BackTable ENT & Allergy

In this episode, Dr. Gavin Setzen of Albany ENT & Allergy Services addresses the current landscape of insurance reimbursement with host Dr. Ashley Agan.

The episode opens by reviewing the current state of healthcare financing, where climbing costs, declining reimbursement, and continued consolidation of medical groups confront physician-owned private practices. Mindful of this context, Dr. Setzen describes his experiences tackling reimbursement challenges. Recounting his successes, Dr. Setzen encourages physicians to base their claims in evidence-based medicine, enlist allies (such as patient unions), and develop relationships with insurers. He then provides strategies to efficiently manage Prior Authorizations, including Peer-to-Peer conversations. Finally, Dr. Setzen shares how coordinating one’s reimbursement strategy with colleagues and advocacy groups helps increase odds of success.

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Stryker ENT

https://ent.stryker.com

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SHOW NOTES

00:00 - Introduction

01:55 - Dr. Gavin Setzen’s Journey and Practice Insights

05:30 - The Challenges of Healthcare Landscape and Insurance

10:06 - Innovations in ENT: Navigating New Technologies & Reimbursement Challenges

20:23 - Strategies for Overcoming Insurance Denials

52:30 - The Importance of Data and Collaboration in Patient Advocacy

55:19 - Closing Thoughts

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RESOURCES

Dr. Setzen’s Albany ENT & Allergy Services Profile:

https://albanyentandallergy.com/bio/gavin-setzen/

In this episode, pediatric otolaryngologist Dr. Julie Wei (Akron Children’s Hospital) and psychologist Dr. Herdley Paolini discuss surgeon burnout with guest host, pediatric otolaryngologist Dr. Anthony Sheyn (Le Bonheur Children’s Hospital).

First, Dr. Paolini reviews causes of surgeon burnout, drawing on three decades of experience working in physician wellness. Then, Dr. Sheyn and Dr. Wei discuss steps they’ve taken to combat burnout. Dr. Wei illuminates challenges unique to female surgeons, including higher levels of emotional exhaustion, fertility struggles, and ‘mom guilt.’ Then, the discussion shifts to address the roles that healthcare administration and medical education play in surgeon burnout. The podcast concludes with Dr. Wei’s experience advocating for needed changes in her hospital’s call policies.

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SHOW NOTES

00:00 - Introduction

03:18 - Operating Through Challenges: Dr. Wei’s Experience with Burnout

06:02 - Exploring Causes of Surgeon Burnout with Dr. Paolini

16:03 - Squashing the Stigma: Embracing Vulnerability in Surgery

25:37 - The Power of Advocacy and Building a Case for Wellness Programs

31:06 - Early Interventions and Transforming Medical Education

34:10 - Balancing Professional & Personal Life As A Surgeon

42:47 - Initiating System Changes for Physician Well-being

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RESOURCES

Dr. Anthony Sheyn’s Le Bonheur Children’s Hospital Profile:

https://www.lebonheur.org/doctors/anthony-sheyn

Dr. Julie Wei’s Akron Children’s Hospital Profile:

https://akronchildrens.org/people/Julie-Wei.html

About Dr. Herdley Paolini:

https://www.physicianintegration.org/about

“Safeguarding Physician Wellbeing” by Dr. Julie Wei:

https://www.routledge.com/Safeguarding-Physician-Wellbeing-Using-Checklists-for-Personal-Professional-and-Psychological-Safety/Wei/p/book/9781032589893

“Inside the Mind of a Physician: Illuminating the Mystery of How Doctors Think, What they Feel, and Why they Do the Things They Do” by Dr. Herdley Paolini:

https://www.amazon.com/Inside-Mind-Physician-Illuminating-Publishing/dp/0982040903

In this episode, Pediatric Speech Language Pathologist (SLP) Olivia Brooks (University of Florida Shands Hospital) shares her experience performing inpatient fiberoptic endoscopic evaluation of swallowing (FEES) with host Dr. Gopi Shah.

First, Olivia reviews the presentation of swallowing disorders in infants. She explains differences between the two most common swallowing tests: videofluoroscopic swallow study (VFSS) and (FEES). Then, she reviews how she uses patient comorbidities and the physical exam to select the appropriate test for each infant. Underscoring the importance of collaboration across care teams, she describes her role performing swallow studies in the NICU and pediatric CVICU. She then shares tips on equipment, ergonomics, and teamwork while performing bedside FEES. The podcast wraps with her advice about working on an interprofessional team to care for children with swallowing disorders.

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Karl Storz Tele Pack

https://www.karlstorz.com/

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SHOW NOTES

00:00 - Introduction

06:26 - The Importance of a Comprehensive Evaluation

13:00 - Choosing Between VFSS & FEES

22:44 - The Evolution of Inpatient Bedside FEES

31:27 - The Role of Speech Pathologists in Swallow Assessment

33:23 - Collaboration between Speech Pathologists & Otolaryngologists

35:31 - Developing Safety Protocols for Bedside FEES

41:21 - Equipment for Bedside FEES

53:20 - Differences between the NICU and the CVICU

01:00:03 - Final Thoughts and Advice Regarding Swallow Studies

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RESOURCES

KARL STORZ ENT Products:

https://www.karlstorznetwork1.com/ent

Olivia Brooks CCC-SLP’s UF Profile

https://ufhealth.org/doctors/olivia-a-brooks/bio

In this episode, Dr. Ashleigh Halderman, Rhinologist and Associate Professor at the University of Texas Southwestern Medical Center, discusses chronic invasive fungal sinusitis with hosts Dr. Gopi Shah and Dr. Ashley Agan,

First, Dr. Halderman outlines her advocacy work as President of the Texas Association of Otolaryngology. Then, the discussion transitions to chronic invasive fungal sinusitis. Dr. Halderman defines the disease, describes typical patient presentation, and reviews concerning imaging findings. Until biopsy can clinch the diagnosis, she maintains a high index of suspicion in cases of bizarre clinical presentation or facial paresthesia. The surgeons then shift their attention to management, which consists of culture-directed antifungals and judicious surgical intervention. Dr. Halderman wraps up the episode by sharing her pearls for operative management and long-term surveillance.

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SHOW NOTES

00:00 - Introduction

02:10 - Exploring the Texas Association of Otolaryngology

05:58 - Understanding Chronic Invasive Fungal Sinusitis: Types & Treatments

20:25 - Diagnostic Challenges and Imaging Insights

27:07 - Navigating Diagnostic Challenges and Treatment Options

29:40 - The Role of Biopsy in Confirming Fungal Infections

30:52 - Surgical Considerations and Pre-Operative Strategies

40:29 - Surveillance Strategies: Managing Chronic Invasive Fungal Sinusitis

46:34 - The Future of Surgical & Antifungal Therapies for Chronic Invasive Fungal Sinusitis

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RESOURCES

Dr. Ashleigh Halderman’s UT Southwestern Profile:

https://utswmed.org/doctors/ashleigh-halderman/

BackTable ENT Episode 30, “Revision Endoscopic Sinus Surgery"

https://www.backtable.com/shows/ent/podcasts/30/revision-endoscopic-sinus-surgery

Texas Association of Otolarynogology:

https://www.taohns.org/

In this episode, Dr. Sohit Kanotra, director of UCLA’s Complex Pediatric Airway Program, discusses open airway surgery in children with host Dr. Gopi Shah.

First, the surgeons review the presentation of pediatric airway stenosis, which causes stridor in younger children and exercise intolerance in older ones. Drawing on his experience at UCLA, Dr. Kanotra addresses how to build a pediatric airway program, emphasizing the importance of relationships with the NICU and PICU. He advises airway surgeons to coordinate with these units to share protocols, organize conferences, and assist with bedside swallow assessments. Then, the discussion transitions to pre-operative evaluation of and contemporary strategies in pediatric airway reconstruction. Dr. Kanotra shares pearls for surgical planning, operative technique, and post-operative management. The episode concludes with Dr. Kanotra’s high-level advice to fellow pediatric airway surgeons.

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SHOW NOTES

00:00 - Introduction

03:03 - Building UCLA’s Complex Airway Program

09:37 - Decision-Making in Pediatric Open Airway Surgery

20:10 - Pediatric Airway Surgery: A Multidisciplinary Effort

32:24 - Preoperative Assessment for Open Airway Surgery

38:16 - Evaluating the Airway: Techniques & Tools

39:34 - Planning for Open Airway Surgery

40:15 - Understanding Expansion & Resection Procedures

56:58 - Using Release Maneuvers in Pediatric Open Airway Surgery

01:00:29 - Post-operative Management and Follow-up

01:06:33 - Concluding Thoughts & Pearls

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RESOURCES

Dr. Sohit Kanotra’s UCLA Profile

https://www.uclahealth.org/providers/sohit-kanotra

In this episode, hosts Dr. Gopi Shah and Dr. Ashley Agan talk to Dr. Stephen Schoeff, laryngologist at Kaiser Permanente (Tacoma, WA) about subglottic stenosis in adults.

Dr. Schoeff introduces subglottic stenosis (SS) as a rare condition affecting adult women of all ages. Patients complain of progressive dyspnea, declining exercise tolerance, and mucus sensation. Sometimes confused for asthma, globus sensation, LPR, or paradoxical vocal fold motion, SS is diagnosed when airway scarring and narrowing is visible on laryngoscopy. After describing workup, Dr. Schoeff reviews etiologies of SS, including iatrogenic, idiopathic, and autoimmune. Treatment options for SS include cricotracheal resection, endoscopic dilation, and airway steroid injections. Dr. Schoeff concludes the episode by sharing his success using periodic airway steroid injections for treatment of SS.

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SHOW NOTES

00:00 - Introduction

01:21 - Dr. Schoeff’s Journey & Practice

08:28 - Symptoms & Differential Diagnosis

12:31 - Physical Examination & Diagnosis

27:23 - Introduction to Endoscopic Dilation

28:57 - Steroid Injections as a Management Option

31:24 - The Three Big Categories of Treatment

33:05 - How Steroids Address Disease Pathophysiology

38:58 - Technique for Airway Dilation

49:06 - Deciding on Cricotracheal Resection

51:14 - How Insurance Affects Treatment Options

55:05 - Final Thoughts & Pearls

In this episode, hosts Dr. Ashley Agan and Dr. Gopi Shah discuss the transition from residency to private practice with Dr. Christopher Gentile of Northeast Atlanta ENT.

First, Dr. Gentile briefly describes his career journey from medical school to private practice. Shedding light on the residency to private practice transition, he addresses the challenges of adapting to a new clinical environment and negotiating an employment contract. Then, he dives into the day-to-day realities of private practice. He advises young otolaryngologists to build strong connections with their clinic team, which includes practice managers, medical assistants, and fellow surgeons. By advocating for themselves, young otolaryngologists can balance their load of surgical cases and pursue areas of clinical interest. Finally, he shares tips on choosing a first job out of residency.

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EARN CME

Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/2jhXN8

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SHOW NOTES

00:00 - Introduction

01:36 - Dr. Gentile’s Journey and Current Practice

08:03 - Determining How Your Contract is Structured

12:02 - Tips for Negotiating Contracts

15:16 - Understanding Patient Scheduling & Practice Structure

20:35 - The Struggles of Balancing Work & Personal Life

24:18 - The Importance of Building a Team Around You

26:37 - Establishing Yourself in a New Practice

31:39 - The Job Hunting Experience: Lessons Learned

38:24 - Final Thoughts & Advice for New Graduates

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RESOURCES

Dr. Gentile’s Northeast Atlanta ENT Profile:

https://northeastatlantaent.com/christopher-gentile-m-d/

In this episode, host Dr. Ashley Agan discusses eustachian tube (ET) dilation with Dr. Dennis Poe, neurotologist and Professor of Otolaryngology at Harvard Medical School.

First, the surgeons describe clinically meaningful differences between adult and pediatric ETs. Then, Dr. Poe reviews workup of pediatric ET disorders. Since inflammation accounts for most ET dysfunction, controlling comorbid allergies and/or performing adenoidectomy provides relief to some patients. For patients with continued symptoms, balloon dilation – now approved for children as young as eight years of age– directly counteracts obstructive inflammation in the tube lumen. To conclude, Dr. Poe describes how to select patients for, perform, and avoid complications of balloon dilation.

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Acclarent AERA Eustachian Tube Balloon Dilation System

https://www.jnjmedtech.com/en-US/product/Acclarent-aera-eustachian-tube-balloon-dilation-system

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SHOW NOTES

00:00 - Introduction

04:03 - Understanding Eustachian Tube Anatomy

07:22 - Causes of Eustachian Tube Dysfunction in Children

12:53 - Examination and Diagnosis of Eustachian Tube Dysfunction

19:10 - Treatment Options for Eustachian Tube Dysfunction

27:05 - Avoiding Unpredictable Injury and Scarring During Balloon Dilation

31:51 - Contraindications and Precautions for Balloon Dilation

37:49 - Understanding Risks & Complications of Balloon Dilation

48:34 - Closing Remarks & Future Prospects

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RESOURCES

Dr. Dennis Poe’s Harvard Profile:

https://oto.hms.harvard.edu/people/dennis-poe

BackTable ENT Ep. 40 – “Diagnosis & Management of Eustachian Tube Disorders with Dr. Dennis Poe:”

https://www.backtable.com/shows/ent/podcasts/40/diagnosis-management-of-eustachian-tube-disorders

American Academy of Otolaryngology-Head and Neck Surgery Clinical Practice Guideline: Otitis Media with Effusion (Update):

https://www.entnet.org/quality-practice/quality-products/clinical-practice-guidelines/ome/

“Complications of Eustachian Tube Balloon Dilation: Manufacturer and User Facility Device Experience (MAUDE) Database Analysis and Literature Review,” Chisolm, P.F. et al: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10731503/

In this episode, Dr. Nora Perkins (Albany ENT & Allergy Services), discusses in-office procedural management of nasal airway obstruction with hosts Dr. Ashley Agan and Dr. Gopi Shah.

First, the surgeons discuss the advantages of in-office procedures. Then, Dr. Perkins describes different presentations of nasal airway obstruction and their medical management. Diving deeper, Dr. Perkins shares her procedural workflow, including anesthetic protocols, her VivAer Aerin device technique, and billing considerations. Finally, the episode concludes with Dr. Perkins’ advice to otolaryngologists interested in performing more in-office procedures.

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CHECK OUT OUR SPONSOR

Aerin Medical

https://aerinmedical.com/

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SHOW NOTES

00:00 - Introduction

02:07 - Discussion of Nasal Airway Obstruction

08:21 - The Patient with Nasal Airway Obstruction

15:29 - Medical Management of Nasal Airway Obstruction

26:17 - The Aerin VivAer RF Ablation Device

32:12 - Anatomical Considerations and Treatment Options

35:10 - Anesthetic Protocol & Patient Comfort

47:56 - Long-term Outcomes and Quality of Life

49:42 - Billing and Insurance Considerations

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RESOURCES

Dr. Nora Perkins’ Albany ENT & Allergy Services Profile:

https://albanyentandallergy.com/bio/nora-w-perkins/

Aerin VivAer Website:

https://vivaer.com/