Payment Reform

The Affordable Care Act included several new Medicare payment reforms designed to improve coordination and collaboration among physicians and other healthcare providers, moving towards integrating quality into payment systems.

These reforms - including the ongoing efforts on the Hill to repeal the SGR and create new systems, the development of Accountable Care Organizations (ACOs), and episode groupers or bundled payments- may provide incentives for otolaryngology- head and neck surgeons to use innovative products that improve quality and create efficiencies in the delivery of care.

Additional Information

AAO-HNS Efforts

In 2013 under the leadership of James L. Netterville, the Ad Hoc Payment Model Workgroup was formed to provide an avenue for the Academy to evaluate current, and future, trends in healthcare payment reform and to develop methods for Otolaryngologist-Head and Neck Surgeons to actively participate in these new models. The workgroup will supplement the work the Physician Payment Policy (3P) workgroup, and the Academy as a whole, is already doing to position ourselves for a future payment system based on quality and efficiency. This includes our work with national quality organizations, such as the American Medical Association's Physician Consortium for Performance Improvement and our participation in the ABIM Foundation's Choosing Wisely campaign which both focus on the enhancement of quality care.

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New Payment Model Resources

In addition to the numerous changes in coding and reporting requirements that are facing physicians today, the fee-for-service model is being rapidly replaced with a variety of value and quality based compensation models. As a part of our strategic plan, the Academy is committed to helping our members sort through the compensation model confusion and implement the optimal payment model for their practice.

The Academy offers resources on emerging payment methods, including ....

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HHS Announces New Funding Opportunities for Providers and Specialty Societies (10/24/14)
In response to the Academy’s repeated advocacy efforts urging the availability of federal resources to ease the transition to alternative payment models and assist specialty societies to develop applicable measures, CMS will award $840 million cooperative agreement funding for two network systems under a new initiative. For important November dates for webinars and LOIs, visit the CMMI webpage here.

Episode / Bundled Payment Analytics White Paper
The Healthcare and Incentives Improvement Institute (HCI3) recently released a White Paper on “Episode Analytics: Essential Tools for New Healthcare Models.”  The paper provides some background and a comparison of the types of episode analytics and explores the real-world experiences of payers and providers in using episode analytics for payment bundling and other purposes. Finally,

The paper includes some recommendations on how to use episode analytics to reduce variations and manage contracts that involve financial risk. To view the White Paper, visit:

Outpatient Bundle Payment Framework for Colonoscopy
As members know, the goal of the Ad Hoc Payment Model work group is to review current and future payment trends in otolaryngology-head and neck surgery and other specialties. This month, the American Gastroentorological Association released a colonoscopy bundle payment framework for their members to use when negotiating with their local entities. For more information on the AGA’s initiative, click here. 

Academy Explores Alternative Payment Models in Vancouver (10/23/13)
The Academy encourages members to utilize our resources on innovative payment strategies, beyond the current fee-for-service (FFS) system, aimed at creating a more sustainable and stable future in the practice of otolaryngology. During the Annual Meeting, Dr. Robert Lorenz, MD, MBA, elaborated on the six steps for creating bundled payment. Click here to learn the six vital steps to creating bundles.

The Academy Explores Bundled Payment as Option for Future Payment for Otolaryngology 
The Academy is exploring options for future payment models, including otolaryngology procedures that could be considered as episode groupers that would be included in bundled payments. For more information on bundled payments click here.