A Look at Business Trends and How Otolaryngologists Can Maximize Opportunities

Trend: Value-Based Care

Dr. Couch: “The fee-for-service payment model is under tremendous pressure. Otolaryngology practices will never be reimbursed at a rate that keeps up with their expenses. Moreover, the payers’ desire to increase reimbursement is zero, so there’s no path forward in the traditional fee-for-service world. That’s why it’s important to introduce the concept of value-based care. Value is the relationship between quality and access divided by cost.

“With few exceptions, I’ve always had colleagues in otolaryngology who were high-value clinicians (good outcomes with low cost), who were evidence-based, who always wanted the best possible outcome for their patients. And they were pretty cost effective. I think otolaryngology is well positioned as we consider value-based care payment models, because there will be a preference for referrals and working with high-value clinicians. In the current fee-for-service payment world, most otolaryngologists are revenue generators. And, I think that, as more health systems and insurers and the CMS payment models go to value-based care, these surgeons might be considered an expense. So, the challenge is to embrace value-based care so that you don’t fear going from a revenue generator to an expense. You become part of the plan to create value.

“Now we’re thinking about how physicians can be part of accountable care organizations that are taking on the health of a population and are paid for quality outcomes. Then the high value otolaryngologist becomes part of the referral system for that population of patients. If the group of clinicians has met their quality performance metrics, they get a bonus, and if they reduce total cost of care they share in that savings.”

Trend: Fostering Future Leaders

Dr. Simon: “Otolaryngology continues to attract some of the best and brightest minds in medicine. Physicians as a group are very determined and resilient people who want to make the world better, and they remain so despite remarkable adversity in recent times. Over the past two to three years, we haven’t seen any declining interest in medical school—if anything, younger generations of doctors coming out of residency and medical school are doubling down on efforts to address healthcare disparities, on finding ways to increase access, and on providing high-quality care for lower costs. So, despite all the doomsday predictions in the media, doctors remain incredibly dedicated. And that makes me optimistic.”

Linda Kossoff is a freelance medical writer based in Woodland Hills, Calif.