Will Reference Pricing Impact Otolaryngology?

He thinks that the yield in otolaryngology is so low, percentage-wise, and the cost to institute this pricing model by the payers so great, that otolaryngology won’t see much of it. “My suspicion is that the people who are most interested in doing it are the private insurers, and the overall bill for otolaryngology services is still low enough where I don’t think we’re looking at it in the next three to five years,” he said. “There may be trial models by certain larger hospital systems, but it’s an issue that, from a federal dollar point of view, is not a big spend.”

Still, Dr. Denneny noted that, in an era of value-based care, alternative payment models, and an overall move away from fee-for-service spending, otolaryngologists need to determine the best care to provide their patients and then determine the appropriate costs for that care.

Dr. Brown added, “Otolaryngologists can determine procedures that are likely targets for reference pricing by simply ranking ENT procedures that meet the reference-pricing criteria by national aggregate reimbursement.”

Dr. Sun said that good candidates for this pricing model would be high-volume, elective procedures for which there might be a wide variation in cost but not necessarily a big difference in quality. For example, tonsillectomies and tympanostomy tubes might be good candidates, he added. These are single procedures for which follow-up may not necessarily be as complex.

Dr. Denneny said that the AAO–HNS has already taken the first steps toward determining the best care by measuring the care currently provided. In October, the AAO-HNS Foundation launched Regent, a clinical data registry the organization believes will serve as a foundation for quality reporting, measures development, quality improvement, and clinical and product research in the field of otolaryngology (see “Practical Knowledge” in the November 2016 issue of ENTtoday).

“Pricing isn’t going to make patients better,” said Dr. Denneny. “It’s the access to the data on what works that will make [them] better. Pricing is just part of the system that has to be. You can’t spend unlimited money that you don’t have, [but] the actual desire to make things better for patients and the data to do it are what’s going to change the quality.”

Richard Quinn is a freelance medical writer based in New Jersey.