Change Is Good, Right?

Change. Funny how a six-letter word can elicit so many emotions—anxiety, excitement, hope, fear. Change, by definition, means to alter, make different (radically or not), replace, shift, or modify, and for many of us, the assumption is that change means progress, moving forward, or improving. Change for the sake of change should not be the goal—similar to conducting wellness surveys just for the sake of conducting them, as Dr. Lindsay wrote in this month’s Editor’s Note. To delve a little deeper into the topic of change, we checked in with some of ENTtoday’s editorial board members to find out what the biggest changes in their practices are, and why.

Emily Boss, MD, MPH

Director of pediatric otolaryngology and a professor of otolaryngology, pediatrics, and health policy and management at the Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health in Baltimore

I’m not sure if it’s the biggest change, but it’s a substantial improvement: Our health system has implemented an AI scribe. It’s fantastic for summarizing the history and assessment/plan, and it’s quickly evolving in descriptions of physical exam and procedures. It has saved me a great deal of angst with documentation and recall at the end of a clinic. It also mitigates the need to pull out the electronic health record and type while speaking with the patient, and it allows me to transition between patients more effortlessly in the clinic.

Subinoy Das, MD

Chief executive officer and medical director for the U.S. Institute for Advanced Sinus Care & Research, in Columbus, Ohio

There’s a significant increase in time having to preauthorize procedures and drugs for patients and appeal denials in payments from insurance companies. Why? Insurance companies have weaponized our guidelines to become the bare minimum of care they will provide, and they require us to document that all aspects of our guidelines have been met. UnitedHealthcare requires us to copy and paste CT scan images to get sinus surgery approved. Insurance companies now arbitrarily deny payment for evaluation and management services if performed with sinus endoscopies.

Eric Gantwerker, MD, MSc, MS

Pediatric otolaryngologist at Cohen Children’s Hospital at Northwell Health in New Hyde Park, N.Y.

For me, the biggest changes have been dealing with the ever-changing hurdles that insurance companies place on us to provide patient care. The prior authorizations, the denials, the request for extra testing but declining to pay for extra testing, authorizing treatment but then refusing to pay for it, etc. It has become a constant battle to try and provide good quality patient care in this climate.

Jonathan Bock, MD

Academic physician–scientist laryngologist at Otolaryngology Center for Advanced Care, Froedtert Hospital, and professor of otolaryngology at the Medical College of Wisconsin, both in Milwaukee

One of the biggest changes in my practice in the last 10 years has been the increased constant connection that patients now expect from their doctors through MyChart messaging and other virtual and phone contact mechanisms. The sheer number of messages we get daily that need to be addressed requires an entire team of nurses and adds significant time and effort to our daily work, and none of it is really reimbursed. There are some positives to this, as patients have easier access to their doctors and can do follow-up through messaging more easily, but the increased work for the care team is significant and not really considered at all in our pay/reimbursement.

The other real change is the utility of virtual visits and care for patients. Many choose these now for follow-up, wound checks, even initial consultations when they live far away from our academic center. It really facilitates care.

Travis Tate Tollefson, MD, MPH

Director and professor of facial plastic and reconstructive surgery at UC Davis, and co-director of the UC Davis cleft and craniofacial program in Sacramento, Calif.

When considering the biggest changes in my practice, I think of the change in patient care note writing.

I remember well the thick file folders of patient records in the clinic doors with written notes and the speed we could open to our last handwritten message that immediately reminded us of the patient’s story and priorities for care. Maybe similar to the often-described benefits of journal writing with a pen or pencil compared to typing out ideas, I long for the written note and the simplicity of a time when note writing was limited to the critical elements. Prior to our reactive compulsion with efficiency, coding, modifiers, and overall clicking to allow metadata to be tracked, we documented less, yet may have communicated more.

Amber Luong, MD, PhD

Professor of otorhinolaryngology–head and neck surgery and vice chair of academic affairs in the department of otorhinolaryngology–head and neck surgery at McGovern Medical School at UTHealth Houston in Texas

For rhinology, it is the introduction of biologics in the management of chronic rhinosinusitis with nasal polyps. Patients who in the past would get multiple surgeries for their recurrent polyps are now being offered biologics.

Another significant change is the use of AI for assisting in generating the clinical note. This seems to be saving time and money (no need for a scribe).

Robin Lindsay, MD, MBA

Physician and surgeon at Massachusetts Eye and Ear, and associate professor of otolaryngology–head and neck surgery at Harvard Medical School in Boston, and physician editor of ENTtoday

My most recent change will be using Ambient AI for my clinical notes. Since I do not like to type my clinic notes while in the room with the patient, as I prefer to look at the patient while speaking with them, I then have to spend many hours at night or on the weekends typing my clinic notes. I did try to use scribes many years ago, but my patient population did not like having another person in the room typing, and there were logistical issues with having an in-person scribe. I am excited to use Ambient AI to hopefully reduce my time typing and further enhance the patient experience.