Hey Extracts, would you say that ENT "encroachment" into immunotherapy is a big concern for A&I physicians? I was shocked to find out that a lot of the ENT docs at my institution provide SCIT. I was just wondering if this is an institution thing or if it's a growing concern out in the community for allergy folks. Thanks.
It's a monetary thing. They are surgeons. I've heard some carriers pay 300-400 bucks for a tonsillectomy which I feel is insane. Also many carriers are not paying (PA Prior Authorization) for surgeries such as turbinate reduction unless there is a clear cut indication. In the golden days of the 80's there were no such thing. But from what I hear from older allergists is that nearly every patient they saw would have have missing tonsils and adenoids. Doing AIT for ENTs is a great way to make up the cost lost to them.
However things are changing.
It's hard enough time to get paid from the commercial carriers even if you are a board certified Allergist. 80% of the time they pay outright. But half of these want clear cut justification. There are more and more restrictions nowadays. The Joint Council of Allergy is a fantastic resource to find out what these are and how to deal with them.
And with the ACA and pay for performance it will make it even more difficult to get reimbursed. But... if you put an asthmatic who has been on inhaled corticosteroids, or a patient who suffers from VKC or just plain allergic conjunctivitis on AIT, you will have no problem getting reimbursed.
Because of these restrictions and carriers not willing to pay providers who are not board certified allergist. Yes you heard right. BCBS in NJ is starting to refuse credentialing to bill for all codes starting with 95***. Pretty much all the allergy codes unless you are board certified. Everyone got the letters. The older guys who are not BC complained and they got grandfathered in. BC is a must, it sucks for those who are not, but it is what it is. My practice is looking for another allergist and it is a requirement. If you are not BC in 2 years, your out.
They must have it even tougher, being another subspecialty. Insurance companies are now looking for any excuse to not pay and this is a great one. Even though they have an otolaryngic allergy society and CMS recognizes them along with allergists to do AIT (its on their site). Anyways, the ENTs in my area have a simple fix. They hire a BC allergist. And they feed him or her all their patients. Everyone is happy. I guess, except the allergists who feel they are a tool. But some don't and they love it. There is one large group and many smaller ones doing this. But again inevitably, once PQRS starts and fee for service is over, they will have to justify every person who is on shots etc.
On the flip side, should we be doing scopes? I do anywhere from 2-3 a day to 2-3 a week. It's super helpful. From everything from VCD (along with spiro showing flattening of inspiratory curve), GERD exacerbating rhinitis and PND. I saw a new patient who had a polypectomy 2 months ago and now they are back with a vengeance. Changed our mgmt and placed her on high dose nasal corticosteroids. We take pictures (for our records, to give patients & I send them along with the patient if they get referred to GI or ENT) and the patients are able to view the entire procedure. It does wonders for compliance. I wonder if any other AI docs can chime in about their experience. Never had an issue getting reimbursed, although a few times the carriers have asked for chart review prior to payment. But ultimately every one has paid.
Also if you visit the otolaryngic allergy society's site, there are courses to do everything from spirometry & skin testing to oral food challenges. Who cares... do the right thing, make your patients well & you'll be good.
But just like Extracts mentioned, if your worried about your dinero flow dropping, I'd apply to Columbia Business school and skidattle out of medicine.
