your practice and your patients. These initiatives, combined with the Academy’s Health Policy efforts, create a continual advocacy mechanism to ensure the specialty is well represented with policymakers and providing Value4U.
Advocacy leaders and staff work in myriad areas to provide value. The work falls into two primary categories—Health Policy: agencies and payers; and Legistative: federal, regional, state, and local. These pages outline each area of endeavor.
LEGISLATIVE AND POLITICAL
Advocated on behalf of the specialty via 129 Capitol Hill meetings and 76 political fundraisers.
Co-signed 34 coalition letters with others in the healthcare community on varied topics, including tobacco control, hearing health, MACRA implementation, and scope of practice.
Testified before the Food and Drug Administration regarding Good Manufacturing Practices and Proposed Stratification of Hearing Aids.
Submitted numerous comment letters in anticipation of the National Academies’ report on “Hearing Health Care for Adults: Priorities for Improving Access and Affordability.”
Successfully thwarted attempts by allied professionals to inappropriately expand their scope of practice, as well as efforts to re-define audiologists as “physicians.”
Supported and advanced “truth-in-advertising” proposals to ensure patients are fully informed in their healthcare decisions.
Joined AAOA, AAFPRS, and others to oppose, on multiple fronts, proposed changes to USP 797 and related changes to in-office compounding regulations.
GRASSROOTS AND STATE TRACKERS
Advanced PROJECT 535, a BOG-sponsored initiative ensuring each Member of Congress is connected to an AAO-HNS Member. In the program’s first year, key contacts in more than 50 percent of states/congressional districts were identified.
Activated nearly 1,800 members of the ENT Advocacy Network, urging them to contact their legislators via eight “Calls to Action.”
Held monthly conference calls with more than 130 volunteer State Trackers to identify legislative trends developing at the state level.
Effective legislative and political advocacy relies on you, our Members. To more broadly recognize AAO-HNS Members who support the Academy’s entire spectrum of advocacy programs, a new “All Star Advocate” distinction was established in 2016. AAO-HNS Members who carry the All-Star Advocate designation help to advance the specialty’s priorities by:
Joining the ENT Advocacy Network. This “opt-in” network provides Members with timely updates and legislative “Calls to Action.” Advocacy Network members also receive information regarding the breadth of the Academy’s advocacy efforts via the monthly e-newsletter, The ENT Advocate.
Participating in PROJECT 535. This initiative aims to recruit a “key contact” for each U.S. Senate and House Congressional seat. Pairing Academy Members with lawmakers in each Congressional district improves our outreach and effectiveness when major issues impacting the specialty are debated by Congress. Remember, elected officials value the input of their constituents/voters when considering legislation, and physicians are important community leaders. Your opinion carries weight! Thanks to the commitment of our AAO-HNS Members, approximately 54 percent of all 535 U.S. Congressional and Senate districts are currently “matched” with an otolaryngologist-head and neck surgeon.
Meeting with lawmakers at home via the In-District Grassroots Outreach (I-GO) Program. This critical program enables AAO-HNS Members to contact, establish relationships, and meet with federal legislators in their home state/district.
Donating to the ENT PAC, the political action committee of the AAO-HNS. ENT PAC is non-partisan and issue-driven, which means we strive to support only pro-otolaryngology incumbents/candidates. By pooling the voluntary contributions of AAO-HNS Members, we are able to further amplify the strength of the specialty’s collective voice on Capitol Hill.
The AAO-HNS thanks the physician volunteers who help ensure the success of the Academy’s various advocacy programs. With the 115th Congress scheduled to convene in January, we encourage all of our Members to get involved with any (or all!) of our legislative, grassroots, and political advocacy efforts. The Academy will provide the direction and resources—we just need your commitment to advocating on behalf of the specialty.
Contact firstname.lastname@example.org for more information or to sign up!
EXAMINING THE ACCESSIBILITY AND AFFORDABILITY OF U.S. HEARING HEALTHCARE
Over the last year, several Administration-related entities have been examining the topic of “access to hearing healthcare services and/or devices,” and what steps could be taken to mitigate perceived barriers associated with accessing such services. The AAO-HNS has been an active participant as this multifaceted investigation has evolved, having provided feedback and/or comments to the President’s Council of Advisors on Science and Technology (PCAST), the National Academies of Medicine (NAM), and the Food and Drug Administration (FDA). Provided below is a brief overview of the Academy’s efforts on behalf of you, your practices, and your patients.
President’s Council of Advisors on Science and Technology (PCAST) – In October 2015, the PCAST issued a report titled “Aging America & Hearing Loss: Imperative of Improved Hearing Technologies” that outlined the advisory group’s recommendations for broadening access to various hearing aid and/or hearing aid-like devices in the United States, including the potential for “over-the-counter” sale of certain hearing aids. After careful analysis, the AAO-HNS submitted a formal comment letter supporting most of the report’s recommendations while emphasizing the importance of a medical evaluation requirement.
National Academy of Medicine (NAM, formerly the Institute of Medicine, IOM) – After a year of information gathering and analysis, the Committee on Accessible and Affordable Hearing Health Care for Adults released a report in June 2016, titled “Hearing Health Care for Adults: Priorities for Improving Access and Affordability.” The extensive report made several recommendations aimed at easing perceived barriers for patients to access various hearing healthcare services. The Academy was pleased the report did not recommend changes to Medicare’s current physician referral requirements (e.g., direct access). Although the report was initially expected to have a substantial impact on a wide range of hearing health-related advocacy efforts, the report has not generated much interest among lawmakers to quickly implement its recommendations. However, stakeholders in the hearing health community convened in December 2016, to discuss “next steps” and areas of possible collaboration.
FDA – In April 2016, AAO-HNS/F Executive Vice President/CEO James C. Denneny III, MD, testified at an FDA Public Workshop on “Streamlining Regulations for Good Manufacturing Practices (GMPs) for Hearing Aids.” And, as follow-up, the AAO-HNS submitted a formal comment letter to the agency (on the same topic) at the end of June. Overall, the AAO-HNS has indicated its support for easing federal regulations associated with access to various hearing devices (hearing aids and/or PSAPs), as long as the requirements for an initial medical evaluation are upheld.
Given the potential impact of these collective efforts, the AAO-HNS continues to closely follow all three entities. And, it remains possible that these reports could have broad implications pertaining to the AAO-HNS’ ongoing efforts (re: audiology scope/direct access) on Capitol Hill. However, the combined efforts of the PCAST, NAM, and FDA to analyze the provision of hearing healthcare services, and the AAO-HNS’ subsequent support for many of the collective recommendations, represent a positive shift from the status quo. As today’s technology evolves at an unbelievable pace, the AAO-HNS and its Members must continue to provide patients with the best pathway for safe, affordable, quality care. Positive patient advocacy includes reevaluating the role of technology and identifying common ground.
It’s Value4U and the right thing to do.
To learn more about the AAO-HNS’ efforts relating to the delivery of hearing healthcare services and/or to read the aforementioned comment letters, contact the Legislative Advocacy team at email@example.com or visit www.entnet.org/advocacy.
The Academy’s Health Policy Team works with the Physician Payment Policy (3P) Advisory Workgroup to represent the membership at large and ensure appropriate advocacy for Members’ interests. This includes developing and fostering relationships with top officials at Medicare and national private payer organizations and advocating for appropriate reimbursement for otolaryngology-related procedures. Coordination with other Academy committees, specialties, and surgical specialty societies is critical to the work of the Health Policy Team and 3P. Below are accomplishments over the last year.
HEALTH POLICY RECAP: PRIVATE PAYER
Reviewed nine national medical payer policies and provided feedback on the following topics: functional endoscopic sinus surgery (FESS), debridement prior authorization, implantable bone-conduction and bone-anchored hearing aids, cochlear implants, balloon sinus ostial dilation for chronic sinusitis, diagnostic fiberoptic flexible laryngoscopy, diagnostic nasal endoscopy, and injectable bulking agents for vocal cord insufficiency. Highlights from three positive changes as a result of Academy advocacy efforts in collaboration with private payers are noted below.
Anthem ultimately accepted the Academy’s request to consider the use of SPECT/CT fusion imaging as medically necessary in the evaluation of parathyroid glands in individuals with hyperparathyroidism when used for anatomic localization prior to parathyroid surgery.
In response to Academy comments, Anthem also revised their Allergy Immunotherapy policy, changing coverage for the provision of increased allergen/antigen preparation for the first year of treatment.
Based on concerns raised with UnitedHealthcare (UHC) regarding the number of debridements (CPT 31237) that are reasonable following FESS procedures, UHC removed CPT 31237 from the list of services that require prior authorization, effective October 1, 2016.
HEALTH POLICY RECAP: CODING/REIMBURSEMENT
Concluded work of FESS Task Force, comprised of experts from the Academy, ARS, and AAOA, resulting in the creation of five new and modification of seven existing nasal/sinus endoscopy codes, presented at the CPT Editorial Panel in October 2016.
Surveyed 25 codes through the RUC survey process including Laryngoplasty, control of nasal hemorrhage, and Tracheostomy codes.
Developed three new Category III codes for insertion, revision, and replacement of chest wall respiratory sensor or lead for Hypoglossal Nerve Stimulation, available for reporting July 1, 2016.
Drafted two CPT Assistant articles: Removal of Impacted Cerumen (69209) and Drug-Eluting Sinus Implant (CPT 0406T, 0407T).
Updated three CPT for ENT articles (Cerumen Removal, Laryngoscopy, and Transtympanic Therapeutic Injections).
HEALTH POLICY ADVOCACY RESOURCES
3P and the Health Policy staff created Position Statements, template appeal letters, advocacy statements, and other resources to help practices receive appropriate reimbursement from private payers, maintaining credibility with national and local representatives on socioeconomic and federal regulatory issues. The accomplishments below highlight responses to the needs and requests from Academy Members to receive relevant and valuable resources.
REUSE OF SINGLE-USE DEVICES: RESPONSIBLE RECYCLING OF MEDICAL INSTRUMENTATION
In July and August 2016, a special project Task Force developed an educational product on multi-use of single-use devices (SUD) designed to address FDA regulation, patient safety, and impact the Academy membership in a resourceful way.
The Task Force developed a white paper that focused on SUDs that helps managing healthcare costs and operating sustainability. This details how it is “critical to recognize not only the importance of disinfection and sterility, but also the preservation of structural integrity to ensure delivery of the originally intended therapeutic result with no additional risk to the patient.”
Further, the white paper addresses the obligations of physicians and practitioners to their patients on informed consent.
You can find this white paper and other valuable resources in the November issue of the Bulletin.
ACADEMY COLLABORATES WITH UNITED HEALTHCARE TO CHANGE DEBRIDEMENT PRIOR AUTHORIZATION
The Academy raised concerns with UHC to request the removal of the number of debridements (CPT 31237) from their prior authorization list that were reasonable following functional endoscopic sinus surgery (FESS) procedures. After the Academy provided medical literature as supporting evidence, UHC decided to remove CPT 31237 from the list of services that require prior authorization. Further, UHC updated their FESS medical policy to reflect the latest (2015) versions of Clinical Indicators. Both advocacy victories were effective October 1, 2016.
To find more information on this policy, a UHC Prior Authorization Requirement FAQ, and a list of UHC Prior Authorization Requirements, visit www.entnet.org/content/private-payer-advocacy.
HEALTH POLICY REGULATORY ADVOCACY
3P and the Health Policy Team provide value for you by advocating to appropriate regulatory agencies on behalf of all Academy Members. Below is a snapshot of some of the policies the Academy has advocated on your behalf during the past year, which are scheduled to take place starting January 1, 2017.
2017 is proving to be a pivotal year of change for otolaryngologist–head and neck surgeons. Starting January 1, 2017, otolaryngologist–head and neck surgeons will begin participation in at least several new programs, all of which may require modifications to practice patterns and substantial investments on the part of practices. These include the MIPS and Alternative Payment Model (APMs) programs, which are replacing the SGR as the payment mechanism for Medicare; reporting Chronic Care Management (CCM) G-codes; and clinicians in certain states will begin reporting on claims data on post-operative visits furnished during the global period of a specified procedure using CPT code 99024 as part of a CMS required data collection for all 010 and 090 day global surgical codes.
In the past year, the Academy has actively worked to reduce the regulatory burden facing otolaryngologist–head and neck surgeons. The Academy has:
Submitted 11 comment letters submitted to CMS on coding and payment related policies, including the proposed new Merit-based Incentive Payment System (MIPS), Alternative Payment Model (APM) and Episode Grouper programs.
Actively worked with Congress, including participating in meetings with representatives from the Doctors Caucus, to ensure robust oversight in the implementation of the MIPS and APM programs.
Personally met with Patrick Conway, MD, Deputy Administrator for Innovation & Quality, CMS Chief Medical Officer, to discuss concerns regarding the implementation of the MIPS and APM programs.
NEW ACADEMY PRACTICE MANAGEMENT RESOURCES
In response to Member inquiries and new regulatory requirements, the following additional resources were developed:
2016 quality reporting programs factsheets
2017 MIPS and APM program overview factsheets
Private Payer Advocacy Toolkit
3P and the Academy also developed:
Five new Position Statements
12 revised Position Statements (As part of a collaborative effort with the American Academy of Otolaryngic Allergy and the American Rhinologic Society, the Academy revised the Position Statement on balloon sinus ostial dilation [BSOP]).
Two reaffirmed Position Statements
Three updated Clinical Indicators
To locate these and other resources, please visit www.entnet.org/content/practice-management.
These efforts contributed to CMS modifying the MIPS reporting periods for FY 2017, including the introduction of two new reporting periods.
The Academy also reviewed, analyzed, provided a summary to Members and provided comments to CMS on the final 2017 Hospital Outpatient Prospective Payment System and the 2017 final Medicare Physician Fee Schedule (MPFS), including calling on CMS to drastically modify the proposal to force all clinicians to report G-codes to collect data on all 10 and 90 day global surgical procedures. Academy staff have also participated in 25 coalition meetings since March 2016 to advocate additional issues of importance to our Members.
In 2017, several new programs clinicians may participate in include:
GLOBAL SURGICAL DATA COLLECTION
For procedures furnished on or after July 1, 2017, practitioners in practices of 10 or more in Florida, Kentucky, Louisiana, Nevada, New Jersey, North Dakota, Ohio, Oregon, and Rhode Island will be required to report on claims data on post-operative visits furnished during the global period of a specified procedure using CPT code 99024. The specified procedures are those that are furnished by more than 100 practitioners and either are nationally furnished more than 10,000 times annually or have more than $10 million in annual allowed charges. CMS will not implement a 5 percent withhold for clinicians that do not report 99024.
MIPS AND APM REPORTING
In 2017, eligible clinicians will begin reporting performance categories as part of the MIPS program or will participate in an Advanced APM. Starting January 1, 2017, clinicians have the option to pick their pace with three reporting periods for MIPS: Report one Quality, Advancing Care Information (ACI), or Clinical Practice Improvement Activity (CPIA) measure at any point in 2017; Report MIPS measures for any consecutive 90 days in 2017 (must begin reporting by October 2, 2017); or Report MIPS measures for all of 2017 starting January 1, 2017.
CHRONIC CARE MANAGEMENT (CCM)
Clinicians can report a new add-on G-code to describe work performed by the billing practitioner once, in conjunction with the start or initiation of CCM services. This new G-code was supported by the Academy as a method to pay separately for CCM services furnished, making reporting of the code less burdensome, and promoting use of the code for appropriate beneficiaries.
As you prepare for changes coming in 2017, the Academy will continue to advocate on your behalf to ensure the regulatory burden placed on practices is as limited as possible, allowing you to continue to care for your patients.