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.

Gordon Sun, MD, MS, an otolaryngologist and medical director at Partnership for Health Analytic Research in Beverly Hills, Calif., agreed that the expansion of quality measures will be essential to keep specialists engaged. “If you set a whole bunch of criteria for outpatient practices to follow to improve quality, but none of them are relevant to your practice, how are you going to be able to meet these guidelines?” he asked. “You cannot.”

“The more quality indicators we have that are applicable to otolaryngology, the more relevant all of the ACA language will be to our subspecialty.”

—Emily Boss, MD, MPH

Along with quality of care, experts say the ACA is also increasing the focus on keeping patients engaged and informed. “There will likely be a shift in emphasis to what’s called patient-centered access,” Dr. Boss said. Because it’s been used more in primary care settings, she said, it’s not yet clear how a concept that includes providing patients with more complete access to their medical records or to immediate advice—via e-mail, for example—will affect subspecialists like otolaryngologists. “It may mean more information for the patient but a little bit more burden on providers to try to explain what sometimes might be inconsequential results or findings,” Dr. Boss said.

Another lesson from the ACA, Dr. Sun said, is that otolaryngology trainees and residents would benefit from greater education and exposure to policy-related issues. “We need to be more involved in either establishing policy or having our voice be heard by people who do establish policy, so that when you’re done with training you have at least helped guide the ship, and you know as best as you can where things are headed,” Dr. Sun said.

Educating otolaryngologists on public policy may not only give them a better idea of what to expect, but also help them effect change. “You have to be able to plan. And if we’re passive as a specialty, then we’re not going to be able to plan effectively, and decisions may be passed down that we may not be particularly happy about,” Dr. Sun said. “But since we weren’t involved in the first place, there’s going to be relatively little we can do other than to respond and react, rather than to be proactive.”

Bryn Nelson is a freelance medical writer based in Seattle.