2019 HSC Section 2 - Practice Management

Reprinted by permission of Laryngoscope. 2018; 128(11):2490-2499.

The Laryngoscope V C 2018 The American Laryngological, Rhinological and Otological Society, Inc.

Contemporary Analysis of Practicing Otolaryngologists

Willard C. Harrill, MD, FACS ; David E. Melon, MD, FACS; Merritt J. Seshul, MD, FACS; Marc S. Katz, PA-C; Adam M. Zanation, MD, FACS

Objectives/Hypothesis: To investigate contemporary issues facing practicing otolaryngologists including workforce dynamics, ancillary service modeling, otolaryngic allergy integration, ambulatory surgery center utilization, and relevant cer- tificate of need legislation. Study Design: A cross-sectional survey analysis of academic and private practicing otolaryngologists in North and South Carolina in 2016. Methods: A cross-sectional survey was e-mailed to 510 practicing otolaryngologists in North and South Carolina. Results: A 21.3% survey response rate was achieved. Otolaryngology workforce was defined by horizontal aggregation of oto- laryngologists into larger group models, with fewer solo practitioners being replaced by younger otolaryngologists or employing otolaryngology extenders. Excluding academic practice, few otolaryngologists have chosen direct hospital employment as a career option, although otolaryngologists with fewer years of practice are pursuing that option with greater frequency. Ancillary services showed audiology and hearing aid services being the most common, followed by otolaryngic allergy, point-of-service computed tomography, and ultrasound. Although otolaryngologists tend to avoid vertical integration, ambulatory surgery center (ASC) owner- ship trends favor a joint venture model with a hospital system partner. Most otolaryngologists favor changes to certificate of need legislation to improve patient access to these lower-cost facilities, regardless of whether they currently utilize or have access to an ASC. Conclusions: Otolaryngology is uniquely positioned to adapt and respond to current paradigm shifts within ambulatory medicine. Further analysis is needed to prepare current and future otolaryngologists for the demands and opportunities these challenges pose as patient-centered care models and consumer dynamics shape future patient expectations and utilization of healthcare. Key Words: Otolaryngology workforce, practice extenders, oto-tech, vertical integration, horizontal integration, ancillary services, point-of-service computed tomography, point-of-service ultrasound, otolaryngic allergy, ambulatory surgery center, certificate of need, sino-allergy home. Level of Evidence: 5. Laryngoscope , 00:000–000, 2018

Act of 2010, centralizing efforts to achieve universal access to healthcare. 1 Previous impacts of healthcare change within otolaryngology have been reported, as have analyses of contemporary trends within practice patterns and workforce needs of the specialty. 2–8 The goal of this survey was to evaluate the current contem- porary practice environment of otolaryngology within North and South Carolina 7 years following the passage of the Affordable Care Act. MATERIALS AND METHODS A cross-sectional survey was developed and emailed to 510 practicing otolaryngologists, both private and academic physi- cians, in North and South Carolina using the web-based Survey Monkey platform. The survey pool consisted of 380 members of the North Carolina Society of Otolaryngology–Head and Neck Surgery and 130 members of the South Carolina Society of Oto- laryngology–Head and Neck Surgery. Response data were col- lected from June 24, 2016 to July 23, 2016. RESULTS A 21.3% survey response rate was achieved. Full results are reported in Table I. Current practice struc- ture and workforce makeup were analyzed. Single- specialty group otolaryngologist (SSGO), was the most

INTRODUCTION Three major legislations have impacted the delivery of medicine over the past 50 years: 1) the Social Security Amendments of 1965, creating Medicare and Medicaid; 2) the Health Maintenance Organization Act of 1973, setting in motion a model for healthcare delivery that became a key driver for private market change in the 1990s; and 3) the Patient Protection and Affordable Care From the Carolina Ear, Nose & Throat/Head and Neck Surgery Center, PA ( W . C . H ., D . E . M ., M . S . K .), Hickory, North Carolina; Department of Otolaryngology Wake Forest Baptist Medical Center ( W . C . H ., M . J . S .), Win- ston-Salem, North Carolina; and the Department of Otolaryngology/ Head and Neck Surgery and Neurosurgery ( A . M . Z .), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A. Editor’s Note: This Manuscript was accepted for publication February 28, 2018. Podium presentation at the 2018 Triological Society Combined Sections Meeting, Scottsdale, Arizona, U.S.A., January 18–20, 2018. W . C . H ., D . E . M ., and M . J . S . have ownership interests in the Viewmont Surgery Center LLC, Hickory, North Carolina, U.S.A. The authors have no other funding, financial relationships, or conflicts of interest to disclose. Send correspondence to Willard C. Harrill, MD, Clinical Associate, Department of Otolaryngology, Wake Forest Baptist Medical Center, Carolina Ear, Nose & Throat/Head and Neck Surgery Center, PA, 304 10th Avenue NE, Hickory, NC 28601. E-mail: wharrill@carolinaearnosethroat.com

DOI: 10.1002/lary.27196

Laryngoscope 00: Month 2018

Harrill et al.: Analysis of Practicing Otolaryngologists

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