In this episode of BackTable ENT, Dr. Shah and Dr. Agan speak with Dr. Mandan Kandula, founder of ADVENT, an ENT private medical practice, about embracing in-office procedures and building an efficient ENT private practice.

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SHOW NOTES

First, Dr. Kandula talks about his journey to becoming a private practice ENT doctor. He became a proponent of office-based treatments when he opened up his solo private practice and has carried this approach into his expansion of ADVENT. Another approach he takes in his medical practice is simplifying all airway problems to identify the defect in the “breathing triangle”, a term he coined for the nose and throat. In order to identify the airway problem in patients, Dr. Kandula emphasizes the importance of defining a healthy airway, which he defines as normal anatomy and lining. Additionally, he notes that ENTs must assess the nose, throat, and sinuses together before choosing a treatment plan for the patient.

Another approach he takes in his medical practice is training nurse practitioners and physician assistants to deal with purely medical ENT matters, such as triage, intake, histories, and physicals. He even trains his NPs and PAs to perform scope examinations and to administer local anesthetic. Dr. Kandula prefers to free up time for his ENT surgeons to have extended conversations with patients and operate in the office or in the OR. However, he emphasizes the importance of having well-trained NPs and PAs. He also outsources sleep study reads to be more efficient.

The doctors then discuss treatments for obstructive sleep apnea. Dr. Kandula usually sees OSA patients who have already tried non-surgical options, such as nasal rinses and sprays. For OSA that is caused by an anatomical issue, he notes that turbinate hypertrophy is the most common cause. For these cases, he will perform a thorough turbinate reduction. He also obtains CT imaging to view the sinuses in order to assess if they are affecting airway patency.

Finally, Dr. Kandula speaks about challenges with insurance with regards to in-office procedures. His office usually takes the lead in dealing with insurance authorizations and repealing insurance denials. He explains that it is more difficult for academic ENTs to change to in-office procedures. Another challenge that doctors might face is the high cost of in-office equipment. He recommends working with industry and getting loans to help offset the financial burden of medical technology.