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Scale, Reimbursement Dominate Vision of Future


Kathleen Yaremchuk, MD, MSA: “Many of today’s hospitals and health systems are leveraging scale to position themselves for population health management and value-based based payment arrangements.”

In many ways, healthcare seems to be on an unstable tectonic plate, with temblors causing shifts—small and large—in the way physicians and medical institutions function. Tuesday, panelists at the “Board of Governors’ Hot Topic 2015: Practicing Otolaryngology in 2025” examined those shifts, and even offered some predictions.

“We wanted to ask, ‘Where are we going in healthcare and how can we prepare for changes in the next 10 years,’” said Sanjay R. Parikh, MD, session moderator and Board of Governors Secretary.

Panelists were AAO-HNS leaders who addressed topics such as mergers and acquisitions, the future of reimbursement, and subspecialization trends in otolaryngology, with one speaker offering a look at the future of medical training and practice.

Kathleen Yaremchuk, MD, MSA, Chair of Otolaryngology/Head & Neck Surgery at Henry Ford Hospital, Detroit, MI, looked at the trend toward more mergers and acquisitions, resulting in larger institutions

“Many of today’s hospitals and health systems are leveraging scale to position themselves for population health management and value-based payment arrangements,” Dr. Yaremchuk said.

The Centers for Medicare and Medicaid Services (CMS) is speeding up its timeline for transitioning Medicare from fee-for-service to value-based reimbursement. She said that 30 percent of payments will be tied to alternative accountable care organization or bundled payment models by the end of 2016. By 2018, 90 percent of Medicare payments will be through programs such as Hospital Value Based Purchasing and Hospital Readmissions Reduction.

James C. Denneny III, MD, the Academy’s Executive Vice President and CEO, discussed the future of reimbursement, which will be tied to quality driving all iterations of payment reform.

Reimbursement changes have had a great impact in 2015, with 18 percent of insurance plans having deductibles of more than $2,000 for patients. In addition, ICD-10 takes effect October 1, Medicaid is expanding, and Meaningful Use penalties commence.

AAO-HNS Members have many concerns, such as the need for quality measures and reporting, the ability to participate in new reimbursement systems, valuation of services, and what is being measured in data collection, Dr. Denneny said.

The Academy has responded by providing tools for Members for quality reporting, maintenance of certification, and continuing medical education, and control of data and quality metrics. A big tool is the development of the RegentSM ENT clinical data registry that will launch in 2016 to start collecting data for quality measurements, he said.

Robert H. Miller, MD, MBA, Executive Director of the American Board of Otolaryngology, looked at otolaryngology subspecialization trends, using data from maintenance of certification (MOC) exams and fellowship plans.

From MOC exam data, the most popular area is general otolaryngology, followed by Facial Plastic, Neurotology, Head and Neck, Allergy/Rhinology, Pediatric Otolaryngology, Laryngology, and Otology.

The “ideal practice focus areas,” based on responses from 2014 oral examinees, were General Otolaryngology, followed by Facial Plastic, Head & Neck, Pediatric Otolaryngology, Rhinology, Laryngology, Neurotology, Otology, Sleep Medicine, and Allergy.

Looking into the future of medicine was David R. Edelstein, MD, Chair-Elect of the Board of Governors. Among the challenges physicians have to look forward to, he said, are online doctor ratings, higher productivity goals, and dramatic increases in costs.

Practice will be increasingly patient-driven, with more medical information being shared with patients, he said. Hospitals will focus on only the care of the very sick, with most care transitioned to local clinics, Dr. Edelstein said. Doctors will become “midlevel managers” directing nurse practitioners and physician assistants. That will affect residency training, with more emphasis on middle management skills, guideline reviews, and understanding the use of data.