SM14: Otolaryngologists Tackle Challenges Facing the Specialty

In the session “Wake Up! Facing the New Challenges in Otolaryngology Practice,” panelists proposed ways to address several hot-button issues.

ACOs

Richard Waguespack, MD, president of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) and clinical professor of otolaryngology-head and neck surgery at the University of Alabama, offered tips for dealing with the emergence of accountable care organizations (ACOs).

In ACOs, primary care doctors, specialists, hospitals, and other providers are integrated into a care and financial entity to boost quality, outcomes, and value in delivering healthcare. They’re meant to be an answer to a system that is now often fragmented, uncoordinated, full of duplication, and expensive.

Dr. Waguespack said that, for independent providers, it’s important to stay aware of what’s happening in your community. Sometimes, if the entity in which you work is creating an ACO, you will have little choice but to participate. But even if that’s not the case, your hand might be forced, he said.

“If I’m not in that ACO, my lines of referral are going to dry up either directly or because [I] have the reputation in the community of not being value-based,” he said. “I would say that one thing to consider is assessing how your practice appears to be as far as value-based models that are coming forward. If you’re considered in the community to be someone who just is fee-for-service-driven, this may not be a very friendly environment long term.”

Mid-Level Providers

Wendy Stern, MD, an otolaryngologist with Northeast Ear Nose and Throat in North Dartmouth, Mass., said mid-level providers are helpful in leveraging your time as an otolaryngologist, but she issued caveats.

How the mid-level provider is hired—whether by the physician directly or by the hospital or clinic—impacts how you bill and how you’re reimbursed. “It’s something you need to think about,” she said. Most mid-level providers are salaried, and the average salary is about $95,000 a year. The providers typically start bringing return on investment after about nine months, she said.

There are big differences in the training and philosophy of physician assistants (PAs) and nurse practitioners (NPs), Dr. Stern said. PAs have college degrees with two years of undergraduate science, and their education is done through the medical school model. Many will rotate with medical students or residents and view themselves as part of the physician team.

NPs are educated in the nursing school model and have advanced degrees, usually a master’s. They are licensed to practice independently and “see themselves as colleagues,” Dr. Stern said.