In 2018, Electronic Medical/Health Records (EHRs) are ubiquitous. It is important for providers to understand the various factors that go into choosing an EHR and are familiar with current regulations and reimbursement incentives.

Medical care in the 21^st century is expensive and prone to waste both through overuse of services and underuse of evidence-based approaches. The fee-for-service model currently in place has been blamed as a major driving factor for medical inflation due to the creation of perverse incentives to provide high-cost, low value care without sufficiently monitoring quality. Alternative payment models have been proposed as a means to both control costs and improve quality. These have included the development of accountable care organizations, bundled episode-based payment models and pat

A business model represents or describes how a business might function.  Business models for the practice of medicine continue to evolve, as physicians must constantly negotiate the concerns of obtaining new patients (customer acquisition); patient satisfaction (customer retention); various practice/revenue models (solo, group, employed, various partnerships, ancillary services, joint ventures); and ensure that revenue is sufficient to cover expenses and ensure continued practice growth. 

On April 16, 2015, the Medicare Access and CHIP Reauthorization Act (MACRA) became law. It replaced the SGR and created what CMS terms the Quality Payment Program. This is a transition from fee-for-service to quality-based payment by implementing two payment pathways for clinicians using the new Merit-based Incentive Payment System (MIPS) or an eligible Alternative Payment Models (APMs). This module outlines an overview of MACRA, its respective component parts, and describes how to incorporate this into an Otolaryngology practice.

In order to allow for a sustainable, profitable business model and provide greater access for patients, many Otolaryngology practices incorporate mid-level providers into their practices.  In addition, these individuals may have the potential to allow for capital improvements to allow for a greater breadth of care for the service area, more and higher quality clinical and clerical staff, purchase and implementation of new technology, funding for research and development, and augmentation of the care that an Otolaryngologist provides.

In order to allow for a sustainable, profitable business model and provide greater access for patients, many Otolaryngology practices incorporate a variety of ancillary services into their practices. In addition, these services may have the potential to allow for capital improvements to allow for a greater breadth of care for the service area, more and higher quality clinical and clerical staff, purchase and implementation of new technology, funding for research and development, and augmentation of the care that an Otolaryngologist provides.

Otolaryngologists may operate in the following settings:

1. Hospital inpatient department
2. Hospital outpatient department
3. Surgical Hospital
4. Ambulatory Surgery Center (ASC)
5. In-office (Physician professional reimbursement at “Non-Facility” RVU value)

The following ownership structures may all be applied in various manners to the above listed operative settings: