2019 HSC Section 2 - Practice Management

expenses, because the CON laws prevent a free market– driven expansion of competition for patients to consider within consolidating markets. States with CON laws cre- ate market conditions favorable to vertical integration strategies by establishing high entry barriers (both legal and monetary) that effectively reduce competition within an HSA. This significantly lowers investment execution risk for such integrations below what would be found in states without CON laws. Further study is needed to delineate the effects of all these processes on patient access, healthcare cost, and network access within the affected markets otolaryngologists practice in. CONCLUSION Although the findings and analysis of this current study are limited by the voluntary respondent size and the geographic restriction of the survey pool that carries the risks of amplified bias within the response data, the several trends noted herein are similar to the findings of larger previously published research. The survey results show that otolaryngology is diversely positioned to adapt and respond to current paradigm shifts within ambula- tory medicine. As healthcare continues to undergo trans- formation, further study of the contemporary issues facing practicing otolaryngologists will be necessary as these new paradigms may define challenges immune to conventional strategies. BIBLIOGRAPHY 1. Centers for Medicare and Medicaid Services. Available at: https://www. cms.gov/About-CMS/Agency-information/History/. Accessed November 29, 2017. 2. Lloyd JS, Mendenhall RC, De Florio GP, Girard RA. A study of the practice of otorhinolaryngology in the United States. Initial findings. Arch Otolaryngol 1979;105:610–620. 3. Smith RV. Workforce issues for the academic otolaryngologist. Laryngoscope 2000;110(10 pt 1):1602–1606. 4. Pillsbury HC III, Cannon CR, Sedory Holzer SE, et al. The workforce in otolaryngology-head and neck surgery: moving into the next millennium. Otolaryngol Head Neck Surg 2000;123:341–356. 5. Kay DJ, Lucente FE. Otolaryngology residents’ objectives in entering the workforce. Laryngoscope 2002;112:1766–1768. 6. Kim JS, Cooper RA, Kennedy DW. Otolaryngology-head and neck surgery physician work force issues: an analysis for future specialty planning. Otolaryngol Head Neck Surg 2012;146:196–202. 7. Hughes CA, McMenamin P, Mehta V, Pillsbury H, Kennedy D. Otolaryn- gology workforce analysis. Laryngoscope 2016;126(suppl 9):S5–S11. 8. Lango MN, Handorf E, Arjmand E. The geographic distribution of the otolar- yngology workforce in the United States. Laryngoscope 2017;127:95–101. 9. American Academy of Otolaryngology-Head and Neck Surgery. Available at: http://www.entnet.org/sites/default/files/AAOHNS_2014_Socioeconomic_ Survey.pdf. Accessed November 21, 2017. 10. Association of Otolaryngology Administrators. Available at: https://www. aoanow.org/store/ViewProduct.aspx?id=9964236. Accessed November 29, 2017. 11. West J, Johnson G, Jha AK. Trends in acquisitions of physician practices and subsequent clinical integration: a mixed methods study. J Eval Clin Pract 2017;23:1444–1450. 12. Kocher R, Sahni NR. N Engl J Med . 2011;364:1790–1793. 13. Neprash HT, Chernew ME, Hicks AL, Gibson T, McWilliams JM. Association of financial integration between physicians and hospitals with commercial health care prices. JAMA Intern Med 2015;175:1932–1939. 14. Price MA, Cohn SM, Love J, Dent DL, Esterl R. Educational debt of physicians- in-training: determining the level of interest in a loan repayment program for service in a medically underserved area. J Surg Educ 2009;66:8–13. 15. Society of Otorhinolaryngology Head and Neck Nurses. Available at: https://sohnnurse.com. Accessed December 30, 2017. 16. Society of Physician Assistants in Otorhinolaryngology/Head & Neck Sur- gery. Available at: http://www.entpa.org. Accessed December 30, 2017. 17. Reger C, Kennedy DW. Changing practice models in otolaryngology-head and neck surgery: the role for collaborative practice. Otolaryngol Head Neck Surg 2009;141:670–673. 18. Norris B, Harris T, Stringer S. Effective use of physician extenders in an outpatient otolaryngology setting. Laryngoscope 2011;121:2317–2321.

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