After an unpredictable 2020, physicians and administrators are thinking about business practices in 2021. Two ENTs shared their thoughts on the factors that will affect their business the most with Becker's ASC Review.
Note: Responses have been lightly edited for style and clarity.
Nicole Aaronson, MD, pediatric otolaryngologist at Alfred I. duPont Hospital (Wilmington, Del.): There will be multiple factors affecting the business side of ENT practices in 2021.
1. The effects of COVID-19 are still being felt throughout the U.S. In the setting of children's hospitals, which is where I work, otolaryngology volumes are down significantly. Children are staying healthier out of school; families are practicing social distancing and masking; some parents are avoiding the healthcare setting due to safety concerns. Further, if more Americans lose their jobs, and as a result their health insurance, this may make them even less likely to seek care. Otolaryngology practices, pediatric otolaryngology practices in particular, will need to consider how to handle this decrease in volume whether by cutting costs, improving efficiency, changing deployment strategies or finding new revenue sources.
2. America is undergoing a change in leadership from divided government to Democratic control of both Congress and the presidency, which will allow the Democratic Party more ability to enact its desired legislative agenda. This will likely have an effect on the U.S. insurance and healthcare systems, although it is unclear exactly what that effect will be, given the different viewpoints espoused by various leaders in the Democratic Party. Otolaryngology practices will have to pivot based on any new legislation that goes into effect to keep their practices profitable while also providing a high quality of care.
3. The 2021 Evaluation & Management coding changes for codes 99202-99215 will also affect otolaryngology practices going forward. While prior coding focused significantly on history and physical elements, the new coding scheme focuses primarily on complexity of medical decision-making and time (including face-to-face and non-face-to-face time activities). Practices will need to train staff to be able to code appropriately. However, they will also need to revise documentation to maintain compliance with this coding system. A majority of otolaryngologists use templates for their clinic notes, but these templates were designed to include the key history and physical elements essential to the old coding system and may not focus on the medical decision-making elements that are now more essential. A code can only be used if the documentation supports it. If care was provided that was not documented, it cannot be billed. Practices will have to decide whether it is worth the cost of updating their documentation systems to maximize returns under the new coding changes.
Kenneth Altman, MD, PhD, chair of otolaryngology at Geisinger Health System (Danville, Pa.): The business side of ENT is affected in similar ways by trends in the practice of medicine as a whole, but we have some unique twists:
- The drive toward employed or large group models will likely continue due to market consolidation and requirements for EHR meaningful use reporting. However, our Academy’s outcomes tool, RegENT, is increasingly adopted which helps support otolaryngologists in a broader diversity of practice settings.
- Changes in Medicare, Medicaid and insurance plan rules are expected to continue in response to our economy, growing need for access and increasing recognition of the value of public health. As a specialty with medical and procedure-based services, we've been able to navigate recent changes in CPT [relative value units] and E&M-based reimbursements.
- I personally believe the biggest change on the horizon has to do with technological advances and policy changes in audiology and hearing aids. These disruptive innovations are bringing portable self-reported audiometry, as well as hearing aids to the populace. Unfortunately, this approach affords less supervision by the traditional otolaryngology/audiology team that helps identify more complex diseases and offer other options.