How Will the Affordable Care Act Impact Otolaryngology?

Beyond the big questions of access, affordability, and capacity, otolaryngologists say some hot-button elements of the Affordable Care Act may have a relatively modest impact on their profession. One example is the fiercely opposed medical device tax levied on manufacturers. The 2.3% excise tax, in place since Jan. 1, 2013, applies to devices sold to hospitals and other healthcare providers. This applies to cochlear implants, intraoperative imaging, endoscopy, and other procedures. It does not apply to over-the-counter devices sold directly to consumers, such as hearing aids. Device manufacturers have warned of big job losses, a claim that remains highly controversial. Otolaryngologists are likely to be affected only indirectly through higher overall costs for some devices.

Other aspects of the ACA with relatively low profiles, however, may impact the profession far more. For example, otolaryngologists say the focus is now sharpening on applicable quality measures, patient-centered access, and public policy training.

“In otolaryngology, the [American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS)] is working really hard to have some applicable measures so that providers can stay in the game,” said Emily Boss, MD, MPH, assistant professor of pediatric otolaryngology at Johns Hopkins University School of Medicine in Baltimore. Those efforts, she said, have begun with the development of clinical practice guidelines and consensus statements based on a solid foundation of evidence.

Beyond the four sleep apnea measures already included in Physician Quality Reporting System (PQRS) requirements, the AAO-HNS worked to get four measures for adult sinusitis approved by CMS.

“The American Board of Otolaryngology’s Maintenance of Certification (MOC) program is based on quality measures developed by its sponsoring societies,” said Robert Miller, MD, MBA, ABOto executive director. “MOC, particularly Part IV (performance in practice), will be a simplified way for otolaryngologists to meet many of the ACA and other reporting requirements without duplication of effort.”

“In the immediate future measure development will be left to the individual subspecialties. We will be tasked with developing relevant measures, getting them endorsed, and implementing their use in programs sponsored by both CMS and private payers,” Dr. Boss said. “The more measures and quality indicators we have that are applicable to otolaryngology, the more relevant all of the ACA language will be to our subspecialty. And if we don’t participate in measure development and measure reporting, then our subspecialty may lag behind in terms of all of the policy and reimbursement changes.”

Given the additional reporting hassles that go along with new quality metrics, she said, otolaryngologists may not want to think about it. However, being proactive will give otolaryngologists more say in the creation of fair and relevant measures.