tion constructively for coding current procedures and futureinnovations.EDUCATIONAL OBJECTIVES: 1) Review the CPT pro-cess, including CPT structure, code development, and codeevaluation. 2) Present the evolving recommendations for cod-ing sinus ostia dilatation and sleep procedures. 3) Presentstrategy for developing appropriate coding for innovativeprocedures.

Cultural Competency, Health Disparities &

Health LiteracyDuane Taylor, MD (moderator); Lisa Perry-Gilkes,MD; Ronald Kuppersmith, MD, MBA; PhyllisBouvier, MD

PROGRAM DESCRIPTION: This will be a dynamic andinteractive miniseminar that looks at the areas of health liter-acy, cultural competency and health disparities and how theyapply in an ever-changing, more diverse population. It willinclude presentations and real scenarios that allow the partic-ipant to gain awareness and insight on treating patients whomay have a perspective on how they access, utilize and incor-porate health care into their lives that is different from our own.The program will explore challenges and successes in interac-tions when the following differences may exist: cultural, gen-der, language, literacy, religious, sexual orientation, racial,ethnic, socioeconomic, and the presence of a hearing impair-ment. The miniseminar will help to open the door to selfexploration for a variety of patient interactions, enhance advo-cacy for our patients and compliance and minimize liability topractitioners in our specialty.EDUCATIONAL OBJECTIVES: 1) Understand their ownperspectives regarding patients from different cultural, ethnicand religious backgrounds. 2) Be able to access resources tohelp facilitate better understanding and compliance for diversepopulations. 3) Be able to enhance how they might improvecultural competency, health literacy in their offices.

Difficult Nasal Polyposis: Evolving Treatments

and RemediesBradford Woodworth, MD (moderator); DouglasReh, MD; Jan Gosepath, MD; James Palmer, MD

PROGRAM DESCRIPTION: Chronic sinusitis with nasalpolyposis (CRSwNP) is a common disorder associated withdifferent underlying disease processes, including aspirin sen-sitive asthma, atopic conditions such as allergic fungal sinus-itis, and cystic fibrosis. CRSwNP has a significant detrimentalimpact on quality of life and may exacerbate co-existing con-ditions such as asthma. Although surgery and anti-inflamma-tories are mainstays of management, there are no universallyaccepted treatment standards partly due to the underlying dis-ease heterogeneity. Patients may develop complications fromboth CRSwNP and its associated therapies making this afflic-

tion difficult to treat effectively. This miniseminar will outlinethe latest theories on disease pathogenesis as well as promoterational medical and surgical strategies for the management ofsevere nasal polyposis. Surgical treatments, including polypec-tomy alone or in combination with functional endoscopic sinussurgery, rarely result in long term control of polyposis and aretypically combined with medical treatment. While oral steroidsare often successful in controlling severe polyposis, their del-eterious side effects and potential complications have led manyotolaryngologists to seek additional therapeutics designed toboth complement and decrease reliance on excessive systemicsteroid administration. The benefits of other medications in-cluding topical budesonide irrigations, macrolides, anti-leukot-rienes, and other future therapies as well as surgical methodsdesigned to enhance delivery of topical therapeutics will bediscussed. The miniseminar will be led by a panel of interna-tional experts who will present the latest innovations in med-ical and surgical treatments for severe nasal polyposis. Indi-vidual case scenarios of difficult patients and strategies forsuccess will be presented to illustrate these advancements.Douglas Reh is a rhinologist at Johns Hopkins University whowill provide an overview of nasal polyposis and basic treat-ment strategies. James Palmer, Director of the Division ofRhinology at the University of Pennsylvania, will present ad-vanced and alternative treatment strategies. Bradford Wood-worth is a rhinologist at the University of Alabama at Birming-ham and an associate scientist at the Gregory Fleming JamesCystic Fibrosis Research Center. He will present the latestinformation on pathogenesis and treatments for cystic fibrosisnasal polyposis. Jan Gosepath, MD, of the Department ofOtolaryngology Head and Neck Surgery at the University ofMainz School of Medicine in Germany will discuss aspirindesensitization and advanced therapeutic strategies for aspirinsensitive nasal polyposis in Samters triad.EDUCATIONAL OBJECTIVES: 1) Understand current the-ories on the pathogenesis of nasal polyposis. 2) Recognizethe newest medical and surgical treatments for difficult nasalpolyposis, including cystic fibrosis. 3) Initiate additional ther-apeutic measures to appropriately care for patients with severenasal polyposis.

Economic Impact of QI Initiatives on Your

PracticeRahul Shah, MD, FAAP (moderator); ElaineKirshenbaum, MPH; John Lazor, MD, MBA

PROGRAM DESCRIPTION: Patient safety and quality im-provement continues to move to the core of medical practice.This is due to the realization of the value of patient safety andquality improvement and the alignment of various stakehold-ers: the patient, the physician and their practice, the hospital,insurers, regulatory agencies, and the government. Stakehold-ers have realized the immense value that can be derived frompatient safety and quality improvement, hence the emergence

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of financial implications for patient safety and quality improve-ment initiatives. This miniseminar will focus on actual eco-nomic implications of current patient safety and quality im-provement (PSQI) measures and programs. We will discusshow the changing healthcare landscape incorporates PSQIwithin the scope of reimbursement and financial penalties. TheMassachusetts Medical Society (MMS) has been on the fore-front of advocating and even going as far as to litigate onbehalf of protecting physicians and ensuring fair application ofquality metrics towards physicians. The President of the MMS,Dr. Alice Coombs, and Elaine Kishenbaum, VP of Policy,Planning, Member Services of the MMS will present updateson the current legal action between the Society and the GroupInsurance Corporation in Massachusetts which has been per-forming physician tiering. Further, they will both discuss theemerging concept of global payment and payment reform. Therole of the physician in advocating for and protecting ourselveswill be expounded upon. The president of the MassachusettsSociety of Otolaryngology (who is an active clinician) willdiscuss the financial effect that physician tiering has on hisgroup and the impact of this for the patients in their group. Hewill also discuss the potential impact of payment reform ontheir practice. The further effects on other otolaryngologists inMassachusetts will be discussed. The co-chair of the PatientSafety and Quality Improvement Committee will present tan-gible ways in which physicians can embed PSQI into theirpractice and develop their own metrics so that they can dem-onstrate to patients, hospitals, insurers, and regulatory agenciesthat they are practicing continuous quality improvement. Suchdata will inevitably be necessary as physicians will need todemonstrate the high quality of care which we are known toprovide.EDUCATIONAL OBJECTIVES: 1) Describe the currenteconomic forces affecting patient safety and quality improve-ment in your practice. 2) Explain how Massachusetts physi-cians navigate the economic landscape which includes payerreform and physician tiering. 3) Be able to implement metricsinto your practice to be proactive against these economic forces.

Evidence and Innovation in Management of

CRSRakesh Chandra, MD (moderator); Alexander Chiu,MD; Raj Sindwani, MD, FRCS; Joseph Han, MD;Pete Batra, MD

PROGRAM DESCRIPTION: Management of chronic rhino-sinusitis (CRS) has undergone continuous evolution throughadvances in technology. Many of these innovations have pro-moted minimally invasive management of complicated pathol-ogies, including neoplastic disease. Such innovations have alsofacilitated treatment of uncomplicated sinus disease with sub-jective improvements in recovery. The current era in manage-ment of CRS was inspired by the proliferation of endoscopy,and the introduction of both the microdebrider and image

guided surgical navigation. More recent innovations have beenin the areas of electrosurgery, balloon dilatation, CT scanning(in-office, intraoperative), and paranasal sinus biomaterials.Further advances in powered instrumentation and image guid-ance have also continued to expand the boundaries of endo-scopic sinus surgery. There are no currently established guide-lines regarding when each of the available technologicalinnovations should be applied, although there is increasingclinical experience and evidence based data regarding howthese modalities may expand the scope of rhinologic practice.This panel will present available clinical and scientific dataregarding the safety and efficacy of recent technological inno-vations in the management of CRS. The potential roles foreach of these modalities in both the operative and outpatientsettings will be discussed. An evidence based algorithm for theapplication of each innovation will be presented. The panelistsconsist of experienced academic rhinologists and sinus surgeonswho represent six academic tertiary centers. The panelists alsolead in funded research for innovations to optimize the man-agement of both basic and complicated sinonasal pathologies.EDUCATIONAL OBJECTIVES: 1) Develop a rational algo-rithm for applying technological innovations in the outpatientand operative setting. 2) Discuss clinical and scientific evi-dence for the safety, efficacy, and benefits of selected techno-logical innovations. 3) Recognize the variety of technologicaltools available for management of patients with chronic rhino-sinusitis.

Evidence Based Medical Management of

Chronic RhinosinusitisJoseph Han, MD (moderator); Peter Hwang, MD;Todd Kingdom, MD; Richard Orlandi, MD

PROGRAM DESCRIPTION: The purpose of this minisemi-nar is to present and discuss the etiology and pathophysiologyfor chronic rhinosinusitis (CRS). As the scientific communitygains better understanding for the development and manage-ment of CRS, we realize that medical management is vital toimproving the quality of life in these patients and that surgicaltreatment does not always provide a cure for them. However,the medical treatment of CRS continues to remain a challengefor many otolaryngologists. Systemic and topical antibiotics,antifungals, corticosteroids, and immunomodulators are justsome examples of the medications being used. Otolaryngolo-gists are desperate for an effective treatment for their symp-tomatic patients who have CRS. Since there are no currentguidelines, consensuses, or recognized standards of care inmedical management of CRS, many otolaryngologists have tofall back on their resident training, experience, and lectures todecide management choices. The panel will discuss the currentevidence-based practice that is available in medically manag-ing patients with CRS through a multimedia PowerPoint pre-sentation. Often, initial and conventional management will failand even be recalcitrant to surgical management. The panelist

P14 Otolaryngology-Head and Neck Surgery, Vol 143, No 2S2, August 2010